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背景:脑出血血肿周围是否存在缺血半暗带是目前研究热点,没有得到证实。采用99Tcm标记的缺氧显像剂4,9-二氮-2,3,10,10-四甲基十二烷-2,11-二酮肟(HL91)检测血肿周围可逆性损伤组织来反映半暗带是否可行,有待证实。目的:探讨99Tcm-HL91SPECT/CT脑显像在检测高血压脑出血出血灶周围缺氧组织中的应用价值。设计:对照分析。单位:广东省江门市中心医院神经科。对象:选择2004-03/2005-03在江门市中心医院住院的脑出血患者22例,所有患者有高血压病史或入院后诊断为高血压,均为前循环供血区出血,出血量10～63mL,有3例行微创抽吸血肿术,1例行开颅清创术,其余行保守治疗;起病至检查的时间12h～1.5年,其中5例超过1个月。对照组6例均为忧郁症或焦虑症患者,经同机CT检查排除脑出血及急性脑梗死。方法:28例受试者均进行99Tcm-HL91SPECT脑显像,同时行同机CT扫描。主要观察指标:①以2个不同轴向断面连续2个层面在病灶一侧周围区域出现肉眼可辨的放射性浓集区为缺氧显像阳性。(下转第185页)②计算病灶中心点与对侧镜像部位的放射性计数比值(R),以R<0.8或>1.2视为异常。③计算缺氧体积及出血量,由CT机采用多田公式出血最大截面的长×宽×层数×1/2得出。以缺氧检查同机CT显示血肿量为同机血肿量,以患者本次发病所有CT检查中的最多积血量为最大血肿量,分析两者与缺氧体积的关系。结果:28例受试者均进入结果分析。①22例患者中18例缺氧显像阳性,阳性率为77.78%;对照组6例均为阴性。②缺氧区大多位于出血区周围,少量出现在血肿内。18例阳性者病灶周围组织缺氧区R值高于对照组基底核区(1.75±0.10,1.05±0.11,P<0.01)。③最大血肿量与缺氧体积呈正直线相关关系,出血量越大,缺氧体积越大,相关系数r=0.7517,P<0.01。(上接第181页)结论:根据SPECT缺氧成像的原理,可能代表缺血半暗带的缺氧脑组织可存在于脑出血血肿周围,缺氧阳性部分可能是半暗带重要的部分。99Tcm-HL91SPECT显像可较好地显示高血压脑出血病病灶周围的缺氧组织,缺氧体积与出血量有密切关系,可应用于指导临床治疗。
Background: Whether there is ischemic penumbra surrounding ICH is the current research hotspot and has not been confirmed. 99Tcm-labeled hypoxia imaging agent 4,9-diazo-2,3,10,10-tetramethyldodecane-2,11-dione oxime (HL91) was used to detect the reversible injury around the hematoma tissue to reflect Penalty is feasible, yet to be confirmed. Objective: To investigate the value of 99Tcm-HL91 SPECT / CT brain imaging in the detection of hypoxic tissue around hemorrhagic hypertensive cerebral hemorrhage. Design: Comparative analysis. Unit: Department of Neurology, Jiangmen Central Hospital, Guangdong Province. PARTICIPANTS: Twenty-two patients with cerebral hemorrhage hospitalized in Jiangmen Central Hospital from March 2004 to March 2005 were selected. All patients had a history of hypertension or were diagnosed as hypertension after admission. All of them had bleeding in the anterior circulation blood supply with a volume of 10 ~ 63mL , 3 cases of minimally invasive suction hematoma, 1 case of craniotomy debridement, the remaining line of conservative treatment; onset to check the time 12h ~ 1.5 years, of which 5 cases more than 1 month. Control group, 6 cases were depression or anxiety patients, by the same CT examination to rule out cerebral hemorrhage and acute cerebral infarction. Methods: Twenty-eight subjects underwent 99Tcm-HL91 SPECT brain imaging and CT scan simultaneously. MAIN OUTCOME MEASURES: ① Histologically positive radiofrequency imaging was observed with two distinct axial sections at two consecutive levels in the area around one side of the lesion. (Continued on page 185) ② Calculate the radioactive count ratio (R) between the center of the lesion and the contralateral mirror, with R <0.8 or> 1.2 deemed abnormal. ③ calculate the volume of hypoxia and bleeding volume, by the CT machine Tada formula hemorrhagic maximum cross-section of the length × width × number of layers × 1/2 drawn. Hypoxia examination with the same CT showed hematoma volume for the same hematoma volume in patients with this incidence of all the CT examination of the maximum amount of hematoma volume of the largest hematoma, both the relationship between hypoxia volume analysis. Results: All 28 subjects entered the result analysis. ①22 cases of patients with 18 cases of hypoxia imaging positive, the positive rate was 77.78%; 6 cases were negative in the control group. ② most hypoxia area is located around the hemorrhage, a small amount appeared in the hematoma. The R value of hypoxia in the tissue around the lesion in 18 cases was higher than that in the control group (1.75 ± 0.10, 1.05 ± 0.11, P <0.01). The maximum amount of hematoma and hypoxia volume was a positive correlation, the greater the amount of bleeding, the greater the volume of hypoxia, the correlation coefficient r = 0.7517, P <0.01. (Continued from page 181) Conclusion: According to the principle of SPECT hypoxic imaging, hypoxic brain tissue that may represent ischemic penumbra may exist around the intracerebral hematoma, hypoxia-positive part may be an important part of the penumbra. 99Tcm-HL91 SPECT imaging can better show the hypoxic tissue around hypertensive intracerebral hemorrhage lesions, hypoxia volume and the amount of bleeding are closely related, can be used to guide the clinical treatment.