Abstract
There are several causes of stroke, but common to all is a critical reduction in cerebral blood flow, resulting in a focal neurological deficit. The presumption that functional imaging, particularly of cerebral perfusion, should therefore have a major role to play in the management of this disorder was contradicted initially by a relatively indifferent attitude to these techniques. A clearer definition of the true value of the technique has now emerged confirming that SPECT has much to offer. This chapter gives an outline of the potential benefits, which can result from a knowledge of regional cerebral perfusion: in the acute post-stroke period where exciting new therapies targeted at limiting the neurological damage are under trial; in the later stages when the main effort lies in rehabilitation; and in the vital ‘warning’ stages in patients with carotid artery disease who are at greatest risk of suffering a stroke.
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References
Jones, T.H., Morawetz, R.B., Crowell, R.M., Marcoux, F.W., Fitzgibbon, S.J., DeGirolami, U. and Ojemann, R.J. (1981) Thresholds of focal cerebral ischaemia in awake monkeys. J. Neurosurg., 54, 773–82.
Camarata, P.J., Heros, R.C., Latchaw, R.E., Piepgras, D.G., Whisnet, J.P. and Smith, R.R. (1994) ‘Brain Attack’: the rationale for treating stroke as a medical emergency. Neurosurgery, 34, 144–58.
Siesjo, B.K., Zhao, Q., Pahlmark, K., Siesjo, P., Katsura, K.I. and Folbergrova, J. (1995) Glutamate, calcium, and free radicals as mediators of ischemic brain damage. Ann. Thorac. Surg., 59, 1316–20.
Von Kummer, R., Holle, R., Rosin, L., Forsting, M. and Hacke, W. (1995) Does arterial recanalization improve outcome in carotid territory stroke? Stroke, 26, 581–7.
Asplund, K. (1995) Stroke therapy — time for a clinical breakthrough: introduction. J. Int. Med., 237, 73–8.
Baron, J.C., von Kummer, R. and del Zopo, G.J. (1995) Treatment of acute ischemic stroke: challenging the concept of a rigid and universal time window. Stroke, 26, 2219–21.
Garcia, J.H., Lassen, N.A., Weiller, C., Sperling, B. and Nakagawara, J. (1996) Ischemic stroke and incomplete infarction. Stroke, 27, 761–5.
Mohr, J.P., Biller, J., Hilal, S.K. et al. (1995) Magnetic resonance versus computed tomography imaging in acute stroke. Stroke, 26, 807–12.
Mountz, J.M., Deutsch, G. and Khan, S.H. (1993) Regional cerebral blood flow changes in stroke imaged by Tc-99m HMPAO SPECT with corresponding anatomic image correlation. Clin. Nucl. Med., 18, 1067–82.
Hanson, S.K., Grotta, J.C., Rhoades, H., Tran, H.D., Lamki, L.M., Barron, B.J. and Taylor, W.J. (1993) Value of single-photon emission-computed tomography in acute stroke therapeutic trials. Stroke, 24, 1322–9.
Baird, A.E., Donnan, G.A., Austin, M.C., Fitt, G.J., Davis, S.M. and McKay, W.J. (1994) Reperfusion after thrombolytic therapy in ischemic stroke measured by single-photon emission computed tomography. Stroke, 25, 79–85.
Laloux, P., Richelle, F., Jamart, J., De Coster, P. and Laterre, C. (1995) Comparative correlations of HMPAO SPECT indices, neurological score and stroke subtypes with clinical outcome in acute carotid infarcts. Stroke, 26, 816–21.
Baird, A.E., Donnan, G.A., Austin, M.C. and McKay, W.J. (1995) Early reperfusion in the ‘spectacular shrinking deficit’ demonstrated by single photon emission computed tomography. Neurology, 45, 1335–9.
Zanette, E.M., Roberti, C, Mancini, G., Pozzilli, C, Bragoni, M. and Toni, D. (1995) Spontaneous middle cerebral artery reperfusion in ischemic stroke. Stroke, 26, 430–3.
Baird, A.E., Donnan, G.A., Sperling, B. and Lassen, N.A. (1993) Increased 99mTc-HMPAO uptake in ischemic stroke (2). Stroke, 24, 1261–2.
Marchai, G., Serrati, C, Rioux, P. et al. (1993) PET imaging of cerebral perfusion and oxygen consumption in acute ischaemic stroke: relation to outcome. Lancet, 341, 925–7.
Moretti, J.L., Defer, G. and Cinotti, L. (1990) Luxury perfusion with 99mTc-HMPAO and 123I-IMP SPECT during the subacute phase of stroke. Eur. J. Nucl. Med., 16, 17–22.
Lassen, N.A. and Sperling, B. (1994) 99mTc-bicisate reliably images CBF in chronic brain diseases but fails to show reflow hyperemia in subacute stroke: report of a multicenter trial of 105 cases comparing 133Xe and 99mTc-bicisate (ECD, neurolite) measured by SPECT on same day. J. Cereb. Blood Flow Metab., 14, S44–8.
Moretti, J.L., Caglar, M. and Weinmann, P. (1995) Cerebral perfusion imaging tracers for SPECT: which one to choose? J. Nucl. Med., 36, 359–63.
