Japanese
Title慢性主幹脳動脈閉塞性病変におけるDiamox負荷99mTc-HMPAO SPECTを用いた手術前後の評価 - PETとの比較 -
Subtitle原著
Authors桑原康雄*, 一矢有一*, 佐々木雅之*, 赤司祐子*, 福村利光*, 吉田毅*, 増田康治*, 藤井清孝**, 福井仁士**
Authors(kana)
Organization*九州大学医学部放射線科, **脳神経外科
Journal核医学
Volume31
Number9
Page1039-1050
Year/Month1994/9
Article原著
Publisher日本核医学会
Abstract「要旨」慢性主幹脳動脈閉塞性病変に対する外科手術前後の脳循環評価におけるDiamox負荷99mTc-HMPAO SPECTの有用性をPETと比較し検討した. 対象は慢性主幹脳動脈狭窄または閉塞の7例である. 視覚的評価では, 術前の低灌流域の有無に関してHMPAOとPETは7例中5例で一致したが, 残り2例ではPETで低灌流域あり, HMPAOでは低灌流域なしと判定した. 循環予備能に関しては2例のみで一致した. 残り5例中3例ではPETで(++), HMPAOでは(+), 1例ではPETで(+), HMPAOでは(-)であり, HMPAOでは循環予備能低下の判定がやや困難であった. 低灌流域の術後変化に関しては両者はよく一致したが, 循環予備能に関しては術前同様, HMPAOの方が過小評価する傾向にあった. 半定量的評価ではHMPAOのカウント比(患側/健側)はPETの血流比(患側/健側)と比較し, 安静時, Diamox負荷時ともに明らかに差が小さく, 視覚的評価を裏づける結果であった. また, HMPAOでのカウント比(患側/健側)のDiamox負荷による変化率からOEFを推定することは困難であった. 以上, Diamox負荷HMPAO SPECT検査はPETと比較し脳循環および予備能の低下を過小評価する傾向があり, 外科手術前後の評価においてはこの点に留意すべきであると考えられた.
Practice臨床医学：一般
KeywordsEmission CT, 99mTc-HMPAO, Diamox, Occlusive cerebrovascular disease, EC-IC bypass surgery.
English
TitlePre and Post Operative Evaluation of the Perfusion Reserve by Acetazolamide 99mTc-HMPAO SPECT in Patients with Chronic Occlusive Cerebral Arteries : A Comparative Study with PET
SubtitleOriginal Articles
AuthorsYasuo KUWABARA*, Yuichi ICHIYA*, Masayuki SASAKI*, Yuko AKASHI*, Tsuyoshi YOSHIDA*, Toshimitsu FUKUMURA*, Kouji MASUDA*, Kiyotaka FUJII**, Masashi FUKUI**
Authors(kana)
Organization*Department of Radiology, **Department of Neurosurgery, Kyushu University
JournalThe Japanese Journal of nuclear medicine
Volume31
Number9
Page1039-1050
Year/Month1994/9
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary] We studied the pre and post-operative perfusion reserve using Diamox 99mTc-HMPAO SPECT in 7 patients with chronic occlusive cerebral arteries and then compared the results with PET. STA-MCA anastomosis was performed on 5 patients, while a carotid endarterectomy was done on 2 patients. The cerebral blood flow, the vascular response to CO2 or Diamox, the oxygen extraction fraction and transit time (CBV/CBF) were measured by PET. In the pre-operative state, the visual evaluations for hypoperfusion area at rest were agreed in 5 out of 7 patients in HMPAO SPECT and PET studies. In the remaining 2 patients, hypoperfusion areas were only detected in the PET study. The pre-operative evaluation of perfusion reserve was agreed ill 2 patients. In the remaining 5 patients, 3 patients showed definite positive (++) in PET and positive (+) in HMPAO SPECT, and one patient showed positive (+) in PET and negative (-) in HMPAO SPECT. The post-operative change of hypoperfusion areas was well agreed in HMPAO SPECT and PET studies. However, the change of perfusion reserve was underestimated in HMPAO SPECT compared with PET. In the semiquantitative and quantitative analyses, the count rate ratios (affected unaffected side) in HMPAO SPECT were apparently higher than those of CBF in PET. The postoperative change of the count rate ratios in HMPAO SPECT were smaller than those of CBF in PET. There was no significant correlation between the change in the ratio of the HMPAO SPECT after the administration of Diamox and the oxygen extraction fraction, and it was thus thought to be impossible to predict the areas with an increased oxygen extraction fraction, Thus, Diamox HMPAO SPECT may underestimate the areas of hypoperfusion or decrease in perfusion reserve when compared with PET. We should consider these limitations in the evaluation of pre and post operative cerebral hemodynamics.
PracticeClinical medicine
KeywordsEmission CT, 99mTc-HMPAO, Diamox, Occlusive cerebrovascular disease, EC-IC bypass surgery.

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