Nuclear Medicine and Molecular Imaging

  • 제42권5호
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  • Pages.347-353
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  • 2008
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  • 1869-3474(pISSN)
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  • 1869-3482(eISSN)
대한핵의학회 (The Korean Society of Nuclear Medicine)
권호 표지

일측 뇌경색 환자에서 반대측 뇌의 보상성 뇌관류 증가에 대한 SPM 분석

Ipsilateral Cerebral and Contralateral Cerebellar Hyperperfusion in Patients with Unilateral Cerebral Infarction; SPM Analysis

  • 홍선표 (아주대학교 의과대학 핵의학교실) ;
  • 윤준기 (아주대학교 의과대학 핵의학교실) ;
  • 최봉회 (아주대학교 의과대학 핵의학교실) ;
  • 주인수 (아주대학교 의과대학 신경과학교실) ;
  • 윤석남 (아주대학교 의과대학 핵의학교실)
  • Hong, Sun-Pyo (Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine) ;
  • Yoon, Joon-Kee (Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine) ;
  • Choi, Bong-Hoi (Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine) ;
  • Joo, In-Soo (Department of Neurology, Ajou University School of Medicine) ;
  • Yoon, Seok-Nam (Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine)
  • 발행 : 2008.10.31
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초록

목적: 본 연구는 일측 뇌관류결손이 있는 뇌경색 환자들에서 $^{99m}Tc-ECD$ 단일 광자방출단층촬영술을 이용하여 반대측 국소 뇌관류의 변화를 관찰하고자 하였다. 대상 및 방법 : 뇌관류결손이 있는 뇌경색 환자 57명이 대조군에 포함되었으며, 좌측과 우측 뇌경색 환자군으로 구분하였으며, 이들은 발병 시기에 따라 6개월을 기준으로 급성 뇌경색 환자군, 만성뇌경색 환자군으로 구분하였다. 대조군들 모두 국소 뇌관류를 측정하고자 SPM분석을 이용한 $^{99m}Tc-ECD$ 단일 광자방출단층촬영술을 실시하였다. 모든 대조군의 결과를 정상 대조군과 비교하였다. 결과: 모든 대조군에서 뇌경색 반대측 대뇌피질에서 뇌관류 증가가 관찰되었으며, 뇌경색 대뇌측에서의 뇌관류 증가는 관찰되지 않았다. 만성 뇌경색 대조군에서는 뇌병변 반대측 일차 감각운동피질에서의 뇌관류 증가가 관찰되었으나, 급성 뇌경색 대조군에서는 관찰되지 않았다. 만성 좌측 뇌경색 대조군에서는 우측 소뇌 뇌관류 증가가 관찰되었다. 결론: 뇌혈류 SPECT의 SPM분석에서 일측성 뇌경색 환자에서 뇌경색 반대측 대뇌의 혈류가 증가하고, 일부 환자군에서는 뇌경색 동측 소뇌의 혈류도 증가함을 관찰하였다. 그러나 이러한 소견이 뇌기능의 회복 기전과 직접적으로 연관성이 있는지 증명하기 위해서는 추가적인 연구가 필요하다.

Purpose: Cortical reorganization has an important role in the recovery of stroke. We analyzed the compensatory cerebral and cerebellar perfusion change in patients with unilateral cerebral infarction using statistical parametric mapping (SPM). Materials and Methods: Fifty seven $^{99m}TC-Ethylene$ Cystein Diethylester (ECD) cerebral perfusion SPECT images of 57 patients (male/female=38/19, mean age=$56{\pm}17\;years$) with unilateral cerebral infarction were evaluated retrospectively. Patients were divided into subgroups according to the location (left, right) and the onset (acute, chronic) of infarction. Each subgroup was compared with normal controls (male/female=11/1, mean age=$36{\pm}10\;years$) in a voxel-by-voxel manner (two sample t-test, p<0.001) using SPM. Results: All 4 subgroups showed hyperperfusion in the ipsilateral cerebral cortex, but not in the contralateral cerebral cortex. Chronic left and right infarction groups revealed hyperperfusion in the ipsilateral primary sensorimotor cortex, meanwhile, acute subgroups did not. Contralateral cerebellar hyperperfusion was also demonstrated in the chronic left infarction group. Conclusion: Using $^{99m}Tc-ECD$ SPECT, we observed ipsilateral cerebral and contralateral cerebeller hyperperfusion in patients with cerebral infarction. However, whether these findings are related to the recovery of cerebral functions should be further evaluated.

