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SPECT Images of Technetium-99m-Ethyl Cysteinate Dimer in Cerebrovascular Diseases: Comparison with Other Cerebral Perfusion Tracers and PET

Departments of Nuclear Medicine and Brain Pathophysiology, Kyoto University Faculty of Medicine, Kyoto, Japan

Correspondence: For correspondence or reprints contact: Sadahiko Nishizawa, MD, Department of Nuclear Medicine, Kyoto University Faculty of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-01, Japan.

ABSTRACT

To assess the clinical role of ^99mTc-ethyl cysteinate dimer (ECD) as a cerebral perfusion tracer, 10 patients with unilateral cerebral infarction were studied. Methods: ECD SPECT images were compared with IMP and/or HMPAO SPECT in nine patients, seven in chronic phases and two in subacute phases. Five of these patients and one additional patient with chronic infarction received PET imaging in order to compare ECD distribution with quantitative regional cerebral blood flow (rCBF) and oxygen metabolism (rCMRO₂) images. Results: In patients with chronic cerebral infarction, regression analysis showed excellent correlation between ECD and IMP in the uptake ratio of lesions-to-nonaffected cortices (r = 0.91). In two cases of subacute infarction, decreased uptake of ECD was observed in the area of "luxury perfusion," which showed elevated or preserved rCBF with diminished rCMRO₂. On visual analysis, ECD image contrast was less prominent compared to that of IMP, but contrast was better than that of HMPAO. Conclusions: ECD uptake showed a curvilinear relationship against rCBF, suggesting flow-limited uptake in a high flow range. ECD is a clinically useful cerebral perfusion tracer with distinct characteristics when compared with other available agents.

Key Words: technetium-99m-ethyl cysteinate dimer • cerebrovascular disease

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