Sperling, B. and Lassen, N.A. (1993) Hyperfixation of HMPAO in subacute ischemic stroke leading to spuriously high estimates of cerebral blood flow by SPECT. Stroke 24, 193–4.
Infeld, B., Davis, S.M., Lichtenstein, M., Mitchell, P.J. and Hopper, J.L. (1995) Crossed cerebellar diaschisis and brain recovery after stroke. Stroke, 26, 90–5.
Costa, D.C. and Ell, P.J. (1989) Tc-99m HMPAO washout in prognosis of stroke. Lancet, i(8631), 213–14.
Weiller, G, Chollet, F., Friston, K.J., Wise, R.J.S. and Frackowiak, R.S.J. (1992) Functional reorganization of the brain in recovery from striatocapsular infarction in man. Ann. Neurol., 31, 463–72.
Mountz, J.M., Modell, J.G., Foster, N.L., DuPree, E.S., Ackermann, R.J., Petry, N.A., Bluemlein, L.E. and Kuhl, D.E. (1990) Prognostication of recovery following stroke using the comparison of CT and Tc-99m HMPAO SPECT. J. Nucl Med., 31, 61–6.
Dam, M., Tonin, P., Casson, S. et al. (1996) Technetium-99m HMPAO SPECT predicts long term recovery after stroke. Neurology, 46, A338–9.
North American Symptomatic Carotid Endarterectomy Trial Collaborators (NASCET) (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high grade carotid stenosis. N. Engl. J. Med., 325, 445–53.
Hoshi, H., Ohnishi, T., Jinnouchi, S., Futami, S., Nagamachi, S., Kodama, T., Watanabe, K. Ueda, T. and Wakisaka, S. (1994) Cerebral blood flow study in patients with moyamoya disease evaluated by IMP SPECT. J. Nucl. Med., 35, 44–50.
Oku, N., Matsumoto, M., Hashikawa, K. et al. (1994) Carbon dioxide reactivity by consecutive Technetium-99m-HMPAO SPECT in patients with chronically obstructed major cerebral artery. J. Nucl. Med., 35, 32–40.
Powers, W.J. (1991) Cerebral hemodynamics in ischemic cerebrovascular disease. Ann. Neurol., 29, 231–40.
Asenbaum, S., Reinprecht, A., Bricke, T., Wenger, S., Podreka, I. and Deecke, L. (1995) A study of acetazolamide-induced changes in cerebral blood flow using 99mTc HMPAO SPECT in patients with cerebrovascular disease. Neuroradiology, 37, 13–19.
Cikrit, D.F., Burt, R.W., Dalsing, M.C, Lalka, S.G., Sawchuk, A.P., Waymire, B. and Witt, R.M. (1992) Acetazolamide enhanced single photon emission computed tomography (SPECT) evaluation of cerebral perfusion before and after carotid endarterectomy. J. Vasc. Surg., 15, 747–54.
Yonas, H., Smith, H.A., Durham, S.R., Pentheny, S.L. and Johnson, D.W. (1993) Increased stroke risk predieted by compromised cerebral blood flow reactivity. J. Neurosurg., 79, 483–9.
Webster, M.W., Makaroun, M.S., Steed, D.L. et al. (1995) Compromised cerebral blood flow reactivity is a predictor of stroke in patients with symptomatic carotid artery occlusive disease. J. Vasc. Surg., 21, 338–45.
Duncan, D.B., Fink, G.R., Wirth, M., Lottgen, J., Pawlik, G. and Heiss, W.D. (1996) Heterogeneity of cerebral haemodynamics in carotid artery disease. J. Nucl. Med., 37, 429–32.
DiRocco, R.J., Kuczynski, B.L., Pirro, J.P. et al. (1993) Imaging ischemic tissue at risk of infarction during stroke. J. Cereb. Blood Flow Metab., 13, 755–62.
McCulloch, J., Bullock, R. and Teasdale, G.M. (1991) Excitatory amino acid antagonists: opportunities for the treatment of ischaemic brain damage in man, in Excitatory Amino Acid Antagonists (ed. B.S. Meldrum), Blackwell Scientific Publications, London, pp. 287–326.
McCulloch, J., Owens, J., Patterson, J., Brown, D.R.P., Teasdale, G.M. and Wyper, D.J. (1994) Imaging NMDA receptor activation in cerebral ischaemia in man with 123I-MK-801 and SPECT, in Pharmacology of Cerebral Ischemia (eds H. Krieglstein and H. Oberpichler-Schwenk), Wissenschaftliche Verlagsgesellschaft, Stuttgart, pp. 233–8.
Matsuda, H., Tsuji, S., Kuji, I., Sniba, K., Hisada, K. and Mori, H. (1995) Dual tracer autoradiography using 125I-iomazenil and 99mTc-HMPAO in experimental brain ischaemia. Nucl. Med. Commun., 16, 581–90.
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Patterson, J., Wyper, D.J. (1998). Cerebrovascular disease. In: Maisey, M.N., Britton, K.E., Collier, B.D. (eds) Clinical Nuclear Medicine. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-3356-0_24
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DOI: https://doi.org/10.1007/978-1-4899-3356-0_24
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