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Brain and Nerve No to Shinkei Volume 37, Issue 9 （September 1985）

Brain and Nerve 脳と神経 37巻9号（1985年9月発行）

Japanese English

原著

多発梗塞性痴呆の脳循環代謝—¹⁵Oを用いたポジトロンCTによる検討 CEREBRAL BLOOD FLOW AND METABOLISM IN MULTI-INFARCT DEMENTIA 氏家隆 ¹ , 赫彰郎 ¹ , 添田敏幸 ¹ , 北村伸 ¹ , 加藤利昭 ¹ , 飯尾正明 ² Takashi Ujike ¹ , Akiro Terashi ¹ , Toshiyuki Soeda ¹ , Shin Kitamura ¹ , Toshiaki Kato ¹ , Masaaki Iio ² ¹日本医科大学第2内科 ²国立中野病院放射線科 ¹Second Department of Internal Medicine, Nippon Medical School ²Department of Radiology, Nakano National Hospital pp.905-912

発行日 1985年9月1日 Published Date 1985/9/1

DOI https://doi.org/10.11477/mf.1406205579

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Abstract 文献概要
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　抄録　老年正常者および多発梗塞性痴呆（MID）患者にC¹⁵O₂および¹⁵O₂ガス持続吸入法を用いたポジトロンCTを実施し，局所の脳血流最（rCBF），酸索抽出分画（rOEF），酸素消費率（rCMRO₂）を測定した。MID例は，X線CTにて皮質下の深部白質，視床，基底核に小梗塞巣が散在し，皮質領域には梗塞巣を認めず，かつ脳血管撮影にて主幹動脈の閉塞を認めない例を選んだ。MIDは軽度〜中等度の痴呆で，発症より2年以内の症例であった。MIDのrCBFは前頭葉，側頭葉，後頭葉，頭頂葉および視床のいずれの領域においても老年正常者の値よりも有意の低値を示し，rCMRO₂も低値を示した。rCBFおよびrCMRO₂の低下は前頭葉と側頭葉と，とくに前頭葉で著しく，前頭葉連合野の血流と代謝の低下が，MIDの知的機能低下に関与していることが示唆された。MID慢性期のOEFは0.46で，血流と代謝の均衡が保たれていたが，発症早期にOEFの亢進を示す症例があった。MIDの原因として，脳深部動脈のアテローム硬化による緩徐な狭窄が小梗塞を併発することによって生じる脳の慢性虚血状態が重要であることが考えられた。

Cerebral blood flow and oxygen metabolism were studied in three aged normal volunteers and 10 patients with multi-infarct dementia (MID) by Positron Emission Tomography using O-15. The diagnosis of MID was done according to the Loeb's modified ischemic score and X-ray CT findings. The MID patients, whose X-ray CT showed localized low density areas in the subcor-tical white matter and basal ganglia and thalamus, were studied. No occulusion was observed at anterior cerebral artery and/or middle cerebral artery on cerebral angiography. All cases of MID were mild dementias. Regional CBF, rOEF and rCMRO₂ were measured by the steady state technique described by Terry Jones et al.

The values of rCBF in MID patients were significantly low compared with those of aged normal subjects in frontal, temporal, occipital, parietal cortices and thalamus. The values of CMRO₂ in MID were significantly low in frontal, temporal, occipital cortices and thalamus compared with normal subjects'. The OEF was 0.46 in aged normal subjects, and 0.52 in MID patients. The MID patients in the early stage of dementia showed the increased oxygen extraction fraction, and this fact suggests that ischemia is a significant pathogenic mechanism in the production and progression of multi-infarct dementia.

The decrease of CBF and CMRO₂ in MID compared from normal subjects' were most remar-kable in frontal cortex. The impairment of mental functions in MID should be caused by the de-creased neuronal activities in frontal association cortex.