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3.3.1.4 SPECT在急性卒中中的应用:对于非溶栓患者,很多研究证实,HMPAO-99mTc SPECT可检查急性卒中症状相关的低灌注区。有两项双盲对照的前瞻性研究显示,SPECT对急性卒中灌注异常的敏感性为61%～74%,特异性为88%～98%(证据级别:A级)。图像所示异常与梗死灶大小、神经功能缺损严重程度及未治疗患者的预后有关,也可作为血管自发性再通的依据(证据级别:A,B级)。SPECT可预测梗死灶大小,并且与CT所示梗死灶的大小显著相关。若发病后6～12h的SPECT显示严重低灌注,则高度预示神经功能预后不佳(证据级别:A级)。若在发病72 h内行SPECT检察,则检查结果对短期预后的判断的准确性要高于临床神经功能评分;若在72 h之后行SPECT检察,则由于可能存在血管自发再通、血流量增加,可能出现假阴性。发病后最初6 h的SPECT图像所显示的rCBF阈值(0.52),是未溶栓脑组织最终梗死或存活的分界点(证据级别:B级)。血管自发再通所引起的灌注改善,与临床预后改善有关(证据级别:B级)。
3.3.1.4 SPECT in Acute Stroke: In non-thrombolytic patients, many studies have demonstrated that HMPAO-99mTc SPECT can detect hypoperfusion areas associated with acute stroke symptoms. Two double-blind, prospective studies have shown that SPECT has a sensitivity of 61% to 74% and a specificity of 88% to 98% for acute stroke perfusion abnormalities (Level of Evidence: Grade A). The abnormalities in the image are related to the size of the infarct, the severity of the neurological deficit, and the prognosis of untreated patients. It can also be used as a basis for spontaneous recanalization (Level of Evidence: Grade A, B). SPECT predicts the size of the infarct and is significantly associated with the size of the infarct shown by the CT. If SPECT 6-12 hours after onset shows severe hypoperfusion, the prognosis is poorly predictive of neurologic function (Level of Evidence: Grade A). If the SPECT examination within 72 hours of onset, the test results for the accuracy of short-term prognosis to determine the accuracy of clinical neurological score higher than; if after 72 h SPECT examination, due to possible vascular recanalization, increased blood flow, False negatives may occur. The rCBF threshold (0.52) shown by SPECT images at the first 6 hours after onset is the culmination of the eventual infarction or survival of unsolvated thrombi (Level of Evidence: Grade B). Perfusion improved due to spontaneous recanalization is associated with improved clinical outcome (Level of Evidence: Grade B).