Ischemic Disease Studied with ¹⁵O Labelled Compounds: Metabolic and Hemodynamic Disparities

Abstract

This article attempts to evaluate how PET may affect the care of patients with ischemic cerebrovascular disease. PET scanning studies of patients with cerebral ischemic disease have been reported in the open literature from 1978 (Baron et al., 1978). Quantitative PET techniques have been described since 1979 for measuring cerebral blood volume (CBV) and cerebral metabolic rate of glucose (CMRGlu) (Phelps et al., 1979; Reivich et al., 1979), and 1980 for cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO₂) (Frackowiak et al., 1980). Since then PET scanning has advanced technically and new methods for measuring a variety of physiological variables have been described or refined (Phelps et al., 1986). The work to date has been confined to relatively few centres around the world and has therefore been oriented very largely in the direction of research rather than routine diagnostic use. A considerable amount of new insight has been obtained over the last 7 years which makes it now possible to classify patients with cerebrovascular disease in physiological as well as clinical terms. These advances with those in anatomical and structural diagnosis made by CT and NMR scanning and digital subtraction angiography now provide the practicing clinician with a very considerable armamentarium for analysing the precise problems of the individual patient, and planning the most appropriate management.