SPECT analysis of recent cerebral infarction.

Raynaud, C.; Rancurel, G; Tzourio, N.; Soucy, Jean Paul; Baron, J. C.; Pappatà, Sabina; Cambon, H; Mazoyer, Bernard; Lassen, N. A.; Ea, Cabanis

doi:10.1161/01.str.20.2.192

Cited by 36 publications

(16 citation statements)

References 33 publications

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“…All patients with an asymmetry index (affected versus contralateral area) of less than 60% had a poor prognosis; patients with an asymmetry index of more than 60% had a good outcome. After 6 hours, the prognostic value of 99 mTc-HMPAO-SPECT deteriorated owing to postischemic hyperemia (absolute or relative lUXury perfusion) (Lassen, 1966;Raynaud et a!., 1989). Hartmann (1985) examined 20 patients with TIA us ing the 133 Xe inhalation technique.…”

Section: Discussionmentioning

confidence: 99%

Differentiation between Transient Ischemic Attack and Ischemic Stroke within the First Six Hours after Onset of Symptoms by Using ^99mTc-ECD-SPECT

Berrouschot

Barthel

Hesse

et al. 1998

J Cereb Blood Flow Metab

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Summary: The aim of this study was to define the accuracy of 99 mTc-ethyl cysteinate dimer-single photon emission com puted tomography e 9 mTc-ECD-SPECT) in distinguishing tran sient ischemic attack from completed ischemic stroke at early stages after the onset of symptoms. In a prospective study we examined 82 patients within 6 hours after the onset of symp toms (neurologic deficit caused by middle cerebral artery isch emia) using both 99 mTc-ECD-SPECT and computed tomogra phy (CT). The follow-up was based on Scandinavian Stroke Scale (SSS) 24 hours and 5-7 days, as well as on CT 7 days, after the event. SPECT evaluation was performed both visually and using semiquantitative region-of-interest (ROI) analysis.According to visual SPECT analysis, on admission 59 of 82 patients had activity deficits in the symptomatic hemisphere. After 7 days, all these patients had neurologic symptoms (SSS 28 ± 12 points), caused by a cerebral infarction as evidencedThe consideration of new and aggressive therapies in patients with acute focal cerebral ischemia calls for re liable diagnostic information within a short therapeutic window. Within this period the following specific infor mation is required: whether the symptoms are caused by stroke, where the stroke is located, and what subtype of stroke it is (Brass, 1997). Moreover, prognostication of the course of stroke is urgently required because it may range from complete neurologic restitution after a few 921with CT. Twenty-three of 82 patients displayed no early activ ity deficit despite clinical symptoms. None of these patients had neurologic symptoms after 7 days (indicating transient isch emic attack or prolonged reversible ischemic neurologic defi cit). In the semiquantitative SPECT analysis, all patients had abnormal count densities in the respective ROI (activity <90% compared with the contralateral side). All patients with tran sient ischemia (n = 23) had count rate densities more than 70% of the respective contralateral ROI, whereas all patients with subsequent infarction (n = 59) had values < 70%. Use of 99 mTc-ECD-SPECT allows transient ischemia to be distin guished from ischemic infarction using relative regional activ ity thresholds within the first 6 hours after onset of symptoms.

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Section: Discussionmentioning

confidence: 99%

Differentiation between Transient Ischemic Attack and Ischemic Stroke within the First Six Hours after Onset of Symptoms by Using ^99mTc-ECD-SPECT

Berrouschot

Barthel

Hesse

et al. 1998

J Cereb Blood Flow Metab

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“…Both techniques are more sensitive than CT for detecting both the presence and the extent of infarction (27,28). In the first 8 h after stroke, SPECT was shown to be positive in 90%, and sensitivities of 61%-74% and specificities of 88%-98% were reported (29).…”

