Kuzmenko D., Makeev S., Novikova Ò., Pedachenko Å.
Romodanov Institute of Neurosurgery, Academy of Medical Sciences of Ukraine, Kiev, Ukraine
The research goal was to study cerebral perfusion in cases with focal traumatic lesion of the brain (FTLB) with the purpose of more effective diagnosis.
Material and Methods. There were 45 and 20 cases with minor and moderate FTLB respectively. CT and SPECT examinations with 99Tc MGMPAO were carried out on the 1st-3rd day after admission and during further treatment in all of them.
Results. According to the asymmetry coefficient (AC), which varied from 0.85 up to 0.29, primary SPECT examination was indicative of hypoperfusion foci in 54 cases. Their localization was in compliance with structural changes, verified with CT. However, their volume was 30-45% greater. Multiple hypoperfusion foci were revealed in 27 cases. It did not correlate with data of CT examination, which had demonstrated a multiple character of FTLB in 12 patients. Repeated SPECT examination of 51 cases did not show aggravation of cerebral perfusion; it corresponded to a favorable clinical course. Unfavorable dynamics of FTLB (widening of hypoperfusion zones, CA reduction) was watched in 5 cases; CT demonstrated formation of meningeal hematomas of the same localization. Repeated CT examination, carried out on the 3rd-5th day, showed formation of delayed contusion foci in 9 cases, whose primary CT and SPECT images were indicative of no changes and presence of hypoperfusion foci (CA of less than 0.4) respectively.
Conclusions. SPECT, included into a multimodality examination of cases with FTLB, and comparison of its data with CT results allows to obtain reliable information on a structural-functional state of the brain substance (1). SPECT advantages include possible preventive diagnosis of contusion foci, which either cannot be visualized with the help of CT or are revealed by it later (2).