摘要目的 研究脑血流灌注SPECT/CT显像及其与脑MRI联合应用对缺血性脑血管疾病患者的诊断价值.方法 回顾性分析2011年8月至2013年8月间107例临床诊断为缺血性脑血管疾病的患者资料(男71例,女36例;年龄33～ 84岁),其中短暂性脑缺血发作患者31例、脑梗死首次发病患者40例、脑梗死再发患者36例.所有患者均在发病7d内行99Tcm-ECD SPECT/CT脑血流灌注显像及脑MRI检查,2种检查间隔≤5d.分别统计分析脑血流灌注SPECT/CT、脑血流灌注SPECT、同机脑CT、脑MRI及其联合应用时的病灶检出数及阳性率.用x2检验对数据进行分析.结果 各种影像学及其组合对缺血性脑血管疾病诊断的阳性率由高到低依次为:SPECT/CT+ MRI=SPECT+MRI＞ SPECT/CT＞ SPECT＞ MRI＞ CT,其值分别为97.20％(104/107)、97.20％(104/107)、95.33％(102/107)、90.65％ (97/107)、85.05％(91/107)、65.42％(70/107).SPECT/CT+ MRI与SPECT+MRI 、SPECT/CT比较差异无统计学意义(x2=0.17、0.13,均P＞0.05),SPECT/CT+ MRI与SPECT、MRI、CT比较差异有统计学意义(x2=4.01、9.76、35.50,均P＜0.05).脑血流灌注SPECT/CT显像能显示出更多的大脑灰质缺血区域,检出了5例存在交叉性小脑失联络现象的急性脑梗死患者,而MRI能检出更多的基底节区、脑干及脑白质深部较小的腔隙性病变.结论 脑血流灌注SPECT/CT显像对缺血性脑血管疾病患者的诊断具有重要价值,与MRI联合应用能更全面地揭示病变.

abstractsObjective To evaluate the diagnostic value of cerebral perfusion SPECT/CT combined with brain MRI in patients with ischemic cerebrovascular disease.Methods A total of 107 cases with ischemic cerebrovascular disease from August 2011 to August 2013 (71 males,36 females,age:33-84years) were retrospectively studied,including 31 cases with transient ischemic attack,40 cases with the first onset of cerebral infarction,36 cases with recurrent cerebral infarction.99Tcm-ECD SPECT/CT and brain MRI were performed within 7 d after attack.The interval between the two scans was within 5 d.The number of lesions and detection rate by SPECT/CT,SPECT,MRI,CT,and their combination were calculated respectively,and analyzed using x2 test.Results The detection rate was:SPECT/CT+MRI (97.20％,104/107)=SPECT+MRI (97.2％,104/107) ＞SPECT/CT (95.33％,102/107)＞SPECT (90.65％,97/107) ＞MRI (85.05％,91/107)＞CT (65.42％,70/107).No statistically significant difference was observed between the detection rate of SPECT/CT+MRI and SPECT+MRI,SPECT/CT (x2 =0.17,0.13;both P＞0.05),while there was statistically significant difference between SPECT/CT+MRI and SPECT,MRI,or CT (x2 =4.01,9.76,35.50;all P＜0.05).SPECT/CT detected more ischemic lesions located in brain gray matter and revealed crossed cerebellar diaschisis,while MRI was better for detecting small lacunar lesions in basal ganglia,brainstem and deep white matter.Conclusions SPECT/CT is valuable for the detection of ischemic cerebrovascular disease.hnproved assessment may be achieved by the combination of SPECT/CT and MRI.