두부외상 후 인지장애 판정에 있어서 국소뇌혈류 SPECT의 유용성

Abstract

The purpose of this study was to evaluate the usefulness of rCBF (regional cerebral blood flow) SPECT comparing to MRI or CT for determining of the cognitive function impairment suggesting severe loss of performance ability after head trauma. Ten patients, who underwent rCBF SPECT, MRI or CT in those with psychiatric assessment after head trauma consulted from the court, were evaluated. In all ten patients, rCBF SPECT, MRI or CT were carried out within a month. rCBF study was done as follows: 1,000 MBp Tc-99m The patients ECD was intravenously injected and SPECT was done at 40 minutes after the injection by dual head SPECT gamma camera (ADAC Lab, USA). Mental status and cognitive function were evaluated by psychiatrists in all patients. The patients were divided into two groups with or without cognitive function impairment, to compare them by anatomical imaging and rCBF SPECT results. Six of ten patients showed cognitive function impairment (impaired group), whereas the rest four patients were normal (non-impaired group). All six patients (100%) in impaired group revealed the decrease in rCBF in SPECT imaging, while thress of four patients (75%) in non-impaired group showed normal finding and only one patient had decreased rCBF (false positive). Among six patients in impaired group, five (83.3%) showed parenchymal lesions in brain MRI/CT but one normal finding (false negative). On the other hand, two patients (50%) had parenchymal lesion in non-impaired group (false positive). In one case of impaired group, rCBF SPECT manifested the decreased rCBF in bilateral frontal cortex, but not showing parenchymal lesion in brain MRI/CT. These results suggest that rCBF SPECT could be considered as better diagnostic modality than the anatomical imagings such as MRI and CT to evaluate the cognitive function impairment after head trauma, which is one of the organic psychiatric disorders.