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Carbon Dioxide Reactivity by Consecutive Technetium-99m-HMPAO SPECT in Patients with a Chronically Obstructed Major Cerebral Artery

The First Department of Internal Medicine, Department of Neurology, Division of Nuclear Medicine and Department of Tracer Kinetics, Osaka University Medical School, Japan

Correspondence: For correspondence or reprints contact: Naohiko Oku, MD, First Department of Internal Medicine, Osaka University Medical School, Yamadaoka 2-2, Suita 565, Japan.

ABSTRACT

In the management of major cerebral artery obstruction, cerebral perfusion reserve is key to introducing cerebral revascularization surgery. The purpose of this study was to evaluate the feasibility of assessing cerebral perfusion reserve by consecutive ^99mTc-hexamethyl-propyleneamine oxime (^99mTc-HMPAO) SPECT with 5% carbon dioxide (CO₂) inhalation. Methods: The CO₂ inhalation and consecutive ^99mTc-HMPAO SPECT study was performed on 30 chronic ischemic cerebrovascular disease patients with unilateral major cerebral artery obstruction and on 27 patients without. CO₂ reactivity was expressed as the percent increase of ^99mTc-HMPAO accumulation from the baseline (%Change) and as a constant k' that was the ratio of ^99mTc-HMPAO accumulation per 1 mmHg change of end-tidal CO₂ tension by exponential curve fitting. Results: The mean %Change and k' in the middle cerebral artery (MCA) territory on the side without an obstructive lesion or in the cerebellum ranged from 10.0% to 11.1% and from 0.98% to 1.13% per mmHg, respectively. In the MCA territory, an obstructive lesion was noted in 5.9% versus 0.54% per mmHg in the contralateral MCA territory (p < 0.01). Eleven of 30 patients with major cerebral artery obstruction revealed significant asymmetry in the k' value between bilateral MCA territories. Conclusion: The results showed compromised cerebral perfusion reserve in the obstructed major cerebral artery territory. The present method was proven clinically useful for evaluating cerebral perfusion reserve in patients with unilateral major cerebral artery obstruction.

Key Words: ^99mTc-hexamethyl-propyleneamine oxime • carbon dioxide • cerebral perfusion reserve • single-photon emission computed tomography

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