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RT Journal Article
SR Electronic
T1 Brain Single-photon Emission CT Studies Using <sup>99m</sup>Tc-HMPAO and <sup>99m</sup>Tc-ECD Early after Recanalization by Local Intraarterial Thrombolysis in Patients with Acute Embolic Middle Cerebral Artery Occlusion
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 48
OP 53
VO 22
IS 1
A1 Ogasawara, Kuniaki
A1 Ogawa, Akira
A1 Ezura, Masayuki
A1 Konno, Hiromu
A1 Suzuki, Michiyasu
A1 Yoshimoto, Takashi
YR 2001
UL http://www.ajnr.org/content/22/1/48.abstract
AB BACKGROUND AND PURPOSE: The brain distribution of 99mTc-hexamethylpropyleneamine oxime (HMPAO) correlates with regional brain perfusion, whereas 99mTc-ethyl cysteinate dimer (ECD) reflects not only perfusion but also the metabolic status of brain tissue. We compared 99mTc-ECD single-photon emission CT (SPECT) with 99mTc-HMPAO SPECT early after recanalization by local intraarterial thrombolysis (LIT) in patients with acute embolic middle cerebral artery occlusion. We also assessed the predictive value of 99mTc-HMPAO and 99mTc-ECD SPECT for the development of ischemic brain damage.METHODS: 99mTc-HMPAO and consecutive 99mTc-ECD SPECT studies were performed in 15 patients within 3 hours of LIT. The two SPECT studies were obtained independently using a subtraction technique. SPECT evaluation was performed using semiquantitative region-of-interest analysis. Noninfarction, infarction, and hemorrhage were identified by follow-up CT or MR imaging.RESULTS: Forty-five lesions were identified (21 noninfarctions, 19 infarctions, and five hemorrhages). Regardless of 99mTc-HMPAO SPECT findings, lesions showing isoactivity (count rate densities of 0.9 to 1.1 as compared with the contralateral side) on 99mTc-ECD SPECT were salvaged. Lesions with hypoactivity (values &lt; 0.9) on 99mTc-ECD SPECT developed irreversible brain damage. Hemorrhage appeared in lesions with both hyperactivity (values &gt; 1.1) on 99mTc-HMPAO SPECT and hypoactivity on 99mTc-ECD SPECT.CONCLUSION: The brain distribution of 99mTc-ECD in a reperfused area identified by 99mTc-HMPAO SPECT early after recanalization of acute ischemic stroke is dependent on cerebral tissue viability. By combining 99mTc-ECD and 99mTc-HMPAO SPECT, performed within the first few hours of LIT, it is possible to identify patients at risk for hemorrhagic transformation reliably.