The Studys Of Imaging Diagnosis And The Effect Of Betahistinemesilate Tablets On Vertebrobasilar Insufficiency

Objective: (1).Investigating the clinical applications of SPECT cerebral perfusion imaging, MRA and CDFI in VBI, in order to find out an objective and ideal clinical method for VBI's early diagnosis.(2).Observing the regional cerebral blood flow (rCBF) measured by SPECT during VBI acute episodes and the therapeutic efficacy of Betahistine mesilate Tablets on VBI.Methods: Brain MRA was performed during VBI acute episodes for 63 patients who had been clinically diagnosed VBI ,32 of the 63 patients received SPECT examination and were comparied with healthy control group meanwhile,30 of 63 patients were taken CDFI examination, the statistical analyses were done for the three methods. All patients were treated with Betahistine mesilate Tablets 12mg,PO,three times a day for two weeks or more,other therapeutic approaches were identical. 16 patients repeated SPECT examination during intermission,the clinical scores and the qualitations and the semiquantitative analyses of rCBF were observed in pre and post therapy.Results: (1).The positive percentage through MRA was 57.1%, the positive percentage with SPECT was 78.1% and the CDFI was 46.7%.The statistic differences were showed ,when SPECT was compared with MRA and CDFI respectively;(2).The results of MRA: only one was abnormal in BA ,showing stenosis; 28 patients(77.8%) were VA stenosis and 8 patients(22.2%) were VA occlusion. And 11 patients(30.6%) were abnormal in left VA, 18(50%) in right,7(19.4%) in both side.(3).The results of CDFI: There were 12 patients (52.2%) whose blood flow rates were abnormal in VA, 7 patients(30.4%)were VA stenosis and 4 patients(17.4%) were VA occlusion. (4).There were 14 patients(31.1 %) whose rCBFs were abnormal in left during VBI acute episodes by visual examination,31patients(68.9%) in right,the right was higher than the left in percentage obviously. And the SPECT showed the ischemic area located in the temporal lobe,cerebellum, occipital lobe et al, and the areas supplied by VBA system exactly;Some patients appeared the ischemic area supplied by cervical internal carotid artery system meanwhile or merely,such as parietal lobe and coxopodite area. (5)The rCBFs of VBI group were lower than control group in many areas through semiquantitative analysis,and there were statistical significances in the temporal lobe, parietal lobe , coxopodite area,cerebellum and thalamus opticus. The rCBFs in left and right had significant differences in the temporal lobe, parietal lobe , coxopodite area,especially in parietal lobe , coxopodite area. (6). 16 patients repeated SPECT examination during VBI intermission,and 4 patients(25%) were abnormal. (7). Through treatment,the 16 patients' clinical scores and rCBFs were improved generally, the pre and post therapy had significant differences,especially in cerebellum. Conclusion: (1).The morphology of VBA can be evaluated by MRA and CDFI during VBI acute episodes, especially in VA, but they can't show the true perfusion of posterior circulation and the compensation ability of collateral circulation, and their positive percentages are inferior to SPECT. SPECT have value in evaluating cerebral blood flow perfusion and therapeutic effect, especially in observing the blood supply of the patient on VBI timely.It can provide an objective foundation for making the therapeutic plan and can be considered to have greater diagnostic value for VBI. (2).The cerebral blood flow perfusion abnormality can involve in the vertebrobasilar system and cervical internal carotid artery system during VBI acute episodes, but the vertebrobasilar system is primary. (3). The cerebral blood flow perfusions of some patients are abnormal during VBI intermission, these show the significance of SPECT for VBI during intermission. Strengthening the therapy during intermission may prevent the recurrence of VBI and the occurrence of cerebral infarction of posterior circulation effectively. (4). Betahistine mesilate Tablets treat VBI through increasing the rCBF and improving many etiological aspects as a new betahistine mesilate,but it's mechanism of action and therapeutic effect need to be observed further due to the samples of patients are small and balnk control group is absenct because of medical ethics.