Summary:The model for quantifying local cerebral glucose metabolic rates originally developed by Sokoloff et aL and modified by Phelps, Huang and co-workers was applied to humans with cerebral ischemia (i.e" stroke), Rate constants for fluorodeoxyglucose were measured in ischemic and nonischemic regions with positron computed tomography, Using measured rate constants for ischemia. the model generates more accurate estimates of local cerebral glucose metabolism as compared to the use of rate constants from normal young adults, because the local metabolic rate is significantly underestimated, and temporal instability of the model is observed when normal values are applied to ischemic regions. A method was also developed to test the stability of the local lumped constant. The estimates of the lumped constant showed no or only small variations between ischemic and nonischemic types. Thus, errors introduced in the calculated local cerebral glucose metabolism by inappropri ate rate constants appear to be more significant than those caused by any potential change in the lumped constant in ischemia.The method of tomographic measurement of the local ce rebral metabolic rate fo r glucose (LCMRGlc) provides, for the first time, a noninva sive method of evaluating local ce rebral metabolism in humans in vivo. The technique has been pre vi ou sly described (Phelps et aI., 1979; Re ivich et aI. , 1979;Huang et al. 1980) and is an extension of the deoxyglucose autoradiographic approach for the me asurement of LCMRGlc (Sokoloff et aI., 1977(Sokoloff et aI., , 1979.The model provides a measurement of LCMRGlc in animals, with [14C]deoxyglucose (DG), or in man, with [18F]fluorodeoxyglucose (FDG), if the fo llow ing parameters are known (parameters will be dis cu ssed only in terms of FDG): (i) the total local Address correspondence and reprint requests to Dr. Phelps at UCLA School of Medicine. Division of Nuclear Medicine: Los Angeles. California 90024.Ahhreviations used: DG, 2-Deoxyglucose: FOG. Fluorode oxyglucose; FDG-6-P, Fluorodeoxyglucose-6-phosphate; G-6-P. Glucose-6-phosphate; LC. Lumped constant; LCMRGlc, Local cerebral metabolic rate for glucose,
37tissue radioactivity co ncentration of IHF [FDG plus FDG-6-phosphate (FDG-6-P)] and the capillary plasma FDG concentration as a fu nction of time; (ii) rate constants for fo rward and reverse transport between plasma and tissue (k� and k�) and fo r phos phorylation of FDG and dephosphorylation of FDG-6-P (ktl and k�); and (iii) the "lumped co n stant" (LC), which is a ratio of arteriovenous ex traction fraction of FDG to that of gluco se under steady-state conditions when k� is small. LC is a term that accounts for the differences in transport and phosphorylation between glucose and FDG.Both DG and FDG are transported from blood to brain in a manner analogous to glucose (Bidder, 1968; Bachelard, 1971;Oldendorf, 1971; Horton et aI., 1973). Both compete for hexokinase for phos phorylation to DG-6-P and FDG-6-P, re spectively (Bessell et aI., 1972; Re ivich et aI., 1979) but...