Section: Detection Of the Ischemic Lesionmentioning

confidence: 99%

Radionuclide Imaging in Ischemic Stroke

Heiss

2014

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the physiologic and metabolic variables relevant for brain function and the radionuclides and methods to measure these variables in cerebrovascular disease, especially ischemic stroke; (2) the radionuclide methods to determine the thresholds of flow and metabolism relevant for preservation of function and morphology and the obtained values in their relevance to prognosis and potential treatment; and (3) the applications of radionuclide imaging for identifying pathophysiologic changes responsible for extension of ischemic lesions, for defining the hemodynamic reserve in vascular disease, for detecting remote effects outside the primary lesions, and for locating compensatory activation in disturbed functional networks.Financial Disclosure: Dr. Heiss is supported by the Wolf-Dieter Heiss Foundation within the Max Planck Society. The author of this article has indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through November 2017.Ischemic stroke is caused by interruption or significant impairment of blood supply to the brain, which leads to a cascade of metabolic and molecular alterations resulting in functional disturbance and morphologic damage. The changes in regional cerebral blood flow and regional metabolism can be assessed by radionuclide imaging, especially SPECT and PET. SPECT and PET have broadened our understanding of flow and metabolic thresholds critical for maintenance of brain function and morphology: PET was essential in the transfer of the concept of the penumbra to clinical stroke and thereby had a great impact on developing treatment strategies. Receptor ligands can be applied as early markers of irreversible neuronal damage and can predict the size of the final infarcts, which is important for decisions on invasive therapy in large ("malignant") infarction. With SPECT and PET, the reserve capacity of the blood supply can be tested in obstructive arteriosclerosis, which is essential for planning interventions. The effect of a stroke on surrounding and contralateral primarily unaffected tissue can be investigated, helping to understand symptoms caused by disturbance in functional networks. Activation studies are useful to demonstrate alternative pathways to compensate for lesions and to test the effect of rehabilitative therapy. Radioisotope studies help to detect neuroinflammation and its effect on extension of tissue damage. Despite the...

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“…It remains unclear whether this late hyperperfusion is associated with an improved neurological outcome (Raynaud et al, 1989). …”

Section: Cerebral Blood Flow Studiesmentioning

confidence: 99%

Clinical, radiological, and functional evaluation following acute stroke.

Grosset¹

1992

Brit J Clinical Pharma

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1. There are currently no proven treatments for cerebral infarction or intracerebral haematoma. Drug testing is at an exciting phase, however, and thrombolytic and neuroprotective agents appear to have the potential to rescue ischaemic cerebral tissue. The heterogeneous nature of stroke demands adequate patient assessment by clinical and radiological study, with standardised approaches to the measurement of recovery. 2. Previous studies have not fulfilled these stringent criteria, impairing interpretation and inter‐study comparison. The needs of drug studies in the acute phase following stroke are discussed in this review.

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SPECT analysis of recent cerebral infarction.

Cited by 36 publications

References 33 publications

Differentiation between Transient Ischemic Attack and Ischemic Stroke within the First Six Hours after Onset of Symptoms by Using ^99mTc-ECD-SPECT

Differentiation between Transient Ischemic Attack and Ischemic Stroke within the First Six Hours after Onset of Symptoms by Using ^99mTc-ECD-SPECT

Radionuclide Imaging in Ischemic Stroke

Clinical, radiological, and functional evaluation following acute stroke.

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SPECT analysis of recent cerebral infarction.

Cited by 36 publications

References 33 publications

Differentiation between Transient Ischemic Attack and Ischemic Stroke within the First Six Hours after Onset of Symptoms by Using 99mTc-ECD-SPECT

Differentiation between Transient Ischemic Attack and Ischemic Stroke within the First Six Hours after Onset of Symptoms by Using 99mTc-ECD-SPECT

Radionuclide Imaging in Ischemic Stroke

Clinical, radiological, and functional evaluation following acute stroke.

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Product

Resources

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Differentiation between Transient Ischemic Attack and Ischemic Stroke within the First Six Hours after Onset of Symptoms by Using ^99mTc-ECD-SPECT

Differentiation between Transient Ischemic Attack and Ischemic Stroke within the First Six Hours after Onset of Symptoms by Using ^99mTc-ECD-SPECT