Use of PET Methods for Measurement of Cerebral Energy Metabolism and Hemodynamics in Cerebrovascular Disease

Baron, Jean‐Claude; Frackowiak, R. S. J.; Herholz, Karl; Jones, Terry; Lammertsma, Adriaan A.; Mazoyer, Bernard; Wienhard, K.

doi:10.1038/jcbfm.1989.105

Cited by 156 publications

(52 citation statements)

References 104 publications

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“…The finding of elevated CBV within hypoperfused but still viable regions suggests compensatory vasodilatation in response to reduced cerebral perfusion pressure. 28,29 It has been suggested that normal or increased CBV indicates tissue unlikely to infarct. 30 However, in the present study, we found that normal or increased rCBV within rCBF and rMTTϾDWI mismatch regions may progress to infarction.…”

Section: Discussionmentioning

confidence: 99%

Perfusion Magnetic Resonance Imaging Maps in Hyperacute Stroke

Parsons

Yang

Barber

et al. 2001

Stroke

143

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Background and Purpose-In ischemic stroke, perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) provide important pathophysiological information. A PWIϾDWI mismatch pattern suggests the presence of salvageable tissue. However, improved methods for distinguishing PWIϾDWI mismatch tissue that is critically hypoperfused from benign oligemia are required. Methods-We investigated the usefulness of maps of relative cerebral blood flow (rCBF), volume (rCBV), and mean transit time (rMTT) to predict transition to infarction in hyperacute (Ͻ6 hours) stroke patients with PWIϾDWI mismatch patterns. Semiquantitative color-thresholded analysis was used to measure hypoperfusion volumes, including increasing color signal intensity thresholds of rMTT delay, which were compared with infarct expansion, outcome infarct size, and clinical status.

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Section: Discussionmentioning

confidence: 99%

Perfusion Magnetic Resonance Imaging Maps in Hyperacute Stroke

Parsons

Yang

Barber

et al. 2001

Stroke

143

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“…Reperfusion after ischemia occurs within hours or days of stroke onset. 25 The precise timing of luxury perfusion is uncertain. This diagnosis requires simultaneous measurements of CBF and oxygen metabolism, the hallmark being CBF in excess of regional metabolism with a reduced oxygen extraction ratio.23,25,26 Perfusion SPECT studies have shown reduced, normal, or even elevated flow in subacute infarcts.…”

Section: Methodsmentioning

confidence: 99%

Cerebral hypoperfusion in stroke prognosis and brain recovery.

Davis

Chua

Lichtenstein

et al. 1993

Stroke

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The value of acute cerebral blood flow measurements in stroke prognosis is controversial. No previous study has determined whether acute perfusion deficits independently add to a validated clinical prognostic score. We aimed to compare the value of acute hypoperfusion deficits with a quantitative clinical score in stroke prognosis and to correlate the changes in perfusion with brain recovery. Volumetric analysis of regional hypoperfusion was performed in 38 patients with middle cerebral infarction within 72 hours of onset by use of single photon emission computed tomography and 99mTc hexamethylpropylene amine oxime. Stroke severity was assessed by the Canadian Neurological Score and Barthel Index. Allen's prognostic score was determined acutely in all patients. Clinical outcome was evaluated in 36 of 38 patients, of whom 18 had repeat blood flow studies. Acute hypoperfusion correlated with both the outcome Barthel Index (P < .001, r = -.61) and Canadian Neurological Score (P < .001, r = -.64). Allen's score correlated better with both the outcome Barthel Index (P < .001, r = .80) and Canadian Neurological Score (P < .001, r = .81). Acute hypoperfusion deficits, after allowing for Allen's score, independently predicted neurological but not functional outcome. Despite overall neurological improvement, mean hypoperfusion increased on the repeat blood flow studies (P < .05). Volumetric analysis of acute regional hypoperfusion within 72 hours of onset predicts stroke outcome after 3 months, but Allen's score is a better prognostic method. Neurological recovery is not associated with chronic infarct reperfusion.

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“…Both CT and PET images obtained in patients provided poor grey-white matter discrimination, making it impossible to segment these anatomic areas and derive appropriately weighted averages for mean CBF and CMRO2 in mixed ROIs. Consequently, unweighted mean data values were obtained from large mixed grey and white matter ROIs in patients and controls, while recognizing that the effect of tissue heterogeneity on 15 O PET models would result in falsely low CBF and CMRO2 values (Baron et al, 1989;Correia et al, 1985;Herscovitch and Raichle, 1983). These data allowed comparison of patients and controls.…”

Section: Image Analysismentioning

confidence: 99%

Incidence and Mechanisms of Cerebral Ischemia in Early Clinical Head Injury

Coles¹,

Fryer²,

Śmielewski

et al. 2004

J Cereb Blood Flow Metab

243

121

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Summary: Antemortem demonstration of ischemia has proved elusive in head injury because regional CBF reductions may represent hypoperfusion appropriately coupled to hypometabolism. Fifteen patients underwent positron emission tomography within 24 hours of head injury to map cerebral blood flow (CBF), cerebral oxygen metabolism (CMRO2), and oxygen extraction fraction (OEF). We estimated the volume of ischemic brain (IBV) and used the standard deviation of the OEF distribution to estimate the efficiency of coupling between CBF and CMRO2. The IBV in patients was significantly higher than controls (67 ± 69 vs. 2 ± 3 mL; P < 0.01). The coexistence of relative ischemia and hyperemia in some patients implies mismatching of perfusion to oxygen use. Whereas the saturation of jugular bulb blood (SjO 2 ) correlated with the IBV (r ‫ס‬ 0.8, P < 0.01), SjO 2 values of 50% were only achieved at an IBV of 170 ± 63 mL (mean ± 95% CI), which equates to 13 ± 5% of the brain. Increases in IBV correlated with a poor Glasgow Outcome Score 6 months after injury ( ‫ס‬ −0.6, P < 0.05). These results suggest significant ischemia within the first day after head injury. The ischemic burden represented by this "traumatic penumbra" is poorly detected by bedside clinical monitors and has significant associations with outcome.

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Use of PET Methods for Measurement of Cerebral Energy Metabolism and Hemodynamics in Cerebrovascular Disease

Cited by 156 publications

References 104 publications

Perfusion Magnetic Resonance Imaging Maps in Hyperacute Stroke

Perfusion Magnetic Resonance Imaging Maps in Hyperacute Stroke

Cerebral hypoperfusion in stroke prognosis and brain recovery.

Incidence and Mechanisms of Cerebral Ischemia in Early Clinical Head Injury

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