Optimal Brain 99mTc–Ethyl Cysteinate Dimer SPECT Imaging and Analysis to Detect Misery Perfusion on 15O PET Imaging in Patients With Chronic Occlusive Disease of Unilateral Major Cerebral Artery

Abstract

PurposeMisery perfusion is defined as marginally sufficient cerebral blood supply relative to cerebral metabolic demand. The aim of the present study was to determine the optimal brain 99mTc–ethyl cysteinate dimer (ECD) SPECT imaging and analysis to detect misery perfusion on 15O PET imaging in patients with chronic occlusive disease of unilateral internal carotid or middle cerebral artery (MCA).MethodsFor 97 patients, cerebral blood flow, cerebral metabolic rate of oxygen, and oxygen extraction fraction were measured using 15O PET; 99mTc-ECD SPECT was performed using dynamic scanning with a scan duration of 10 minutes each for 50 minutes after tracer administration. A region of interest was placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres in all standardized images using a 3-dimensional stereotaxic region-of-interest template and affected-to-contralateral asymmetry ratio in the MCA territory (ARMCA) and contralateral-to-affected asymmetry ratio in the cerebellar hemisphere (ARcbl) were calculated.ResultsThe ARMCA or ARcbl on 99mTc-ECD SPECT with a scan time of 20 to 30 minutes after tracer administration (ARMCA20–30 or ARcbl20–30) was correlated with ARMCA on PET cerebral blood flow (r = 0.654) or ARMCA on PET cerebral metabolic rate of oxygen (r = 0.576), respectively, more strongly than with other scan times. The area under the receiver operating characteristic curve for detecting abnormally elevated ARMCA on PET oxygen extraction fraction was significantly greater for ARcbl20–30/ARMCA20–30 (0.947) than for ARMCA20–30 alone (0.780) (difference between areas, 0.167; P = 0.0001) on 99mTc-ECD SPECT.ConclusionsCombination of asymmetries in the cerebellar and cerebral hemispheres on 99mTc-ECD SPECT in a scan time of 20 to 30 minutes after tracer administration optimally detects misery perfusion in unilateral internal carotid artery or MCA occlusive disease.

BOLD cerebrovascular reactivity as a novel marker for crossed cerebellar diaschisis

“…40 This would explain why recovery of CCD is seen in participants with small infarcts after reperfusion with thrombolysis 2 and CCD is even found in stenoocclusive disease participants with misery perfusion but without radiologically defined stroke lesions. 41 From our point of view, we believe a pathophysiologic distinction needs to be made between lesion-induced and hemodynamic-induced CCD, especially as the current definition of CCD still requires the presence of a supratentorial lesion. We will further study this hypothesis in a larger CCD cohort.…”

Preoperatively reduced cerebrovascular contractile reactivity to hypocapnia by hyperventilation is associated with cerebral hyperperfusion syndrome after arterial bypass surgery for adult patients with cerebral misery perfusion due to ischemic moyamoya disease

“…15 Technetium-99 m-labeled ( 99m Tc) ethyl cysteinate dimer (ECD), an accumulative radioligand, is used as a brain perfusion tracer for single-photon emission computed tomography (SPECT) to image reduced blood flow in the cerebral hemisphere with internal carotid artery or MCA occlusive disease. 16 Use of 99m Tc-ECD SPECT can also image CBF changes by hypocapnia induced by hyperventilation in patients with moyamoya disease. 17 The purpose of the present study using PET and SPECT was to determine whether preoperatively reduced cerebrovascular contractile reactivity to hypocapnia by hyperventilation is associated with development of cerebral hyperperfusion syndrome after arterial bypass surgery for adult patients with cerebral misery perfusion due to ischemic moyamoya disease.…”

Brain Perfusion Imaging Under Acetazolamide Challenge for Detection of Impaired Cerebrovascular Reserve Capacity: Positive Findings with 15O-Water PET in Patients with Negative 99mTc-HMPAO SPECT Findings

“…Increased oxygen extraction fraction as measured by PET with 15 O gas was used as the gold standard. The area under the receiveroperating-characteristic curve for detection of misery perfusion by the ipsilateral-to-contralateral 99m Tc-ECD uptake in the supply territory of the middle cerebral artery increased from 0.780 to 0.974 (P 5 0.0001) when the 99m Tc-ECD uptake ratio in the middle cerebral artery territory was scaled to the contralateralto-ipsilateral ratio of 99m Tc-ECD uptake in the cerebellum (12). This was due to crossed cerebellar hypoperfusion (12).…”

“…The area under the receiveroperating-characteristic curve for detection of misery perfusion by the ipsilateral-to-contralateral 99m Tc-ECD uptake in the supply territory of the middle cerebral artery increased from 0.780 to 0.974 (P 5 0.0001) when the 99m Tc-ECD uptake ratio in the middle cerebral artery territory was scaled to the contralateralto-ipsilateral ratio of 99m Tc-ECD uptake in the cerebellum (12). This was due to crossed cerebellar hypoperfusion (12). These findings suggest that the accuracy of brain perfusion SPECT with chemical microspheres such as 99m Tc-ECD and 99m Tc-HMPAO for detection of hemodynamic impairment can be considerably improved CVRC reduction in left temporooccipital cortex in patient 14 did not reach threshold for automatic delineation (Fig.…”

“…Matsumoto et al evaluated SPECT with 99m Tc-labeled ethyl cysteinate dimer ( 99m Tc-ECD) for detection of misery perfusion in patients with unilateral chronic occlusive disease (12). Increased oxygen extraction fraction as measured by PET with 15 O gas was used as the gold standard.…”