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目的探讨单光子发射型计算机体层摄影(SPECT)在脑积水诊断和治疗中的应用价值。方法选择经CT或MRI检查确诊的脑积水患者36例进行SPECT检查。采用99mTc-DTPA185MBq,经腰穿注入脊髓蛛网膜下腔,注药后1,3,6,24,48h摄取图像进行分析。结果36例患者中梗阻性脑积水26例,交通性脑积水9例,脑萎缩1例。正常情况下SPECT前后位像脑脊液动力学表现为典型的上行三叉影像。梗阻性脑积水其核素明显蓄积于腰池和基底池或囊腔内,其早期典型的三叉上行影像亦消失。交通行脑积水表现为上行三叉影像圆钝,核素在脑表面和纵裂区蓄积且消散时间延长。26例梗阻性脑积水患者均行神经内镜治疗,术中及术后均未发生严重并发症且恢复满意,随访1～30个月均无复发。9例交通性脑积水行脑室腹腔分流术。随访6～28个月,8例恢复良好,1例症状体征及脑室系统无明显改善。结论应用SPECT进行脑脊液动力学评价,对于判断和区分不同类型的脑积水及指导临床治疗具有重要意义。
Objective To investigate the value of single photon emission computed tomography (SPECT) in the diagnosis and treatment of hydrocephalus. Methods Thirty-six patients with hydrocephalus diagnosed by CT or MRI were selected for SPECT. 99mTc-DTPA185MBq was injected into the spinal subarachnoid space through the lumbar puncture, and the images taken at 1, 3, 6, 24 and 48h after injection were analyzed. Results Among the 36 patients, there were 26 cases of obstructive hydrocephalus, 9 cases of communicating hydrocephalus and 1 case of brain atrophy. Under normal circumstances, SPECT before and after the bit-like cerebrospinal fluid dynamics showed a typical upward trigeminal image. Obstructive hydrocephalus its radionuclide accumulation in the lumbar spine and basal cistern or cyst cavity, the typical early trigeminal uplink image also disappeared. Transportation of hydrocephalus for the performance of the upward trigeminal image dull, nuclide accumulation in the brain surface and longitudinal rupture area and dissipate time. Twenty-six patients with obstructive hydrocephalus underwent endoscopic neurosurgery. No serious complications were found during and after operation, and satisfactory recovery was achieved. All cases were followed up for 1 to 30 months without recurrence. Nine cases of traffic hydrocephalus peritoneal shunt. Followed up for 6 ~ 28 months, 8 cases recovered well, 1 case of signs and symptoms and no significant improvement of ventricular system. Conclusions The evaluation of cerebrospinal fluid dynamics using SPECT is of great significance in judging and distinguishing different types of hydrocephalus and guiding the clinical treatment.