technetium-tc-99m-bicisate and Brain-Infarction

The aim of the present study was to test the hypothesis that perfusion single-photon emission computed tomography (SPECT), carried out in addition to transmission computed tomography (TCT), improves the predictive value of brain imaging within the therapeutically relevant time window after acute cerebral ischemia.. Using TCT and [(99m)Tc]ethyl cysteinate dimer (ECD)-SPECT within 6 hours after symptom onset, we examined 108 patients (44 women, 64 men; mean age 65+/-13 years) with acute ischemic stroke attributed to the territory of the middle cerebral artery (MCA). In each case, 3 experts prospectively evaluated the early SPECT and TCT images. We correlated these ratings with follow-up TCT findings for the final infarction as well as with clinical outcome (Scandinavian Stroke Scale, Barthel Index, Modified Rankin Scale) after 30 and 90 days.. Severe activity deficits on SPECT, not caused by local atrophy on TCT, were the best predictors (positive predictive value [PPV ]94%, 95% CI 89% to 99%; negative predictive value [NPV] 90%, 95% CI 78% to 100%; P<0.001) for evolving cerebral infarction. Complete MCA infarctions were predicted with significantly higher accuracy with early SPECT (area under receiver operating characteristic curve [AUC] index 0.91) compared with early TCT (AUC index 0.77) and clinical parameters (AUC index 0.73, P<0.05). Logistic regression analysis revealed 1 independent predictor for completed MCA territory infarction: SPECT activity deficits in the corresponding areas (PPV 88%, 95% CI 65% to 100%; NPV 96%, 95% CI 92% to 100%; P<0.001). Furthermore, death after stroke was optimally predicted by [(99m)Tc]ECD-SPECT. Clinical outcome up to 90 days after the stroke event best correlated with the degree of activity deficits in early SPECT (r=0.53, P<0.001).. [(99m)Tc]ECD brain perfusion SPECT that completes TCT definitely improves the predictive value of brain imaging after acute cerebral ischemia. Thus, the combined imaging of brain edema and of cerebral perfusion early after stroke is recommended for clinical use.

Topics: Acute Disease; Aged; Brain Infarction; Brain Ischemia; Cysteine; Disease Progression; False Positive Reactions; Female; Follow-Up Studies; Forecasting; Humans; Male; Middle Cerebral Artery; Organotechnetium Compounds; Perfusion; Prospective Studies; Radiopharmaceuticals; Stroke; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The purpose of this study was to evaluate the relationship between the recovery of gross motor function and cerebrovascular reserve (CVR) capacity measured by brain perfusion single-photon emission computed tomography (SPECT) in patients with first-ever supratentorial infarction. Gross motor function was assessed according to the locomotor and mobility subset of the functional independence measure. The CVR was measured as the difference in the regional cerebral blood flow (rCBF) after acetazolamide (ACZ)-challenged(99m)Tc-ECD perfusion SPECT from baseline rCBF. All 22 hemiplegic patients (mean age, 60.97 years) enrolled were admitted at a mean of 20.86 days from onset and received rehabilitation care for an average of 38.82 days. The recovery of gross motor function was significantly correlated with baseline rCBF and CVR of ACZ-SPECT in the areas of affected supratentorial hemisphere (r=0.447 and r=0.444, respectively, p < 0.05). Analysis of the linear regression model, adjusted for time to SPECT testing, revealed that the CVR in the affected supratentorial hemisphere was a significant predictor of the gross motor outcome (p< 0.05). In conclusion, the CVR of the affected supratentorial hemisphere may be employed along with other parameters to predict the gross motor recovery of patients with subacute infarction.

Topics: Acetazolamide; Adult; Aged; Aged, 80 and over; Brain Infarction; Carbonic Anhydrase Inhibitors; Cerebrovascular Circulation; Cysteine; Female; Humans; Linear Models; Male; Middle Aged; Motor Activity; Organotechnetium Compounds; Perfusion; Radiopharmaceuticals; Recovery of Function; Tomography, Emission-Computed, Single-Photon

We present a 70-year-old man who suffered two attacks of possible incomplete infarction. At the first attack, the responsible lesion was unclear on MRI including DWI, but demonstrated a high uptake of (99m)Tc-ECD SPECT during the acute phase; thereafter the lesion became atrophic with a low uptake on SPECT during the chronic phase. At the second attack, the responsible lesion revealed weakly hyperintense changes on DWI without marked changes on conventional modalities, but had a high uptake on SPECT and capillary blush on angiography during the acute phase. It is suggested that incomplete infarction can solely result in a massive and clinically critical lesion without an accompanying complete infarction.

Topics: Aged; Brain Infarction; Cerebral Angiography; Cysteine; Humans; Magnetic Resonance Imaging; Male; Organotechnetium Compounds; Radiopharmaceuticals; Recurrence; Time Factors; Tomography, Emission-Computed, Single-Photon