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Technetium-99m-ECD Brain SPECT in Misery Perfusion

Department of Radiology and Nuclear Medicine, Research Institute of Brain and Blood Vessels, Akita, Japan

Correspondence: For correspondence or reprints contact: Eku Shimosegawa, MD, Dept of Radiology and Nuclear Medicine, Research Institute of Brain and Blood Vessels, 6–10 Senshu-Kubota Machi, Akita 010, Japan.

ABSTRACT

Discordant findings of ^99mTc-methyl cysteinate dimer (^99mTc-ECD) brain distribution have been reported when brain tissue is supplied by excess blood flow. We evaluated changes in ^99mTc-ECD brain activity in the opposing pathological state, in which cerebral blood flow (CBF) is more profoundly impaired than metabolism, and analyzed the relationship of ^99mTc-ECD activity with CBF and metabolism to investigate the dominant regulating factor on ECD distribution. Methods: Twelve patients with unilateral intracranial steno-occlusive diseases were evaluated using dynamic and static ^99mTc-ECD SPECT. Relative ^99mTc-ECD activities and the retention ratio of the affected and unaffected cortices were compared with CBF and oxygen metabolism obtained by PET. Change in the relationships until 1 hr after tracer injection were also analyzed. Results: Relative ^99mTc-ECD activity was significantly correlated with CBF, and the highest correlation was obtained for the first minute of imaging (r = 0.674, p < 0.001). Fifteen minutes after injection, the correlation coefficient with CBF decreased, whereas higher correlation was observed with the parameter of oxygen metabolism (r = 0.758–0.815, p < 0.001). Changes in the retention ratio were dependent on changes in oxygen metabolism, and the retention ratio for the high oxygen extraction fraction (OEF) area was the same as that for the normal OEF area. Conclusion: In addition to CBF, brain distribution on ^99mTc-ECD SPECT images is affected by brain metabolism, especially on delayed images after injection. The degree of discrepancy between CBF and metabolism should be considered when interpreting images of the misery perfusion state.

Key Words: SPECT • steno-occlusive disease • technetium-99m-ECD • PET

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