【摘要】 目的　探讨SPECT脑血流灌注显像在研究轻度脑外伤后临床症状发病机理中的作用。方法　对 3 9例无意识丧失、CT检查正常的轻度脑外伤患者进行99Tcm 双半胱乙酯 (ECD)脑血流灌注断层显像。以双侧小脑平均每像素的均数为参比值 ,计算各大脑感兴趣区 (ROI)放射性计数比值(RAR)。大脑皮质或基底神经节RAR低于 70 % ,颞叶中部低于 50 %视为异常。结果　 3 9例患者中2 3例 (59% )SPECT显示异常 ,其中 3例为弥漫性血流灌注减低 ,2 0例为局部血流灌注减低灶 ,共计 74个病灶。伤后 3个月内脑血流灌注异常 15例 ,2例为弥漫性血流灌注减低 ,13例为局灶性血流灌注减低 ;13例中发现病灶 58个。 8例受伤 3个月后显像异常者 ,1例为弥漫性血流灌注减低 ,7例为局灶性血流灌注减低 ,发现病灶 16个。结论　轻度脑外伤后患者主要症状为头痛、头昏、记忆力减退 ;无意识丧失的脑外伤患者可出现局部脑血流灌注减低 ,且SPECT检查比CT灵敏更多还原

【Abstract】 Objective To study the clinical value of SPECT brain perfusion imaging after mild traumati c brain injury and to evaluate the mechanism of brain blood flow changes in the brain traumatic symptoms. Methods SPECT 99 Tc m-ethylene cysteinate dimer (ECD) brain perfusion im aging was performed on 3 9 patients with normal consciousness and normal computed tomography. The study w as performed on 23 patients within 3 months after the accidental injury and on 1 6 patients at more than 3 months post-injury. The cerebellum was used as the re ference site (100% maximun value). Any decrease in cerebral perfusion in cortex or basal ganglia to below 70%, or even to below 50% in the medial temporal lobe , compared to the cerebellar reference was considered abnormal. Results The results of 23 patients (59%) were abnormal. Among them, 20 patients s howed 74 focal lesions with an average of 3.7 per patient (15 studies performed within 3 months and 8 studies performed more than 3 months after injury).The re maining 3 showed diffuse hypoperfusion (two at the early stage and one at more than 3 months after the injury). The 13 abnormal studies performed at the early stage showed 58 lesions (average, 4 5 per patient), whereas there was a reduct ion to an average of 2.3 per patient in the 7 patients(total 16 lesions) at mor e than 3 months post-injury. In the 20 patients with focal lesions, mainly the following regions were involved: frontal lobes 43.2% (32/74), basal ganglia 24.3 % (18/74) and temporal lobes 17.6% (13/74). Conclusions ①SPECT brain perfusion imaging is more sensitive than computed tomography in d etecting brain lesions of mild traumatic brain injury. ②SPECT brain perfusion i maging is more sensitive at early stage than at late stage after injury. ③The m ost co mmon complaints were headache, dizziness, memory deficit. The patients without l oss of consciousness may present brain hypoperfusion, too. ④The changes may exp lain a neurological component of the patient symptoms in the absence of morphol ogical abnormalities while using other imaging modalities.更多还原