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Journal of the Korean Neurological Association 2001;19(2): 88-95.
급성 중뇌동맥영역 뇌경색에서 확산강조 M R I와Tc99m-ECD SPECT 소견:부피 측정 분석을 이용한 임상 상태 및 예후와의 비교
황인용, 이성민 최성민 조연희 김병채 김명규 조기현 송호천* 범희승* 서정진
전남대학교 신경과학교실,핵의학과학교실*,진단방사선과학교실†
Diffusion Weighted MRI and Tc99m-ECD SPECT inAcute Middle Cerebral Artery Territory Infarction: Comparison with Clinical Status and Outcome Using Volumetric Analysis
In-Yong Hwang, M.D., Sung-Min Lee, M.D., Sung-Min Choi, M.D.,Yeon-Heui Cho, M.D., Byeong-Chae Kim, M.D., Myeong-Kyu Kim, M.D.,Ki-Hyun Cho, M.D., Ho-Cheon Song, M.D.*, Hee-Seung Bom, M.D.*, Jeong-Jin Seo, M.D.†
"Department of Neurology, Nuclear Medicine* and Diagnostic Radiology† , Chonnam University Medical School"
Abstract
"Background : Diffusion weighted magnetic resonance imaging (DWI) and single photon emission computed tomog-raphy (SPECT) can demonstrate ischemic brain injury within the first several hours after the onset of symptoms. We investigated the utility of combined DWI and SPECT in the assessment of acute cerebral infarction. M e t h o d s : Nineteen patients with acute middle cerebral artery territory infarction underwent DWI and SPECT within 12 hours of symptom onset (mean, 9.6 hour). In SPECT, we defined abnormality as a perfusion defect region (perfusion ??30% compared to a normal cortex) and an ischemic region (perfusion difference ??10% compared to a contralateral normal hemisphere). The initial DWI and SPECT lesion volume ratios (lesion volume / hemispheric volume) were analyzed with subsequent neurological deficits as determined by the National Institutes of Health Stroke Scale (NIHSS) score and Barthel index (BI). Results : There was a high correlation between clinical scores within 7 days and lesion volumes determined by DWI and SPECT respectively (p<0.05). The lesion volumes detected by DWI and SPECT significantly correlated with each other (p<0.01). Ischemic lesions on SPECT were larger in the group (n=10) with ICA occlusions than in the other group (p=0.034). In 15 patients with cortical lesions, the ratio of perfusion defect volumes on SPECT to lesion volumes on DWI was higher in the group with favorable outcome than in the group with unfavorable outcome (p=0.01). Conclusions : Both DWI and SPECT are highly correlated with the severity of neurological deficit in acute cerebral infarction. Furthermore, combined use of DWI and SPECT would be more powerful than either study alone in predicting clinical outcome. J Korean Neurol Assoc 19(2):88~95, 2001 Key Words : Diffusion weighted magnetic resonance imaging, Stroke assessment, Single-photon emission computed tomography, Acute cerebral infarction"