58 99mTc HMPAO BRAIN SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT) AND PERINATAL ASPHYXIA

Abstract

This study was designed to rate the clinical value of 99mTc HMPAO brain SPECT in perinatal asphyxia. 12 full-term babies were included. HMPAO SPECT were performed in neonates respectively at 1 and 10 hours after the asphyxial event and repeated 24 hours after. In the 10 remainders HMPAO SPECT were initiated within 1 to 4 days following the asphyxial event. TcPO2, TcPCO2, StaO2, pH values, mean arterial blood pressure, blood glucose levels, pulsed Doppler recordings of middle cerebral artery and ultrasound scans were available at the moment of the SPECT procedures. In acute phase of brain asphyxia (1.10 hours) (2 cases), HMPAO SPECT demonstrated reduction of regional cerebral blood flow (rCBF) in the cerebrum and cerebellum whereas brain stem and basal ganglia were perfused and CBF velocities were significantly reduced. In the subacute phase (24-96 hours), 6 neonates demonstrated high CBF velocities and high rCBF on BMPAO SPECT (two of them belonging to the first group) with total vaso-paralysis. In one case, high rCBF were noted in parasagittal areas. This infant domonstrated cerebral parasagittal lesions on magnetic resonance imaging; whereas the 4 remainders died. The 6 other neonates showed no abnormalities on rCBF neither on CBF velocities, and were neurologically nonual at 6 months of age. These results indicate that 99mTc HMPAO brain SPECT shows a potential clinical value in evaluating perinatal asphyxia. It documents reliably changes in rCBF and demonstrates two distinct features following cerebral asphyxia respectively hypo and hypercerebral perfusion associated with bad outcome.