^<133>Xe吸入法とSPECTによる脳血流測定 : 頸部内頸動脈閉塞症での臨床応用
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概要
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Cerebral blood flow (CBF) was measured with ^<133>xenon inhalation and single photon emission computed tomography in 33 cases of internal carotid artery occlusion, in the resting state and 25 minutes after acetazolamide (Diamox^(R)) administration. The patient population consisted of 24 males and nine females with a mean age of 57 years, who presented with transient ischemic attacks or stroke. Acetazolamide inhibits carbonic anhydrase, and CBF increases as a result of dilatation of cerebral arteries due to CO_2 accumulation. The mean CBF was 46 ml/100 g/min on the affected hemisphere and 56 ml/100 g/min on the unaffected hemisphere. The mean CBF value obtained by the same method in 10 normal volunteers was 55 ml/100 g/min. Thus, in the patients, CBF decreased on the affected side. The average increase in CBF after acetazolamide administration was 9% on the affected side and 17% on the unaffected side. The average increase in 10 normal volunteers was 32%. The reduced cerebral arterial reactivity to acetazolamide administration was bilateral in the patient group, which suggests that the cerebral arteries were dilated in order to maintain normal CBF. Extra-intracranial (EC-IC) bypass surgery was performed in nine patients. Preoperatively, the mean CBF was 48 ml/100 g/min on the affected side and 57 ml/100 g/min on the unaffected side; the postoperative CBF was 48 ml/100 g/min on the affected side and 56 ml/100 g/min on the unaffected side. Thus, there was no notable change in CBF on either side after surgery. However, with postoperative acetazolamide administration, the percent increase in CBF rose from 13% to 22% on the affected side and from 17% to 23% on the unaffected side. These changes were statistically significant on the affected side. The bilateral change toward normal in cerebral arterial reactivity to acetazolamide indicates that the dilated cerebral arteries returned to normal after EC-IC bypass surgery. This suggests that bypass surgery is effective in patients with internal carotid artery occlusion in whom ischemia is caused only by hemodynamic factors, and that measurement of CBF Dia acetazolamide loading is useful in identifying appropriate candidates for bypass surgery.
- 日本脳神経外科学会の論文
- 1989-06-15