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

睡眠时吞咽显像及吞咽时rCBF SPECT评估头颈肿瘤患者无声误吸的研究

• 批准号: 16591213
• 负责人: NAGAMACHI Shigeki
• 金额: $ 1.28万
• 依托单位: University of Miyazaki
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2004
• 资助国家: 日本
• 起止时间: 2004 至 2005
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-16591213/
• 关键词: Silent aspiration; rCBF SPECT; Deglutition scintigraphy; SPM; 3D-SSP; 嚥下シンチ; TC-99m-DTPA; TC-99m-HMPAO; 3DSSP; 誤嚥性肺炎; 頭頸部腫瘍

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.

发现头颈部肿瘤的隐匿性误吸，预测吸入性肺炎的发生具有重要意义。此外，已知当中枢神经功能存在异常时，误吸的风险增加。因此，适当评估大脑高度晚期功能障碍对吸入性肺炎的预测和预防非常重要。本研究旨在对有吸入性肺炎危险的头颈部肿瘤患者进行无症状性误吸的诊断和rCBF的变化分析。头颈部肿瘤患者给予99 m-Tc-DTPA给药，24小时显像显示肺内示踪剂摄取者为静吸证实。应用SPECT和SPM、3DSSP分析法对无症状性误吸患者的rCBF分布进行了估计。20例头颈部肿瘤患者24小时后常规扫描均正常，11例发现无症状性误吸。SPM分析显示，基底节和大脑皮层（包括额内侧回）的rCBF降低。在透视下使用造影剂的传统方法很难诊断无症状性误吸。但近年来的研究表明，头颈部肿瘤的无声误吸发生率较高。此外，基底神经节和大脑皮层，包括额内侧回，被认为有助于调节吞咽功能。这些rCBF异常似乎是有效的结果，为吸入性肺炎的发病预测。结论：睡眠期连续99 m-DTPA吞咽造影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。