A Multicenter Brain Perfusion SPECT Study Evaluating Idiopathic Normal-Pressure Hydrocephalus on Neurological Improvement
A Multicenter Brain Perfusion SPECT Study Evaluating Idiopathic Normal-Pressure Hydrocephalus on Neurological Improvement
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DOI：
10.1159/000328972
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发表时间：
2011-01-01
影响因子：
2.4
通讯作者：
Sakakibara, Ryuji
中科院分区：
文献类型：
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作者：
Ishii, Kazunari;Hashimoto, Masaaki;Sakakibara, Ryuji
目的：本研究旨在研究特发性正常压力脑积水（iNPH）患者的特定脑血流（CBF）模式以及多中心研究中分流反应性的预测价值（特发性正常压力脑积水对神经功能改善的研究：SINPHONI）。研究方法：84名iNPH患者使用SINPHONI的MRI选择标准接受分流术，并接受CBF单光子发射计算机断层扫描（SPECT）。SPECT的灌注模式分为：前向主导CBF减少型（A型）、后向主导CBF减少型（P型）和混合或弥漫性CBF减少型（M型）。评价了CBF模式对良好分流结局的预测价值。结果：76%（64/84）的患者获得了良好的结局，85%（71/84）的患者获得了分流反应性。在胼胝体周围和侧裂区域，显示出严重减少的相对CBF区域，包括脑室和侧裂的收缩以及在高凸度处内侧和外侧额叶、顶叶和枕叶区域灌注相对增加的影响。A型49例（58%），M型25例（30%），P型10例（12%）。A型、M型和P型病例的分流反应性阳性预测值分别为83%、84%和90%。A型组改良兰金量表和简易精神状态检查量表评分均优于其他组。结论：iNPH患者表现出不同的CBF减少模式，但三种模式之间的预测值无显著差异，尽管CBF减少模式可能提示iNPH的严重状况。版权所有（C）2011 S. Karger AG，巴塞尔
Purpose: This study was designed to investigate the specific cerebral blood flow (CBF) pattern in patients with idiopathic normal-pressure hydrocephalus (iNPH) and a predictive value for shunt responsiveness in a multicenter study (Study of Idiopathic Normal-Pressure Hydrocephalus on Neurological Improvement: SINPHONI). Methods: Eighty-four iNPH patients underwent shunt operations using MRI selection criteria from the SINPHONI and were subjected to CBF single photon emission computed tomography (SPECT). The perfusion patterns on SPECT were classified: anterior-dominant CBF reduction type (A type), posterior-dominant CBF reduction type (P type), and mixed or diffuse CBF reduction type (M type). The predictive value of the CBF pattern for favorable shunt outcome was evaluated. Results: Favorable outcomes were obtained in 76% (64/84) of patients, and shunt responsiveness was achieved in 85% (71/84) of patients. Areas of severely reduced relative CBF were demonstrated around the corpus callosum and in the sylvian fissure area, which included the effects of dilatations of the ventricles and sylvian fissures and relatively increased perfusion in the medial and lateral frontal, parietal, and occipital areas at high convexity. Forty-nine (58%) cases were A type, 25 (30%) cases were M type, and 10 (12%) cases were P type. A, M, and P type cases exhibited 83, 84, and 90% positive predictive values for shunt responsiveness, respectively. Mean modified Rankin scale and Mini-Mental State Examination scores of the A type group were significantly better than those of other groups. Conclusion: The iNPH patients showed various patterns of CBF reduction, but there was no significant difference in the predictive value among the three patterns, though CBF reduction patterns may suggest a severe condition of iNPH. Copyright (C) 2011 S. Karger AG, Basel