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目的采用单光子发射计算机断层扫描(SPECT)结合二氧化碳(CO2)吸入试验评价单侧颈内动脉(ICA)或大脑中动脉(MCA)狭窄或闭塞患者的脑血管储备力(CVR)。方法分别在静息状态下及CO2吸入试验后,对43例单侧ICA或MCA狭窄或闭塞患者行SPECT检查。设定12个感兴趣区(ROI),左右对称各6个,计算各ROI的平均局部脑血流量比值(rCBF%),比较正常侧与患侧rCBF%的差值及CO2吸入试验前后各ROI的rCBF%变化。结果 43例患者检测516个ROI,对CO2反应存在4种情况:①静息状态下和CO2吸入试验后,各ROI rCBF%均正常241个;②静息状态时ROI rCBF%正常,CO2吸入试验后减低190个;③静息状态时ROI rCBF%减低,CO2吸入试验后减低更为显著25个;④静息状态时ROI rCBF%减低,CO2吸入试验后较前升高65个。另43例患者中有13例(30.2%)CVR正常,其中单侧ICA狭窄患者7例,单侧MCA狭窄患者6例。结论 SPECT ROI rCBF%提示单侧ICA或MCA狭窄或闭塞患者脑血管CVR存在4种不同情况;单侧ICA或MCA狭窄或闭塞的患者中存在CVR正常者。
Objective To evaluate the cerebrovascular reserve (CVR) in patients with unilateral carotid artery (ICA) or stenosis or occlusion of middle cerebral artery (MCA) by single photon emission computed tomography (SPECT) and carbon dioxide (CO2) METHODS: Forty-three patients with unilateral ICA or MCA stenosis or occlusion were examined by SPECT at rest and after CO2 inhalation, respectively. Twelve regions of interest (ROI) were set up, each of which was symmetrical with six sides. The mean regional cerebral blood flow rate (rCBF%) of each ROI was calculated. The difference between normal and ipsilateral rCBF% RCBF% change. Results There were 516 ROIs detected in 43 patients and there were 4 cases of CO2 responses: ①Results: All patients with normal ROI rCBF% at rest and CO 2 inhalation test had 241 normal ROI rCBF% (P <0.05); (3) The ROI rCBF% decreased at resting state and decreased more significantly after CO2 inhalation test; (2) The ROI rCBF% decreased at resting state and increased 65 after CO2 inhalation test. Thirteen of the 43 patients (30.2%) had normal CVR, including 7 with unilateral ICA stenosis and 6 with unilateral MCA stenosis. Conclusions SPECT ROI rCBF% suggests that there are four different CVRs in patients with unilateral ICA or MCA stenosis or occlusion; patients with unilateral ICA or MCA stenosis or occlusion have normal CVR.