目的 分析合并大脑后动脉(PCA)病变的烟雾病患者脑血流异常灌注情况.方法 共纳入27例合并PCA病变的烟雾病患者,根据DSA检查结果,判定27例患者54侧的半球的铃木分期,及54支PCA的病变程度.27例患者均接受单光子发射断层显像术(SPECT)检查,记录额叶、顶叶、颞叶、枕叶、基底核区3～4个感兴趣区的平均局部脑血流量(rCBF),用各个脑区rCBF与小脑的rCBF的比值作为各个脑区rCBF的相对值.判定PCA病变程度、不同铃木分期对各脑叶rCBF相对值的影响. 结果 ①随着PCA病变程度的加重,额叶、顶叶、颞叶、枕叶、基底核区的rCBF相对值均逐渐下降,差异具有统计学意义,均P＜0.05；其中顶叶轻度PCA病变的rCBF相对值(74±6)高于中度(63±9)、重度病变(60±17) PCA的rCBF相对值,差异有统计学意义；枕叶轻度PCA病变的rCBF相对值(72±7)高于中度(65±9)、重度病变(60±15) PCA的rCBF相对值,差异有统计学意义.②不同铃木分期的额叶、顶叶、颞叶、枕叶、基底核区rCBF相对值比较,差异均无统计学意义,P＞0.05. 结论 各脑叶的rCBF相对值随着PCA病变程度加重而下降,但与铃木分期的病变程度无关.脑血管后循环病变可能是影响烟雾病患者脑血流灌注水平的重要因素.%Objective To analyze the abnormal cerebral blood flow perfusion in moyamoya diseased patients with posterior cerebral artery ( PCA) lesions. Methods A total of 27 moyamoya diseased patients with posterior cerebral artery lesions were enrolled in the study. According to the digital subtract an-giography (DSA) results, the Suzuki s stages of 27 patients ( 54 hemispheres) were determined and the PCA grading in all the 27 patients were identified. All the patients accepted single photon emission tomography ( SPECT) examination, and the mean value of three or four regions of interest was calculated in five regions ( frontal, parietal, temporal, and occipital lobes and basal ganglia). The cerebral - to - cerebellar activity ratio was calculated by dividing the count in these regions by that in the cerebellar hemisphere to assess the rCBF. The effects of the lesion grading of PCA, different Suzuk's grades on rCBF ratio were determined. Results ① With the increasing of PCA severity, the rCBF in frontal lobe, parietal lobe, temporal lobe, occipital lobe, and basal ganglia decreased gradually. There were significant differences ( all P<0.05).The rCBF ratio value (74 ±6) of the slight PCA lesions in the parietal lobe was higher than that of moderate lesions (63 ± 9) or severe lesions (60 ± 17). There were significant differences. The rCBF ratio value (72 ± 7 ) of slight PCA lesions in the occipital lobe was higher than that of the moderate lesions (65 ±9) and severe lesions (60 ± 15). There were significant differences. ②There were no significant differences in the rCBF ratio comparisons of frontal lobe, parietal lobe, temporal lobe, occipital lobe, and basal ganglia (P > 0.05). Conclusion The rCBF ratio in each lobe decreases with the severity of PCA lesions, but they are not associated with the severity of the Suzuki's stage. Posterior circulation lesion is an important factor of affecting the cerebral perfusion level in patients with moyamoya disease.
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