交叉性小脑神经机能联系不能的发病机制及影像学研究进展

doi:10.13481/j.1671-587x.20150641

摘要/Abstract

摘要：

交叉性小脑神经机能联系不能(CCD)是幕上脑组织损伤后出现的主要继发性机能变化。单光子发射计算机断层成像术(SPECT)是一种常用的核医学成像技术,其中的脑血流灌注显像可对脑部功能性疾病进行显像诊断。而SPECT/CT将SPECT与CT的图像进行后处理融合,能够同时提供脏器、组织功能代谢和精细的形态解剖信息,为疾病的定性和定位诊断提供了客观的依据。因此SPECT/CT融合技术对于提高治疗效果,积极改善预后有很大价值。本文从CCD的定义及发病机制入手,对脑血流灌注技术在CCD诊断中的应用进行回顾性分析,并对目前诊断CCD现象的影像学方法进行比较。

关键词: 交叉性小脑神经机能联系不能, 皮质-脑桥-小脑通路, 脑血流灌注显像, 局部脑血流量

中图分类号:

R742.82

余悦, 熊晓亮, 赵银龙, 宋晓良, 罗云霄. 交叉性小脑神经机能联系不能的发病机制及影像学研究进展[J]. 吉林大学学报(医学版), 2015, 41(06): 1307-1310.

参考文献

[1] Feeney DM,Baron JC.Diaschisis[J].Stroke,1986,17(5):817-830.

[2] Von Monakow C:Diaschisis[1914 article translated by G.Harris][A].In:Pribram KH.Brain and Behavior I:Mood States and Mind[M].Baltimore:Penguin Group,1969:27-36.

[3] Kempinsky WH.Experimental study of distant effects of acute focal brain injury:Study of diaschisis[J].AMA Arch Neurol Psychiatry,1958,79(4):376-389.

[4] 楚冰,邵国富.神经机能联系不能[J].国外医学:脑血管疾病分册,2001,9(l):30-32.

[5] Baron JC,Bousser MG,Comar D,et al."Crossed cerebellar diaschisis" in human supratentorial brain infarction[J].Trans Am Neurol Assoc,1981,105:459-461.

[6] Gold L,Lauritzen M.Neuronal deactivation explains decreased cerebellar blood flow in response to focal cerebral ischemia or suppressed neocortical function[J].Proc Natl Acad Sci USA,2002,99(11):7699-7704.

[7] Ito H,Kanno I,Shimosegawa E,et al.Hemodynamic changes during neural deactivation in human brain:a positron emission tomography study of crossed cerebellar diaschisis[J].Ann Nucl Med,2002,16(4):249-254.

[8] 王琳琳.DSC-PWI在交叉性小脑机能联系不能中的临床应用研究[D].郑州:郑州大学,2011.

[9] Lin DD,Kleinman JT,Wityk RJ,et al.Crossed cerebellar diaschisis in acute stroke detected by dynamic susceptibility contrast MR perfusion imaging[J].AJNR,2009,30(4):710-715.

[10] Jeon YW,Kim SH,Lee JY,et al.Dynamic CT perfusion imaging for the detection of crossed cerebellar diaschisis in acute ischemic stroke[J].Korean J Radiol,2012,13(1):12-19.

[11] 黄泽春,汪文胜,成丽娜,等.三维动脉自旋标记脑血流灌注加权成像在交叉性小脑神经机能联系不能的应用价值[J].影像诊断与介入放射学,2015,24(2):108-112.

[12] 管民,马丽佳,连浩君,等.三维动脉自旋标记成像对亚急性单侧幕上脑梗死交叉性小脑失联络的诊断价值[J].中华实用诊断与治疗杂志,2014,28(12):1178-1180.

[13] Chen S,Guan M,Lian HJ,et al.Crossed cerebellar diaschisis detected by arterial spin-labeled perfusion magnetic resonance imaging in subacute ischemic stroke[J].J Stroke Cerebrovasc Dis,2014,23(9):2378-2383.

[14] Nocuń A,Wojczal J,Szczepańska-Szerej H,et al.Quantitative evaluation of crossed cerebellar diaschisis,using voxel-based analysis of Tc-99m ECD brain SPECT[J].Nucl Med Rev Cent East Eur,2013,16(1):31-34.

[15] Ferré JC,Bannier E,Raoult H,et al.Arterial spin labeling(ASL)perfusion:techniques and clinical use[J].Diagn Interv Imaging,2013,94(12):1211-1223.

