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Imaging of Cerebral Blood Flow-to-Volume Distribution Using SPECT

Institute for Nuclear Medicine, German Cancer Research Center
Neurologic Department, University of Heidelberg, FRG

Correspondence: For reprints contact: W. H. Knapp, MD, Herzzentrum Nordrhein-Westfalen D-4970 Bad Oeynhausen 1, FRG.

ABSTRACT

The ratio between cerebral blood flow (CBF) and cerebral blood volume (CBV) has been proposed as an adequate parameter for the evaluation of cerebrovascular disease (CVD), but to date it has not been assessed with SPECT. We have chosen [¹²³I]IMP for CBF and [^99mTc] erythrocytes for CBV imaging. The distribution of both nuclides was investigated in succession using corrections for the contamination of the ^99mTc tomograms by ¹²³I. The ratio between ¹²³I and ^99mTc tomograms yielded the CBF/CBV distribution. Quantitation was obtained by side-to-side comparison of both hemispheres and of segments containing the territories affected by CVD. In 16 patients with CVD, CBF of the affected territories was 85 ± 19% (s.d.) when related to the nonsymptomatic contralateral side (100%). When the regions of interest defined within one slice encompassed the entire affected hemisphere, the average CBF was 95 ± 9%, again related to the nonsymptomatic side. The corresponding CBF/CBV data in 15 of these 16 patients were 60 ± 32% and 81 ± 16%. In unilateral internal carotid artery stenoses >50% (N = 10), segmental CBF averaged 81.1 ± 10.1% and CBF/CBV 49.6 ± 15.5% relative to the contralateral side. The figures for the hemispheres were 92.8 ± 5.8 and 75.8 ± 12.6, respectively. These clinical findings mirror the characteristics of CBF autoregulation, namely the vasodilation of small vessels in decreased arterial perfusion pressure. They, therefore, substantiate SPECT imaging of CBF/CBV for the assessment of cerebral perfusion reserve in CVD.

FOOTNOTES

^* Present address: Herzzentrum Nordrhein-Westfalen, Georgstr. 11, D-4970 Bad Oeynhausen, FRG.

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