Sensitivity of computer assisted radionuclide angiography in transient ischemic attack and prolonged reversible ischemic neurological deficit. Comparison with findings in radiographic angiography and transmission computerized axial tomography.

Abstract

SUMMARY Computer assisted radionuclide angiography (CARNA) with "Tc-DTPA was employed to study 143 patients with transient lscbemic attacks (TIA) and 79 patients with prolonged reversible ischemic neurologic deficit (PRIND). The results of CARNA were compared with findings from radiographic angiography (RGA) in 173 patients and with findings in transmission computerized axial tomography (T-CAT) in 154 patients. In patients with TIA, CARNA showed a hemispherical perfusion deficit in 74.8%, and with PRIND 873%. This deficit, determined as the relative difference between the involved and the non-involved hemisphere, was significantly (p < 0.0025) greater In PRIND (minus 23%) than in TIA (minus 17%). Sensitivity of CARNA was independent of the interval from ictus to examination for more than 4 months. RGA in TLA revealed true positives in 82.0%, in PRIND it was 89.5%. T-CAT was positive in TIA in only 16.8% but in PRIND it was 64.4%. Combined sensitivities in TIA (92.4%) and in PRIND (94.0%) were highest with the combination of CARNA and RGA. However, in PRIND the combination of non-invasive methods (CARNA and T-CAT) revealed 93.2% positive findings. Combinations of these evaluation methods may be used to detect cerebrovascular disease in patients with such dysfunction. Stroke, Vol 12, No 6, 1981 RADIONUCLIDE angiography (RNA) with T cpertechnetate or wm Tc-DTPA is the first component of cerebral serial scintigraphy (CSS) and the second is static imaging. CSS yields useful results in both the detection and identification of intra-cranial tumors 1 as well as in the detection and localization of cranial vascular disease.1 Intra-cranial vascular disease in static nuclear images is reflected by intra-cranial accumulation of T c at the site of a disrupted blood brain barrier. Since such accumulation occurs mainly in completed stroke, less severe changes of intra-cerebral perfusion may be detected exclusively by employing RNA, evaluated either by visual Computer assisted radionuclide angiography (CARNA) was employed in patients with transient ischemic attacks (TIA) or prolonged reversible ischemic neurologic deficit (PRIND) to establish the sensitivity of CARNA in detecting and quantifying changes of cerebral perfusion. Results of CARNA were compared with findings from transmission computerized axial tomography (T-CAT) and with findings from cranial radiographic angiography (RGA) to obtain data on the combined sensitivities of these methods.From the Departments of Radiology, Neurosurgery, and Neurology, University of Munich, Klinikum Grosshadern, Munich, Federal Republic of Germany.Reprints: Dr. Buell, Dept. Radiology, University of Munich, Klinikum Grosshadern, 8000 Munich 70, Federal Republic of Germany. Material and MethodsA total of 222 patients were studied. Of these, 143 had TIA and 79 had PRIND. The patients were further divided according to the interval of time which had elapsed between ictus and examination. Patients included in the present study were not initially examined to compare results of CARNA, T-CAT a...