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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Brain perfusion assessed by 99mTc-ECD SPECT imaging in pediatric patients with neurally mediated reflex syncope.
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Brain perfusion assessed by 99mTc-ECD SPECT imaging in pediatric patients with neurally mediated reflex syncope.

机译：通过99mTc-ECD SPECT成像对小儿神经介导的反射性晕厥患者的脑灌注进行评估。

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BACKGROUND: The involvement of cardiogenic and neurogenic mechanisms in neurally mediated reflex syncope is well documented. In our previous studies in patients with neurally mediated reflex syncope, we have found evidence for differential regulation of the noradrenergic receptors in tilt-positive and tilt-negative patients. The present work concentrates on the observations of differences in regional brain perfusion using brain SPECT via injecting the patient at the completion of the tilt test. METHODS AND RESULTS: The following study was designed to assess the reduction and regional differences in cerebral blood flow by means of SPECT using technetium-99m labeled V-oxo-1,2-N1ethylenedylbisl-cysteine diethylester (ECD) in patients with an injection during tilt testing. Twenty patients with NMS were included in the study with a mean age of 12.2 years (age range; 8-16 years). HUT was positive in 10 patients and negative in 10 patients. When tilt (+) and tilt (-) were evaluated together, regional cortical/cerebellum ratios were ranging from 0.85 to 1.25 in different cortical areas with highest variability of perfusion index in left frontoparietal cortex. The lowest perfusion index values were observed in the left anterior frontal region followed by the left prefrontal-frontoparietal-anterior, parietal-orbito frontal, and anterior temporal regions where perfusion is predominantly supplied via the anterior and middle cerebral arteries, while these differences did not reach statistical significance in a single dominant region compared to the other regions examined using ANOVA (P > 0.05) with this sample size. Decreases in [99mTc]ECD uptake were more widespread regionally on the left hemisphere than were decreases in right side of the brain. However when tilt- and tilt+ groups were compared, perfusion was significantly lower in the right periinsular posterior parietal and temporal regions (P < 0.05) in tilt + group. CONCLUSION: These tilt induced regional differences in brain perfusion suggest the distinct roles of middle cerebral artery dominant territory-related vasodepressor compensation mechanisms in neurally mediated reflex syncope phenomena where cerebral lateralization of cardiac control and insular ischemia may play an important role.
机译：背景：心源性和神经源性机制参与神经介导的反射性晕厥已有很好的文献记载。在我们先前对神经介导的反射性晕厥患者的研究中，我们发现了在倾斜阳性和倾斜阴性患者中去甲肾上腺素能受体差异调节的证据。本工作着重于通过倾斜测试完成后向患者注射使用脑SPECT观察局部脑灌注的差异。方法和结果：以下研究旨在通过使用ECT-99m标记的V-oxo-1,2-N1亚乙基二乙基-半胱氨酸二乙酯（ECD）进行SPECT评估脑血流量的减少和区域差异。倾斜测试。该研究纳入了20名NMS患者，平均年龄为12.2岁（年龄范围：8-16岁）。 HUT阳性10例，阴性10例。当同时评估倾斜度（+）和倾斜度（-）时，不同额叶区域的皮质/小脑区域比率在0.85至1.25范围内，左额顶叶皮质的灌注指数变化最大。在左前额叶区域观察到最低的灌注指数值，然后是左前额叶-额叶前额叶-前壁，顶眶-眶额叶和前颞叶区域，其中主要通过前脑和中脑动脉进行灌注，而这些差异没有在使用该样本量的情况下，与使用ANOVA（P> 0.05）检查的其他区域相比，在单个主要区域中达到统计学显着性。 [99mTc] ECD摄取的减少在左半球区域的分布比在大脑右侧的减少更为广泛。然而，当比较倾斜和倾斜+组时，倾斜+组在右岛周围后壁和颞区的灌注显着降低（P <0.05）。结论：这些倾斜引起的脑灌注区域差异表明，在神经介导的反射性晕厥现象中，大脑中动脉支配区域相关的血管加压素补偿机制具有独特的作用，其中心脏控制和岛状局部缺血可能起重要作用。

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