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Detection of Postural Cerebral Hypoperfusion with Technetium-99m-HMPAO Brain SPECT in Patients with Cerebrovascular Disease

Department of Radiology, National Cardiovascular Center, Department of Tracer Data Analysis, Biomedical Research Center, Medical School, Osaka University, Osaka, Japan

Correspondence: For correspondence or reprints contact Kohei Hayashida, MD, National Cardiovascular Center, Dept. of Radiology. 5-7-1 Fujishirodai, Suita, Osaka, 565 Japan.

ABSTRACT

Seventeen of 19 patients (67 ± 8 yr, 17 males and 2 females) had more than 75% unilateral stenosis or occlusion of the internal carotid or middle cerebral artery and two patients had carotid endarterectomy that previously had 90% stenosis of the internal carotid artery. They were studied during upright ^99mTc-HMPAO brain SPECT. HMPA was injected immediately after arising from a supine position. Patients were classified into Group A (n= 10) with occlusion of the internal carotid or the middle cerebral artery or Group B (n= 9) with more than 75% unilateral stenosis of the internal carotid or the middle cerebral artery and with carotid endarterectomy. Additional cerebral blood flow perfusion abnormalities between upright and supine ^99mTc-HMPAO brain SPECT were detected in seven patients in Group A and in only one patient in Group B. Semiquantitative analysis showed that the asymmetric ratios between upright and supine positions changed significantly in Group A from 0.82 ± 0.15 to 0.89 ± 0.10 (p < 0.01), but not in Group B, from 0.89 ± 0.11 to 0.92 ± 0.12 (ns). Additional perfusion abnormalities were relevant to occlusion of the internal carotid or middle cerebral artery indicated postural cerebral hypoperfusion. We conclude that upright ^99mTc-HMPAO brain SPECT visualizes postural cerebral hypoperfusion possibly related to silent cerebral ischemia.

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