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Diagnosis of Misery Perfusion Using Noninvasive ¹⁵O-Gas PET

¹ Biomedical Imaging Research Center, University of Fukui, Fukui, Japan; ² Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan; and ³ Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan

Correspondence: For correspondence or reprints contact: Hidehiko Okazawa, MD, PhD, Biomedical Imaging Research Center, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan. E-mail: okazawa{at}fmsrsa.fukui-med.ac.jp

To avoid arterial blood sampling and complicated analyses in ¹⁵O-gas PET studies, we evaluated a noninvasive technique using the count-based method for measuring asymmetric increases in oxygen extraction fraction (OEF) in cerebrovascular disease. Methods: Eighteen patients (mean age ± SD, 61 ± 16 y) with atherothrombotic large-cerebral-artery disease were studied for the measurement of hemodynamic parameters using the ¹⁵O-gas steady-state method with inhalation of ¹⁵O₂, C¹⁵O₂, and C¹⁵O. All patients also underwent H₂¹⁵O PET with the bolus injection method. Count-based ratio images of ¹⁵O₂/C¹⁵O₂ and ¹⁵O₂/H₂¹⁵O were calculated, and asymmetry indices (AIs) were obtained (cbOEF_SS-AI and cbOEF_BO-AI, respectively) using regions of interest drawn bilaterally on the cerebral cortices. These AIs were compared with the AIs of absolute OEF (qOEF-AI) and with those after cerebral blood volume (CBV) correction. A contribution factor for this correction was defined as a variable , and the effect of the correction was evaluated. Results: cbOEF_SS-AI underestimated qOEF-AI significantly, especially with a greater AI (P < 0.05). cbOEF_BO-AI linearly correlated well with qOEF-AI. CBV correction improved the slopes of regression lines between qOEF-AI and cbOEF_SS-AI, and the optimal was defined as 0.5. On the other hand, cbOEF_BO-AI fairly estimated qOEF-AI without CBV correction. Correlation between qOEF-AI and cbOEF_BO-AI was adversely affected, and the mean bias was increased, with a greater . Conclusion: cbOEF_BO-AI can fairly estimate the AI of OEF without CBV correction, whereas cbOEF_SS-AI might require CBV correction for better estimation. The examination time and stress to patients would be reduced with the count-based method because it is noninvasive.

Key Words: oxygen extraction fraction • misery perfusion • gas PET study • noninvasive method • cerebrovascular disease

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				M. Kobayashi, T. Kudo, T. Tsujikawa, M. Isozaki, Y. Arai, Y. Fujibayashi, and H. Okazawa Shorter Examination Method for the Diagnosis of Misery Perfusion with Count-Based Oxygen Extraction Fraction Elevation in 15O-Gas PET J. Nucl. Med., February 1, 2008; 49(2): 242 - 246. [Abstract] [Full Text] [PDF]