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【目的】评价99Tcm-HL91脑乏氧显像检测急性脑卒中患者乏氧脑组织及其意义。【方法】急性大脑梗塞患者57例(14例完全前循环梗塞,33例部分前循环梗塞,10例腔隙样梗塞)和脑出血患者12例(4例基底节区出血,8例大脑半球皮质出血)行99Tcm-HL91SPECT/CT显像,部分患者与99Tcm-ECD血流灌注显像或/和18F-FDG代谢显像对照。显像结果与临床基础状况和随后的神经功能改变对比分析。【结果】①脑梗塞组:乏氧阳性共34例,阳性率为59.7%(34/57),发病<12h者,乏氧灶主要位于梗塞灶;而≥12h者乏氧灶主要位于梗塞灶的边缘及其周围。②脑出血组:乏氧阳性3例,位于出血灶的周围,均为基底节区出血;脑实质出血患者均阴性。③部分前梗塞患者中,有脑血管基础疾病的患者乏氧阳性率45.5%(10/22),无基础疾病患者乏氧阳性率91%(10/11)。④12例乏氧阳性患者中,于发病后7～42d后再次或多次显像(最多3次),仍见乏氧灶存在;但乏氧程度有不同程度的减轻,范围减少。其中7例乏氧明显减轻者,临床改善明显,肌力增加Ⅱ级以上。【结论】99Tcm-HL91能有效地检测急性脑卒中患者的乏氧脑组织;乏氧阳性率与脑梗塞的类型及脑出血的部位、是否存在严重的脑血管基础疾病等关系密切;乏氧的部位随时间的延长会从中央区向外周区扩大;乏氧脑组织存在预示较好的预后,应积极治疗。
【Objective】 To evaluate the significance of 99Tcm-HL91 cerebral hypoxia imaging in the detection of hypoxic brain tissue in acute stroke patients. 【Methods】 57 patients with acute cerebral infarction (14 cases of complete anterior circulation infarction, 33 cases of partial anterior circulation infarction, 10 cases of lacunar infarction) and 12 cases of cerebral hemorrhage (4 cases of basal ganglia hemorrhage and 8 cases of hemispheric cortex Bleeding) 99Tcm-HL91SPECT / CT imaging, some patients with 99Tcm-ECD perfusion imaging or / and 18F-FDG metabolic imaging control. The imaging results were compared with the clinical baseline and subsequent neurological changes. 【Results】 ① Cerebral infarction group: There were 34 cases of hypoxia positive, the positive rate was 59.7% (34/57), the incidence of <12h, hypoxia mainly in the infarction; and> 12h hypoxia mainly in the infarction The edge and its surroundings. ② cerebral hemorrhage group: 3 cases of hypoxia positive, located in the periphery of the hemorrhage, both basal ganglia hemorrhage; patients with cerebral parenchymal hemorrhage were negative. ③ In some patients with pre-infarction, the rate of hypoxia positive was 45.5% (10/22) in patients with underlying cerebrovascular diseases, and 91% (10/11) in patients without underlying diseases. ④ In 12 cases of hypoxia-positive patients, hypoxia was still seen after 7 ~ 42 days after onset (up to 3 times). However, the degree of hypoxia was reduced to a lesser extent. Among them, 7 cases were significantly reduced hypoxia, clinical improvement was obvious, muscle strength increased more than grade Ⅱ. 【Conclusion】 99Tcm-HL91 can effectively detect the hypoxic brain tissue in acute stroke patients. The positive rate of hypoxia is closely related to the type of cerebral infarction, the site of cerebral hemorrhage, whether there is a serious cerebrovascular underlying disease, etc. The hypoxic The location will expand from the central area to the peripheral area with the extension of time. The hypoxic brain tissue has a better prognosis, which should be actively treated.