The study of silent aspiration of head-neck tumor patient assessed by deglutition scintigraphy during sleep and rCBF SPECT during deglutition

发现头颈部癌无症状吸入性肺炎，对预测吸入性肺炎的发病有重要意义。此外，众所周知，当中枢神经功能异常时，吸入的风险会增加。因此，正确评估脑部高度进展性功能障碍对预测吸入性肺炎和预防吸入性肺炎具有重要意义。本研究旨在对有吸入性肺炎危险因素的头颈部肿瘤患者进行无声抽吸诊断，并分析其局部脑血流变化。对于头颈部肿瘤患者，我们让~(99m)Tc-DTPA服药，而对静止性抽吸的肯定定义了24小时显像显示肺部示踪剂摄取的情况。采用SPECT和SPM、3DSSP分析方法对无症状吸入患者的rCBF分布进行评估。20例头颈部肿瘤患者常规扫描正常，但11例24小时后发现无症状吸引者。SPM分析显示，基底节和大脑皮质，包括额叶内侧回，rCBF明显降低。常规透视下使用造影剂难以诊断静止性误吸。但目前连续观察的研究显示，头颈部肿瘤中无痛性抽吸的发生率较高。此外，基底节和大脑皮质，包括额叶内侧回，被认为有助于调节吞咽功能。这些rCBF异常似乎是预测吸入性肺炎发病的有效发现。结论：睡眠时连续~(99m)Tc-DTPA吞咽显像是诊断无症状性误吸的有效方法。RCBF分析也是预测吞咽功能调节缺陷的有效工具。

It is very important to discover silent aspiration of head and neck cancer and predict the onset of aspiration pneumonia. In addition, it is known that risk of aspiration increases when there is abnormality in central nervous function. Therefore, appropriate evaluation of cerebral highly advanced dysfunction is important for a prediction of aspiration pneumonia and prevention. The current study was to develop diagnose silent aspiration and analyzes rCBF alteration of head and neck tumor patient having risk with aspiration pneumonia. We let Tc-99m-DTPA take medicine for the head and neck tumor patient, and affirmation of silent aspiration defines the case that imaging at 24 hours show lung tracer uptake. We estimated rCBF distribution of silent aspiration patient by SPECT and SPM, 3DSSP analysis. As for the results in 20 head and neck tumor patients, conventional scan was normal, but the silent aspiration patient was found in 11 at 24 hours later. By SPM analysis, decrease of rCBF was noted in basal ganglia and the cerebral cortex including medial frontal gyrus. A diagnosis of silent aspiration was difficult by the conventional method using contrast media under fluoroscopy. But the current study with serial observation demonstrated high incidence silent aspiration in head and neck tumor. In addition, basal ganglia and cerebral cortex including medial frontal gyrus were suggested to contribute to regulate deglutition function. These rCBF abnormalities seem to be effective findings for an onset prediction of aspiration pneumonia. In conclusion, serial Tc-99m-DTPA deglutition scintigraphy during sleeping time was confirmed as effective methods for diagnosing silent aspiration. rCBF analysis was also effective tool for predicting the deglutition functional regulation deficiency.