[16] Kwon YC,Kim JH,Ahn TB.Ataxia of cortical origin viacrossedcerebellar diaschisis[J].Neurol Sci,2015,36(1):161-163.

[17] Yamamoto R,Johkura K,Nakae Y,et al.The mechanism of ipsilateral ataxia in lacunar hemiparesis:SPECT perfusion imaging[J].Eur Neurol,2015,73(1/2):106-111.

[18] 王美豪,程敬亮,杨运俊,等.MRI上梗死灶体积及分布状况与交叉性小脑神经机能联系不能的相关性研究[J].放射学实践,2013,28(3):260-263.

[19] 梁盼.交叉性小脑神经机能联系不能的发生机制[J].放射学实践,2012,27(6):675-676.

[20] Fulham MJ,Dietz MJ,Duyn JH,et al.Transsynaptic reduction in N-acetyl-aspartate in cerebellar diaschisis:a proton MR spectroscopic imaging study[J].J Comput Assist Tomogr,1994,18(5):697-704.

[21] 张翼,张学勤.SPECT观察脑梗死患者脑血流变化的研究现状[J].中国实用医学,2009,4(4):241-243.

[22] 张春银.尼莫地平对脑出血后脑损害保护作用的研究[D].泸州:泸州医学院,2005.

[23] Wu YT,Chang ST.Concurrence of crossed cerebellar diaschisis and parakinesia brachialis oscitans in a patient with hemorrhagic stroke[J].Case Rep Med,2013.doi:org/10.1155/2013/519808.

[24] 赵鹏.脑血流灌注显像对缺血性脑血管病支架植入术的疗效评价[D].沈阳:中国医科大学,2010.

[25] Komaba Y,Mishina M,Utsumi K,et al.Crossed cerebellar diaschisis in patients with cortical infarction:logistic regression analysis to control for confounding effects[J].Stroke,2004,35(2):472-476.

[26] Thajeb P,Shih BF,Wu MC,et al.Crossed cerebellar diaschisis in herpes simplex encephalitis[J].Eur J Radiol,2001,38(1):55-58.

[27] 罗章伟,梁绍奖.SPECT脑灌注显像早期诊断脑梗塞86例临床分析[J].右江民族医学院学报,2004,26(4):551-552.

[28] 张晓雷,朵振顺.急性脑梗死脑血流与脑功能的相关性研究[J].山西医药杂志,2004,33(10):843-845.

[29] 张芬茹,宋锦宁,胡国瑛,等.脑外伤患者^99mTc-ECD SPECT显像的影像特征和应用价值[J].中国医学影像技术,2002,18(10):1021-1023.

[30] 朱传明,李慧英,杨淑珍,等.CT、MRI及脑血流灌注显像诊断缺血性脑卒中的价值[J].现代中西医结合,2014,23(25):2740-2744.

[31] Acharya S,Srivastava A,Virmani S,et al.Resolution of physical signs and recovery in severe cervical spondylotic myelopathy after cervical laminoplasty[J].Spine,2010,35(21):E1083-1087.

[32] 夏光明,黄虎翔,王洲羿,等.前循环进展性卒中患者早期^99mTc-ECD SPECT脑血流显像的影像特征和应用价值[J].中风与神经疾病杂志,2014,31(10):926-928.

[33] 赵鹏,高沁怡,尹雅芙,等.SPECT脑血流灌注显像的临床应用价值及对缺血性脑血管病支架植入术后的疗效评价[J].同位素,2010,23(4):242-246.

[34] Matti-Fabregas JA,Catafau AM,Mendpza G,et al.Cerebral perfusion and haemodynamies measured by SPECT in symptom-free patients with transient ischaemie attack:clinical implications[J].Eur J Nucl Med,2001,28 (12):1828-1835.

[35] Kim J,Lee SK,Lee JD,et al.Decreased fractional anisotropy of middle cerebellar peduncle in crossed cerebellar diaschisis:diffusion-tensor imaging-positron-emission tomography correlation study[J].AJNR,2005,26(9):2224-2228.

[36] Kim HS,Kim DI,Lee JD,et al.Significance of ^99mTc-ECD SPECT in acute and subacute ischemic stroke:comparison with MR images including diffusion and perfusion weighted images[J].Yonsei Med J,2002,43(2):211-222.

[37] Kajimoto K,Moriwaki H,Yamada N,et al.Cerebral hemodynamic evaluation using perfusion-weighted magnetic resonance imaging:comparison with positron emission tomography values in chronic occlusive carotid disease[J].Stroke,2003,34(7):1662-1666.