13N-Ammonia PET/CT脑血流灌注显像结合醋甲唑胺负荷试验在缺血性脑血管病中的应用

doi:10.3969/j.issn.1006-9771.2020.07.001

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (7): 745-748.doi: 10.3969/j.issn.1006-9771.2020.07.001

¹³N-Ammonia PET/CT脑血流灌注显像结合醋甲唑胺负荷试验在缺血性脑血管病中的应用

苏玉盛^1a(),王红艳²,吉训明^1b,梁志刚^1a,卢洁^1a,崔春蕾^1a

1.首都医科大学宣武医院,a. 核医学科;b. 神经外科,北京市 100053
2.北京中医药大学东直门医院核医学科,北京市 100700

收稿日期:2019-08-06 修回日期:2020-06-11 出版日期:2020-07-25 发布日期:2020-07-24
通讯作者: 苏玉盛 E-mail:suyusheng0819@sina.com
作者简介:苏玉盛(1972-),男,汉族,北京市人,博士研究生,副主任医师,主要研究方向：PET/CT的临床应用。
基金资助:
北京市科学技术委员会首都临床特色应用研究专项(Z161100000516085)

Application of ¹³N-Ammonia PET/CT Cerebral Blood Perfusion Imaging Combined with Methazolamide Challenge in Ischemic Cerebrovascular Diseases

SU Yu-sheng^1a(),WANG Hong-yan²,JI Xun-ming^1b,LIANG Zhi-gang^1a,LU Jie^1a,CUI Chun-lei^1a

1. a. Department of Nuclear Medicine; b. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
2. Department of Nuclear Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China

Received:2019-08-06 Revised:2020-06-11 Published:2020-07-25 Online:2020-07-24
Contact: SU Yu-sheng E-mail:suyusheng0819@sina.com
Supported by:
Beijing Municipal Commission of Science and Technology Capital Clinical Application Research Program(Z161100000516085)

摘要/Abstract

摘要：

目的探讨¹³N-ammonia PET/CT脑血流灌注显像结合醋甲唑胺负荷试验评估缺血性脑血管病患者脑血管储备(CVR)的应用价值。方法 2014年1月至2016年12月,单侧大脑中动脉或颈内动脉重度狭窄患者56例,在基态和醋甲唑胺负荷后分别行¹³N-ammonia PET/CT脑血流灌注显像,评估CVR情况;治疗后6个月再次行基态脑血流灌注显像。根据CVR将患者分为CVR正常组(n = 29)和CVR下降组(n = 27),随访24个月,观察两组脑缺血事件发生率和治疗前后基态脑血流(CBF)的变化。结果 CVR下降组短暂性脑缺血发作的发生率高于CVR正常组(χ² = 4.389, P < 0.05),缺血性脑卒中的发生率略高于CVR正常组,但无显著性差异( P > 0.05)。CVR正常组治疗后基态CBF改善 ( t = 2.409, P < 0.05);CVR下降组治疗后基态CBF与治疗前无显著性差异( t = 0.648, P > 0.05)。结论 ¹³N-ammonia PET/CT脑血流灌注显像结合醋甲唑胺负荷试验能很好评估缺血性脑血管病患者CVR变化,并估计预后,对早期干预有指导意义。

关键词: 缺血性脑血管病, 脑血管储备, 氮放射性同位素, 醋甲唑胺, 正电子发射体层摄影, X线计算机体层摄影, 缺血预适应

Abstract:

Objective To apply ¹³N-ammonia PET/CT cerebral blood perfusion imaging combined with methazolamide challenge for cerebrovascular reserve (CVR) evaluation in ischemic cerebrovascular diseases. Methods From January, 2014 to December, 2016, 56 ischemic stroke patients with serious stenosis of unilateral internal carotid artery or middle cerebral artery accepted basal and stress PET/CT with methazolamide challenge. The patients were divided into normal-CVR group (n = 29) and reduced-CVR group (n = 27) according to the results of CVR, and followed up for 24 months. The ischemic cerebrovascular events and cerebral blood flow were observed. Results The incidence of transient ischemic attack was more in the reduced-CVR group than in the normal-CVR group (χ² = 4.389, P < 0.05), while the incidence of ischemic stroke increased a little with no significant difference between the two groups ( P > 0.05). The CBF was improved in normal-CVR group after treatment ( t = 2.409, P < 0.05), and the improvement was not significant in reduced-CVR group ( t = 0.648, P > 0.05). Conclusion ¹³N-ammonia PET/CT cerebral blood flow perfusion imaging combined with methazolamide challenge can be used to evaluate CVR to predict the outcome for patients with cerebral ischemic disease, which is helpful for early intervention.

Key words: ischemic cerebrovascular diseases, cerebrovascular reserve, nitrogen radioisotopes, methazolamide, positronemission tomography, computerized tomography, ischemic preconditioning

中图分类号:

R743

苏玉盛,王红艳,吉训明,梁志刚,卢洁,崔春蕾. ¹³N-Ammonia PET/CT脑血流灌注显像结合醋甲唑胺负荷试验在缺血性脑血管病中的应用[J]. 《中国康复理论与实践》, 2020, 26(7): 745-748.

SU Yu-sheng,WANG Hong-yan,JI Xun-ming,LIANG Zhi-gang,LU Jie,CUI Chun-lei. Application of ¹³N-Ammonia PET/CT Cerebral Blood Perfusion Imaging Combined with Methazolamide Challenge in Ischemic Cerebrovascular Diseases[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(7): 745-748.

图/表 3

参考文献 16

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项目	CVR正常组 (n = 29)	CVR下降组 (n = 27)	χ²/t值	P值
年龄(岁)	57.21±10.27	56.48±9.23	0.260	0.612
性别(男/女, n)	21/8	18/9	0.218	0.640
高血压(n)	19	17	0.040	0.842
高血脂(n)	12	13	0.259	0.611
糖尿病(n)	15	9	1.931	0.165
冠心病(n)	10	11	0.234	0.629
吸烟(n)	10	12	0.582	0.446
饮酒(n)	14	9	1.290	0.256

¹³N-Ammonia PET/CT脑血流灌注显像结合醋甲唑胺负荷试验在缺血性脑血管病中的应用

Application of ¹³N-Ammonia PET/CT Cerebral Blood Perfusion Imaging Combined with Methazolamide Challenge in Ischemic Cerebrovascular Diseases

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