PET/CT在颅脑损伤植物状态大脑功能的研究进展

李若金; 杜  昕; 李  贺; 林承赫; 李贞兰

中国临床医学影像杂志 ›› 2016, Vol. 27 ›› Issue (11) : 823-826.

综述

李若金，杜昕，李贺，林承赫，李贞兰

作者信息 +

Research progress of PET/CT in brain function of vegetative state patients after traumatic brain injury

LI Ruo-jin, DU Xin, LI He, LIN Cheng-he, LI Zhen-lan

Author information +

文章历史 +

摘要

严重颅脑损伤所致植物状态预后具有很大的差异，其意识不同水平决定着植物状态临床治疗和家庭护理的延续，因此准确判断意识障碍的类型和程度具有重要的临床指导意义。PET/CT通过放射性示踪剂定量反映大脑功能变化和残存活性，为意识障碍患者的诊断及预后评估提供客观依据。本文就PET/CT在颅脑损伤意识障碍诊断中的应用和大脑功能变化研究进展做一综述。

Abstract

Patients with severe traumatic brain injury often survive in vegetative state, and show a significant difference in the prognosis. The level of consciousness in these patients decides whether the clinical treatment and home care for them to be continued or not, thus it makes great sense in the diagnosis of the type and degree of disorders of consciousness. The degree of brain dysfunction can reflect the level of consciousness, PET/CT quantitatively shows the change of brain function and corresponding residual activity area by using radioactive tracer, and further provides the clinical objective evidence for the diagnosis and prognosis assessment. Then this article will make a summary on the research progress of PET/CT about residual brain’s function and diagnosis of disorders of consciousness in traumatic brain injury.

导出引用

李若金，杜昕，李贺，林承赫，李贞兰. PET/CT在颅脑损伤植物状态大脑功能的研究进展[J]. 中国临床医学影像杂志. 2016, 27(11): 823-826

LI Ruo-jin, DU Xin, LI He, LIN Cheng-he, LI Zhen-lan. Research progress of PET/CT in brain function of vegetative state patients after traumatic brain injury[J]. Journal of China Clinic Medical Imaging. 2016, 27(11): 823-826

