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 Ogawaa,
Masayuki Ezuraa,
Hiromu Konnoa,
Michiyasu Suzukia and
Takashi Yoshimotoa
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.
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FIG 1. Schematic presentation of the protocol for SPECT; x axis is time (min) and y axis is decay-corrected regional counts
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FIG 2. Outcome versus posttreatment SPECT findings of both tracers. Count densities of the ROIs on the affected side were classified as hypoactivity, hyperactivity, or isoactivity if the A/C ratio was below 0.9, above 1.1, or 0.9 to 1.1, respectively. Open circles represent noninfarction; gray circles, infarction; black circles, hemorrhage
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FIG 3. Patient 6: 58-year-old man with left-sided MCA occlusion.
A, Pretreatment 99mTc-HMPAO SPECT scan shows a perfusion defect in the left MCA territory.
B, Posttreatment 99mTc-HMPAO (left) and 99mTc-ECD (right) SPECT scans obtained 2.5 hours after recanalization by LIT.
C, MR image 2 weeks after the onset of stroke. Infarction did not develop in ROI 2, which showed hyperactivity (A/C ratio of 1.14) on 99mTc-HMPAO SPECT scan and isoactivity (A/C ratio of 0.97) on 99mTc-ECD SPECT scan. In ROI 1, however, which showed hypoactivity (A/C ratio of 0.85) on 99mTc-ECD SPECT scan, infarction did develop despite isoactivity (A/C ratio of 1.06) on 99mTc-HMPAO SPECT scan.
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FIG 4. Patient 8: 61-year-old man with right-sided MCA occlusion.
A, Posttreatment 99mTc-HMPAO (left) and 99mTc-ECD (right) SPECT scans obtained 2 hours after recanalization by LIT.
B, CT scan 30 hours after the onset of stroke. Hemorrhagic transformation with ischemic brain edema developed in ROI 3, which showed hyperactivity (A/C ratio of 1.36) on 99mTc-HMPAO SPECT scan and hypoactivity (A/C ratio of 0.85) on 99mTc-ECD SPECT scan.
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