Abstract
The purpose of this study was to investigate whether Magnetic Resonance Angiography (MRA) with single photon emission computed tomography using I-123 iodoamphetamine (IMP-SPECT) can distinguish peripheral vestibular disorders (PVD) from central vestibular disorders (CVD) in elderly vertigo patients. Of a total of 65 patients, 30 patients who were clinically diagnosed with PVD, and 35 patients diagnosed with CVD were enrolled in this study. We investigated blood flow in the posterior brain consisting of the upper medulla, bilateral hemisphere and occipital lobe using IMP-SPECT and compared blood flow with MRA findings. Posterior brain blood flow (BBF) in PVD patient's was significantly higher than that in CVD patients (P<0.05). The number of patients in MRA types, I, II, III and IV was 34, 18, 4 and 9 cases, respectively. BBF in each area of the posterior brain in patients, with type IV was significantly lower than that in patients with other MRA types (P<0.05). All of the type II cases revealed hypo form of vertebral artery. The number of PVD patients was significantly higher than that of CVD (P<0.05) in type II.
From these findings, we suggested that the pathogenesis of CVD is closely connected to the insufficiency of the posterior BBF and that MRA with SPECT findings in the diagnosis of vertigo patients is very effective in distinguishing CVD from PVD. Some patterns of MRA with SPECT may correspond to insufficiency of vertebrobasilar blood flow. We consider that in vertigo patients, MRA with IMP-SPECT examination is useful not only to assist in the elucidation of etiology but also to predict the stage of vertebro-basillar insufficiency in each patient.
