Optical Management of Blood Pressure in the hypertensive patients with cerebrovascular disease.-Split dose I-123 IMP SPECT Study-

确定高血压合并脑血管疾病(CVD)患者的最佳血压是非常重要的。为此，由正电子发射计算机断层扫描测得的氧摄取分数(OEF)被认为是最可靠的指标。然而，PET需要大量的成本和人力。我们已经建立了无创性SPECT方法，即分剂I-123 IMP SPECT，它可以用注射乙酰唑胺(PR)后脑血流量增加的百分比来估算血流储备。本研究以33例脑血管疾病患者为研究对象，探讨了该方法所测参数与正电子发射计算机断层扫描(PET)检测参数的关系。在第一项研究中，根据血管造影结果将大脑中动脉区域分为3组。A组为同侧颈内动脉系统大脑中动脉严重狭窄区(75%以上)，对侧为NA组，NP组为双侧无病变组。A组PR显著低于NP组，CBV显著高于NA组。CBV与PR呈显著负相关，而OEF与PR无相关性。其次，探讨SPECT预测OEF升高的可行性。结论：PR可检出轻度脑血流灌注不足的病变，表现为CBV增加而OEF不升高，但OEF升高与正常的病变很难区分。为此，必须考虑其他方式或临床过程。

To determine the optimal blood pressure for hypertensive patients with cerebrovascular disease (CVD) is very important. For this purpose, oxygen extraction fraction (OEF) measured by PET had been considered as the most relable index. However, PET takes lots of costs and manpower. We had developed non-invasive SPECT method, split dose I-123 IMP SPECT, which enables to estimate perfuion reserve as %increase of CBF afar acetazolamide injection (PR). In this study, the relationship between the parameters obtained by this method and those of PET study.Totlally 33 patients with CVD were investigated. In the first study, the MCA territories were divided into 3 groups by angiographic findings. Group A was consisted of the MCA areas with sever stenotic lesion (more than 75%) in the ipsilateral ICA system, Group NA in the contralateral ICA system, and Group NP with no lesions in both sides. PR of Group A was significantly decreased in comparison with that of Group NP.CBV of Group A was significantly increased compared with Group NA.There was sinificant negative correlation between CBV and PR, however, no correlation were found between OEF and PR.Secondary, we investigated the feasibility that OEF-elevated lesions were can be predicted by SPECT.In 7 lesions with more high OEF (more than 60%), decreased resting CBF and decreased OEF were shown. However, there was no significant differences in OEF between 2 groups, with and without low PR (less than 10%).In concludion, the lesions with mild insufficiency of cerebral perfusion may be detected by PR, where CBV is increased without elevation of OEF.However, to discriminate the lesion with elevated OEF from that with normal OEF was difficult. For this purpose, other modality or clinical course have to be considered.