키워드

참고문헌

  1. Choi JW, Park JH, Yu SJ. Plasma Neuron-specific enolase and glutamic acid level in acute ischemic stroke. J Korean Soc Emerg Med 2006;17:254-8
  2. Taub E, Miller NE, Novack TA, Cook EW 3rd, Fleming WC, Nepomuceno CS, et al. Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 1993;74:347-54
  3. Feeney DM, Gonzalez A, Law WA. Amphetamine, haloperidol, and experience interact to affect rate of recovery after motor cortex injury. Science 1982;217:855-7 https://doi.org/10.1126/science.7100929
  4. Nelles G, Jentzen W, Jeuptner M, Muller S, Diener HC. Arm training induced brain plasticity in stroke studies with serial positron emission tomography. Neuroimage 2001;13:1146-54
  5. Schaechter JD, Kraft E, Hillard TS, Dijkhuizen RM, Benner T, Finklestein SP, et al. Motor recovery and cortical reorganization after constraint-induced movement therapy in stroke patients: a preliminary study. Neurorehabil Neural Repair 2002;16:326-38 https://doi.org/10.1177/154596830201600403
  6. Yan T, Hui-Chan CW, Li LS. Functional electrical stimulation improves motor recovery of the lower extremity and walking ability of subjects with first acute stroke: a randomized placebo-controlled trial. Stroke 2005;36:80-5 https://doi.org/10.1161/01.STR.0000149623.24906.63
  7. Cramer SC, Bastings EP. Mapping clinically relevant plasticity after stroke. Neuropharmacology 2000;39:842-51 https://doi.org/10.1016/S0028-3908(99)00258-0
  8. Cao Y, Vikingstad EM, Huttenlocher PR, Towle VL, Levin DN. Functional magnetic resonance studies of the reorganization of the human hand sensorimotor area after unilateral brain injury in the perinatal period. Proc Natl Acad Sci USA 1994;91:9612-6 https://doi.org/10.1073/pnas.91.20.9612
  9. Palmer E, Ashby P, Hajek VE. Ipsilateral fast corticospinal pathways do not account for recovery in stroke. Ann Neurol 1992;32:519-25 https://doi.org/10.1002/ana.410320407
  10. Chu WJ, San Pedro EC, Hetherington HP, Liu HG, Mountz JM. Post-stroke cerebral reorganization in human identified by 31P MR Spectroscopic imaging and F-18 FDG PET. Proc Int Soc Magn Reson Med 2002;10:1030
  11. Witte OW. Lesion induced plasticity as a potential mechanism for recovery and rehabilitative training. Curr Opin Neurol 1998; 11:655-62 https://doi.org/10.1097/00019052-199812000-00008
  12. Kelly HM, Wolf PA, Kase CS, Gresham GE, Kannel WB, D'Agostino RB. Time course of functional recovery after stroke : the Framingham study. J Neurol Rehabil 1989;3:65-70
  13. Lee RG, van Donkelaar P. Mechanism underlying functional recovery following stroke. Can J Neurol Sci 1995;22:257-63 https://doi.org/10.1017/S0317167100039445
  14. Li Y, Jiang N, Powers C, Chopp M. Neuronal damage and plasticity identified by microtubule-associated protein 2, growthassociated protein 43, and cyclin D1 immunoreactivity after focal cerebral ischemia in rats. Stroke 1998;29:1972-80 https://doi.org/10.1161/01.STR.29.9.1972
  15. Chollet F, DiPiero V, Wise RJ, Brooks DJ, Dolan RJ, Frackowiak RS. The functional anatomy of motor recovery after stroke in humans: A study with positron emission tomography. Ann Neurol 1991;29:63-71 https://doi.org/10.1002/ana.410290112
  16. Nelles G, Spiekramann G, Jueptner M, Leonhardt G, Muller S, Gerhard H, et al. Evolution of functional reorganization in hemiplegic stroke: a serial positron emission tomographic activation study. Ann Neurol 1999;46:901-09 https://doi.org/10.1002/1531-8249(199912)46:6<901::AID-ANA13>3.0.CO;2-7
  17. Hendricks HT, van Limbeek J, Geurts AC, Zwarts MJ. Motor recovery after stroke: a systematic review of the literature. Arch Phys Med Rehabil 2002;83:1629-37 https://doi.org/10.1053/apmr.2002.35473
  18. Feydy A, Carlier R, Roby-Brami A, Bussel B, Cazalis F, Pierot L, Burnod Y, Maier MA. Longitudinal study of motor recovery after stroke: recruitment and focusing of brain activation. Stroke 2002;33:1610-7 https://doi.org/10.1161/01.STR.0000017100.68294.52
  19. Jodzio K, Drumm DA, Nyka WM, Lass P, Gasecki D. The contribution of the left and right hemispheres to early recovery from aphasia: a SPECT prospective study. Neuropsychol Rehabil 2005;15:588-604 https://doi.org/10.1080/09602010443000137
  20. Pantano P, Formisano R, Ricci M, Di Piero V, Sabatini U, Di Pofi B, Rossi R, et al. Motor recovery after stroke. Morphological and functional brain alteration. Brain 1996;119:1849-57 https://doi.org/10.1093/brain/119.6.1849
  21. Baron JC, Bousser MG, Cornar D, Castaigne P. 'Crossed cerebellar diaschisis' in human supratentorial brain infarction. Trans Am Neurol Assoc 1980;105:459-61
  22. Middleton FA, Strik PL: Anatomical evidence for cerebellar and basal ganglia involvement in higher cognitive function. Science 1994;266:458-61 https://doi.org/10.1126/science.7939688
  23. Small SL, Hlustik P, Noll DC, Genovese C, Solodkin A. Cerebellar hemispheric activation ipsilateral to the paretic hand correlates with functional recovery after stroke. Brain 2002;125: 1544-7 https://doi.org/10.1093/brain/awf148
  24. Mohr JP, Foulkes MA, Polis AT, Hier DB, Kase CS, Price TR, et al. Infarct topography and hemiparesis profiles with cerebral onvexity infarction: the stroke data bank. J Neurol Neurosurg Psychiatry 1993;56:344-51 https://doi.org/10.1136/jnnp.56.4.344
  25. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Stroke. Neurologic and functional recovery the Copenhagen Stroke Study. Phys Med Rehabil Clin N Am 1999;10:887-906 https://doi.org/10.1016/S1047-9651(18)30169-4
  26. Jorgensen HS, Reith J, Nakayama H, Kammersgaard LP, Raaschou HO, Olsen TS. What determines good recovery in patients with the most severe strokes? The Copenhagen Stroke Study. Stroke 1999;30:2008-12 https://doi.org/10.1161/01.STR.30.10.2008
  27. Sparks R, Helm N, Albert M. Aphasia rehabilitation resulting from melodic intonation therapy. Cortex 1974;10:303-16 https://doi.org/10.1016/S0010-9452(74)80024-9