小脑共济失调为主要症状的多系统萎缩患者脑99mTc-SPECT影像学特征分析

An analysis of brain 99mTc-SPECT features in patients with multiple system atrophy with predominant cerebellar ataxia

摘要:

目的 探讨小脑共济失调症状为主的多系统萎缩（MSA-C）患者的脑局部血流量水平变化规律。方法 以在我院神经内科就诊的12例MSA-C患者与25名正常对照者为研究对象，进行锝[^99mTc]双半胱乙酯为显像剂的脑单光子发射计算机断层成像（SPECT）检查以评价脑局部血流量，其SPECT影像以SPM8、xjview9软件进行基于体素的形态学分析（VBM），将与正常对照在脑局部血流量有上统计学差异的区域投射至标准脑模版上，并分析其主要累及脑区、峰值位置、最大t值等特征。结果 与正常对照者相比较，MSA-C患者主要出现小脑双侧小脑后叶、小脑蚓部、脑桥的脑局部血流量显著下降（P<0.01_FDR校正，簇水平）；未发现有明显统计学意义上的大脑皮质及壳核的脑局部血流量降低。结论 MSA-C患者主要可出现小脑及脑桥的脑局部血流量降低。

Abstract:

Objective To investigate the changing pattern of regional cerebral blood flow in patients with multiple system atrophy (MSA) with predominant cerebellar ataxia (MSA-C).Methods Twelve MSA-C patients in the neurology department of our hospital and 25 normal controls were enrolled. Brain single-photon emission computed tomography (SPECT) with technetium-99m ethyl cysteinate dimer as the imaging agent was performed to evaluate their regional cerebral blood flow. The SPECT images of both MSA-C patients and normal controls were analyzed by voxel-based morphometry with SPM8 and xjview9. The regions with significantly different cerebral blood flow compared with normal controls were projected onto the standard brain template, and the main affected cerebral areas, peak positions, and maximum t values were analyzed.Results Compared with the normal controls, the MSA-C patients had significantly reduced regional cerebral blood flow mainly in the bilateral posterior lobe of the cerebellum, the vermis, and the pons (P<0.01_{FDR correction}, cluster level), and there was no significant decrease in the blood flow in the cerebellar cortex and putamen.Conclusions In MSA-C patients, regional cerebral blood flow is reduced mainly in the cerebellum and the pons.