Combined SPECT Imaging of Regional Cerebral Blood Flow (99mTc-HexamethylPropyleneamine Oxime, HMPAO) and Blood Volume (99mTc-RBC) to Assess Regional Cerebral Perfusion Reserve in Patients with Cerebrovascular Disease

U. Buell; H. Braun; A. Ferbert; H. Stirner; C. Weiller; E. B. Ringelstein

doi:10.1055/s-0038-1629503

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 1988; 27(02): 51-56
DOI: 10.1055/s-0038-1629503

Originalarbeiten — Original Articles

Schattauer GmbH

Combined SPECT Imaging of Regional Cerebral Blood Flow (^99mTc-HexamethylPropyleneamine Oxime, HMPAO) and Blood Volume (^99mTc-RBC) to Assess Regional Cerebral Perfusion Reserve in Patients with Cerebrovascular Disease^[1]

Kombinierte SPECT-Bildgebung des regionalen zerebralen Blutflusses (^99mTc-Hexamethyl-Propylenamin-Oxim, HMPAO) und des Blutvolumens (^99mTc-RBC) zur Beurteilung der regionalen zerebralen Perfusionsreserve bei Patienten mit zerebrovaskulärer Krankheit

Authors

U. Buell

²NeurologyTechnical University, Aachen, FRG
H. Braun

²NeurologyTechnical University, Aachen, FRG
A. Ferbert

^*From the Departments of Nuclear Medicine, Aachen, FRG
H. Stirner

^*From the Departments of Nuclear Medicine, Aachen, FRG
C. Weiller

^*From the Departments of Nuclear Medicine, Aachen, FRG
E. B. Ringelstein

^*From the Departments of Nuclear Medicine, Aachen, FRG

Abstract

In 53 patients with cerebrovascular disease (CVD), regional cerebral blood flow (CBF) and blood volume (CBV) were imaged by SPECT within one session. Slice division (CBF: CBV) yielded distribution of regional cerebral perfusion reserve (CPR). Semiquantitative evaluation was obtained from manually set ROIs by interhemispherical ratios (for CBF, CBV and CPR), using 2 SD from a normal group (n = 10) as a threshold. Sensitivities were 59% for CBF, 94% for CBV and 83% for CPR. Combined sensitivity was 98%. Establishing three constellations for CBF, CBV and CPR, regionally normal CBFs but quantitatively increased CBVs (+69%) and decreased CPRs (−31 %) were found in relatively early stages of CVD. Very advanced cases showed decreased CBFs (−65%), CBVs (−40%), CPRs (−49%) and a surrounding penumbra. In 87% (46/53 patients), such Theologically postulated constellations could be demonstrated. We conclude that combined CBF and CBV SPECT, assisted by CPR images, is a promising tool to detect CVD and to assess its individual regional severity.

Zusammenfassung

Bei 53 Patienten mit zerebrovaskulärer Erkrankung wurden regionale Hirndurchblutung (CBF) und Blutvolumen (CBV) im Laufe einer Untersuchung schichtweise erfaßt. Die Division der Schichten von F durch V (F:V) ergab die Verteilung der regionalen zerebralen Perfusionsreserve (CPR). Eine semiquantitative Bewertung erfolgte mit manuell plazierten ROIs und der Bildung von Seitenverhältnissen zwischen den Hemisphären für CBF, CBV und CPR. Als Richtwerte wurden die doppelten Streubreiten einer Normalgruppe (n = 10) verwendet. Die Sensitivität für CBF betrug 59%, für CBV 94% und für CPR 83%. Aus der Kombination der drei Verhältnisse ergab sich eine Sensitivität von 98%. Für CBF, CBV und CPR wurden Werte-Konstellationen erstellt: relativ frühe Stadien der Erkrankung zeigten normale Hirndurchblutung aber erhöhtes CBV (+69%) und eine verminderte Reserve (CPR: −31%). Bei sehr fortgeschrittenen Stadien waren alle drei Parameter regional vermindert (CBF: −65%; CBV: −40%, CPR: −49%), es fand sich eine umgebende Penumbra. Bei 87% der Patienten (46/53) konnten diese rheologisch sinnvollen Parameter-Konstellationen nachgewiesen werden. Die kombinierte CBF/CBVSPECT, unterstützt von CPR-Befunden, erwies sich in Erkennung und individueller Bewertung einer zerebrovaskulären Erkrankung als vielversprechende Untersuchungsmethode.

Full Text

References

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Combined SPECT Imaging of Regional Cerebral Blood Flow (99mTc-HexamethylPropyleneamine Oxime, HMPAO) and Blood Volume (99mTc-RBC) to Assess Regional Cerebral Perfusion Reserve in Patients with Cerebrovascular Disease[1]

Authors

Combined SPECT Imaging of Regional Cerebral Blood Flow (^99mTc-HexamethylPropyleneamine Oxime, HMPAO) and Blood Volume (^99mTc-RBC) to Assess Regional Cerebral Perfusion Reserve in Patients with Cerebrovascular Disease^[1]