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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 22:48-53 (1 2001)
© 2001 American Society of Neuroradiology

ARTICLE

Brain Single-photon Emission CT Studies Using ^99mTc-HMPAO and ^99mTc-ECD Early after Recanalization by Local Intraarterial Thrombolysis in Patients with Acute Embolic Middle Cerebral Artery Occlusion

Kuniaki Ogasawara^,a, Akira Ogawa^a, Masayuki Ezura^a, Hiromu Konno^a, Michiyasu Suzuki^a and Takashi Yoshimoto^a

^a From the Department of Neurosurgery and the Cyclotron Research Center, Iwate Medical University (K.O., A.O., H.K., M.S.); the Department of Intravascular Neurosurgery, Kohnan Hospital (M.E.); and the Department of Neurosurgery, Tohoku University School of Medicine (T.Y.), Japan.

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 < 0.9) on ^99mTc-ECD SPECT developed irreversible brain damage. Hemorrhage appeared in lesions with both hyperactivity (values > 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.

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