中图分类号： Ｒ651.15 Ｒ817.4

参考文献

[1]Seel RT, Sherer M, Whyte J, et al. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research[J]. Arch Phys Med Rehabil, 2010, 91(12): 1795-1813.
[2]Caroline S, Steve M, Joseph G, et al. A French validation study of the Coma Recovery Scale-R(CRS-R)[J]. Brain Inj, 2008, 22(10): 786-792.
[3]沈抒. 修订版昏迷恢复量表简介及临床研究进展[J]. 中华物理医学与康复杂志，2015，37（8）：628-630.
[4]Cruse D, Chennu S, Laureys S, et al. Bedside detection of awareness in the vegetative state: a cohort study[J]. Lancet, 2011, 378(9809): 2088-2094.
[5]Giacino JT, Ashwal S, Childs N, et al. The minimally conscious state: definition and diagnostic criteria[J]. Neurol, 2002, 58(2): 349-353.
[6]Schnakers C, Vanhaudenhuyse A, Giacino J, et al. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assement[J]. Bmc Neurol, 2009, 9(1): 1-5.
[7]Bender A, Jox RJ, Grill E, et al. Persistent vegetative state and minimally conscious state[J]. Dtsch Arztebl Int, 2015, 112(14): 235-242.
[8]王永慧，张扬，马艳平，等. 影响持续植物状态患者苏醒的多因素分析[J]. 中华物理医学与康复医学杂志，2010，32（3）：212-215.
[9]Luauté J, Maucort-Boulch D, Tell L, et al. Long-term outcomes of chronic minimally conscious and vegetative states[J]. Neurology, 2010, 75(3): 246-252.
[10]Giacino JT, Kalmar K. The vegetative and minimally conscious ststes: a comparison of clinical features and functional outcome[J]. J Head Trauma Rehabil, 1997, 12(4): 36-51.
[11]唐忠，温瑞. 微意识状态与持续植物状态疗效的对比研究[J]. 中华神经医学杂志，2012，11（9）：912-915.
[12]张红远，张祖进，郭召平，等. PET-CT的显像原理及临床应用[J]. 医疗卫生装备，2008，29（10）：100-101.
[13]Stender J, Gosseries O, Bruno MA, et al. Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study[J]. Lancet, 2014, 384(9942): 514-522.
[14]Shulman RG, Hyder F, Rothman DL. Baseline brain energy supports the state of consciousness[J]. Proc Nati Acad Sci, 2009, 106(27): 11096-11101.
[15]Geeraerts T, Coles JP, Aigbirhio FI, et al. Validation of reference tissue modeling for [11C] flumazenil positron emission tomography following head injury[J]. Ann Nucl Med, 2011, 25(4): 396-405.
[16]Kudo K, Terae S, Katoh C, et al. Quantitative cerebral blood flow measurement with dynamic perfusion CT using the vascular-pixel elimination method: comparison with H215O positron emission tomography[J]. Am J Neuroradiol, 2003, 24(3): 419-420.
[17]Rudolf J, Sobesky J, Ghaemi M, et al. The correlation between cerebral glucose metabolism and bebzodiazepine receptor density in the acute vegetative state[J]. Eur J Neurol, 2002, 9(3): 671-677.
[18]Heiss WD, Grond M, Thiel A, et al. Permanent cortical damage detected by flumazenil positron emission tomography in acute stroke[J]. Stroke, 1998, 29(2): 454-461.
[19]Shiga T, Lkoma K, Katoh C, et al. Loss of neuronal integrity: a cause of hypometabolism in patients with traumatic brain injury without MRI abnormality in the chronic stage[J]. Eur J Nucl Med Mol Imaging, 2006, 33(7): 817-822.
[20]Baron JC, Jones T. Oxygen metabolism, oxygen extraction and positron emission tomography: historical perspective and impact on basic and clinical neuroscience[J]. Neuroimage, 2012, 61(61): 492-504.
[21]Levy DE, Sidtis JJ, Rottenberg DA, et al. Differences in cerebral blood flow and glucose utilization in vegetative versus locked-in patients[J]. Ann Neurol, 1987, 22(6): 673-682.
[22]Bernat JL. Chronic disorders of consciousness[J]. Lancet, 2006, 367(4): 1181-1192.
[23]Beuthien-Baumann B, Handrick W, Schmidt T, et al. Persistent vegetative state: evaluation of brain metabolism and brain perfusion with PET and SPECT[J]. Nucl Med Commun, 2003, 24(24): 643-649.
[24]Hattori N, Huang SH, Yeh E, et al. Correlation of regional metabolic rates of glucose with glasgow coma scale after traumatic brain injury[J]. J Nucl Med, 2003, 44(11): 1709-1716.
[25]Johan S, Ron K, Anders R, et al. Quantitative rates of brain glucose metabolism distinguish minimally conscious from vegetative state patients[J]. J Cere Blood F Met, 2015, 35(1): 58-65.
[26]Perri CD, Thibaut A, Laurey S, et al. Measuring consciousness in coma and related states[J]. World J Radiol, 2014, 6(8): 589-597.
[27]Nakashima T, Iwama T, Naksyama A, et al. Relationship between regional cerebral metabolism and consciousness disturbance in traumatic diffuse brain injury without large focal lesions: an FDG-PET study with statistical parametric mapping analysis[J]. J Neurol Neurosurg Psychiatry, 2006, 77(7): 856-862.
[28]Demertzi A, Soddu A, Laureys S. Consciousness supporting networks[J]. Curr Opin Neurobiol, 2013, 23(2): 239-244.
[29]Thibaut A, Bruno MA, Chatelle C, et al. Metabolic activity external and internal awareness networks in severly brain damaged patients[J]. J Rehabil Med, 2012, 44(6): 487-494.
[30]Menon DK, Owen AM, Williams EJ, et al. Cortical processing in persistent vegetative state[J]. Lancet, 1998, 352(9123): 1148-1149.
[31]Laureys S, Faymonville MC, Fiore G, et al. Auditory processing in the vegetative state[J]. Brain, 2000, 123(8): 1589-1601.
[32]Friston KJ, Buechel C, Fink GR, et al. Psychophysiological and modulatory interactions in neuroimaging[J]. Neuroimage, 1997, 6(3): 218-229.
[33]Owen AM, Coleman MR, Menon DK, et al. Residual auditory function in persistent vegetative state: a combined PET and fMRI study[J]. Neuropsychol Rehabil, 2005, 15(3-4): 290-306.
[34]Boly M, Faymonville MP, Lambermont B, et al. Auditory processing in severely brain injured patients: differences between the minimally conscious state and the persistent vegetative state[J]. Arch Neurol, 2004, 61(2): 233-238.
[35]Kassubek J, Juengling FD, Els T, et al. Activation of a residual cortical network during painful stimulation in long-term postanoxic vegetative state: a 15O-H2O PET study[J]. Neurol Sci, 2003, 212(1-2): 85-91.
[36]Laureys S, Damas P, Faymonvile ME, et al. Cortical processing of noxious somatosensory stimuli in the persistent vegetative state[J]. Neuroimage, 2002, 17(2): 732-741.
[37]Boly M, Peigneux P, Lambermont B, et al. Cerebral processing of auditory and noxious stimuli in sverely brain injured patients: differences between VS and MCS[J]. Neuropsychol Rehabil, 2005, 15(3-4): 283-289.
[38]Haibo D, Boly MX, Ledoux D, et al. Neuroimaging activation studies in the vegetative state: predictors of recovery?[J]. Clin Med, 2008, 8(5): 502-507.