脑血流SPECT断层显像对糖尿病脑血管病的早期检测

摘要

目的评价脑血流SPECT断层显像对糖尿病脑血管病(DCD)的早期诊断价值。方法用99mTc-ECD对30例临床确诊2型糖尿病患者进行了脑血流SPECT断层显像，按脑正常解剖和脑SPECT图像应用解剖关系将有每侧大脑灰质分为11个区域，用目测法对每个区域的核素分布进行判定。结果糖尿病组检出22人共60处有脑血流灌注异常减低，低灌注以颞叶发生率最高(33.33)％，提示脑缺血以大脑中动脉受累为主。糖尿病<5年的异常影像主要表现为脑皮层限局性楔形样稀疏/缺损；随病程延长，尤其是>10年者，主要表现为一叶皮层大范围核素分布稀疏，甚至还可伴有楔形病性，说明糖尿病病程也是影响DCD的主要因素。该法对诊断糖尿病缺血性脑血管病的灵敏度，特异性、准确性分别为73.33％，90.00％和80.00％。结论脑血流SPECT断层显像能直观显示脑皮层缺血部位，范围及程度，有助于l临床早期发现DCD，以达到积极治疗目的。%Objective To enhance the sensitivity and accuracy in early detection of diabetic cerebrovascular disease(DCD)with single-photon emission-computed tomography. Method The cerebral blood tomography imaging with SPECT was performed in 30 patients with diabetic and 20 controls. Resutts ① Sixty areas of 22 patients with diabetic had significant hypoperfusion of cerebral blood. ②The temporal lobes had the highest detection rate. It showed that the middle cerebral artery was involved particularly. ③The cerebral cortex perfusion abnormality showed small regional wedge with radioactive nuclide decrease/defect in multiareas or severe reduction in big areas. ④The cerebral blood was affected by course of diabetic disease. ⑤The sensitivity, specificity and accuracy rate of cerebral blood flow tomography with SPECT in DCD were 73.33 %、 90.00 % and 80.00 % respectively. Conclusion The results demonstrate that cerebral blood flow tomography with SPECT not only directly reflects the area ranges and degree of cerebrovascular ischemia but also the severity of clinical manifestation of DCD and helps to decide the therapeutic measure.