대한핵의학회지 (The Korean Journal of Nuclear Medicine)

대한핵의학회 (The Korean Society of Nuclear Medicine)
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뇌혈관 협착 환자에서 SPM과 확률뇌지도를 이용한 기저/아세타졸아미드 SPECT의 정량적 분석법의 유용성

The efficacy of Quantitative Analysis of Basal/Acetazolamide SPECT Using SPM and Statistical Probabilistic Brain Atlas in Patients with Internal Carotid Artery Stenosis

  • 이호영 (서울대학교 의과대학 핵의학교실) ;
  • 이동수 (서울대학교 의과대학 핵의학교실) ;
  • 팽진철 (서울대학교 의과대학 핵의학교실) ;
  • 오창완 (서울대학교 의과대학 신경외과학교실) ;
  • 조맹제 (서울대학교 의과대학 정신과학교실) ;
  • 정준기 (서울대학교 의과대학 핵의학교실) ;
  • 이명철 (서울대학교 의과대학 핵의학교실)
  • Lee, Ho-Young (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Lee, Dong-Soo (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Paeng, Jin-Chul (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Oh, Chang-Wan (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Cho, Maeng-Jae (Department of Psychiatry, Seoul National University College of Medicine) ;
  • Chung, June-Key (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Lee, Myung-Chul (Department of Nuclear Medicine, Seoul National University College of Medicine)
  • 발행 : 2002.12.30
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초록

목적: 뇌혈관질환에 있어서 뇌혈류와 뇌혈류예비능을 기저/아세타졸아미드 뇌혈류SPECT로 평가 가능하나 재관류 수술효과를 비교 평가하기 위해서는 정량적인 평가가 필요하다. 대상 및 방법: 12명의 환자($51{\pm}15$세, 남:녀:6:6)의 수술 전후 기저 시와 아세타졸아미드 부하 뇌관류 SPECT를 SPM에서 공간정규화하고 소뇌의 계수를 기준으로 계수정규화한 후 확률뇌지도(statistical probabilistic anatomical map, SPAM)를 이용하여 부위별 혈류를 정량화하였다. 이 결과로부터 수술 전후 및 정상대조군($59{\pm}15$세, 남:녀:10:11)과의 비교를 McNemar test와 Mannwhitney test를 이용하여 비교하였다. 혈류예비능은 기저 시와 부하시의 차이를 기저 시 계수를 기준으로 백분율로 표현하였다. 결과: 수술 후 수술 부위의 기저 시와 아세타졸아미드 부하 시 혈류 그리고 혈류예비능 모두가 유의하게 향상되었다(p<0.05). 정상군과의 비교에 있어서는 기저 시 혈류는 정상군과 차이가 없을 정도로 호전되었으나, 아세타졸아미드 부하시 혈류와 혈류예비능은 수술 후에도 유의한 차이를 보였다(p<0.05). 혈류예비능은 주로 수술부위를 중심으로 향상되었다. 결론: SPM 및 SPAM을 이용하여 기저/아세타졸아미드 뇌혈류 SPECT의 수술 전후결과를 정량적, 객관적으로 쉽게 비교 평가할 수 있다.

Purpose: While cerebral blood flow and cerebrovascular reserve could be evaluated with basal/acetazolamide Tc-99m-HMPAO SPECT in cerebrovascular disease, objective quantification is necessary to assess the efficacy of the revascularization. In this study we adopted the SPM method to quantify basal cerebral blood flow and cerebrovascular reserve on basal/acetazolamide SPECT in assessment of the patients who underwent bypass surgery for linternal carotid artery (ICA) stenosis. Materials and Methods: Twelve patients ($51{\pm}15$ years) with ICA stenosis were enrolled. Tc-99m-HMPAO basal/acetazolamide perfusion SPECT was peformed before and after bypass surgery. After spatia1 and count normalization to cerebellum, basal cerebral blood flow and cerebrovascular reserve were compared with 21 age-matched normal controls and postoperative changes of regional blood flow and reserve were assessed by Statistical Parametric Mapping method. Mean pixel values of each brain region were calculated using probabilistic anatomical map of lobes. Perfusion reserve was defined as the % changes after acetazolamide over basal counts. Results: Preoperative cerebral blood flow and cerebrovascular reserve were significantly decreased in involved ICA territory, comparing with normal control (p<0.05). Postoperative improvement of cerebral blood flow and cerebrovascular reserve was observed in grafted ICA territories, but cerebrovasculr reserve remained with significant difference with normal control. Improvement of the cerebrovascular reserve was most prominent in the superior temporal and the angular gyrus, nearest to the anastomosis sites. Conclusion: Using SPM quantification method on hasal/acetazolamide Tc-99m-HMPAO SPECT, the cerebral blood flow and cerebrovascular reserve could be assessed before revascularization and so could the efficacy of the bypass surgery.

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참고문헌

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