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Cranial Scintiphotographic Blood Flow Defects in Arteriographically Proven Cerebral Vascular Disease

University of California School of Medicine and San Francisco General Hospital, San Francisco, California

Correspondence: For reprints contact: Mathews B. Fish, Clinical Laboratories, Bldg. 100, Room 163, San Francisco General Hospital, 1001 Potrero St., San Francisco, Calif. 94110.

ABSTRACT

The accuracy and sensitivity of rapid sequential cranial scintiphotography after intravenous bolus injection of ^99mTc in CVD were assessed by correlation with the vascular changes and clinical phases of 84 angiographically proven cases of CYD. Patients were divided into three clinical groups: (A) asymptomatic and transient ischemic attacks; (B) acute and subacute strokes; (C) chronic completed strokes. Abnormality of the scintiphotographic study was noted in 53% of Group 1, 83% of Group 2, and 75% of Group 3. Of those with isotopic abnormalities, all except one patient had a HF abnormality. Most patients in Group 1 were with out BBB defects, and only half of the patients in Group 2 and one-third of the patients in Group 3 with HF abnormalities had BBB defects. Correlation of HF studies with specific arteriographic findings revealed isotopic abnormalities in 68% of the patients with extracranial vascular disease and 85% of patients with intracranial vascular disease. While less frequent, BBB defects occurred in 25% of the patients with extracranial involvement and in 44% of patients with intracranial involvement. These studies also indicate that the frequency of BF abnormalities correlated with the severity of vascular involvement and the degree of symptomatology.

The overall diagnostic accuracy in this study of 75% is noteworthy because over one-half of the patients were not in the acute or subacute phase of their disease. Use of conventional BBB studies alone would reduce overall diagnostic accuracy from 75 to 32%.