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Embolic Distribution Through Patent Foramen Ovale Demonstrated by ^99mTc-MAA Brain SPECT After Valsalva Radionuclide Venography

Departments of Radiology and Medicine, National Cardiovascular Center, Osaka, Japan

View larger version (57K): [in a new window]   FIGURE 1. Criteria for cortical uptake visualization

View larger version (39K): [in a new window]   FIGURE 2. Placement of ROIs in middle cerebral arterial territory (shaded) and posterior cerebral arterial territory (white).

View larger version (15K): [in a new window]   FIGURE 3. Correlation between HMPAO- and MAA-corrected counts in brain. *P < 0.01 vs. HMPAO.

View larger version (55K): [in a new window]   FIGURE 4. Distribution difference depending on anterior and posterior circulations of HMPAO- and MAA-corrected counts in brain (MCA, middle cerebral arterial territory; PCA, posterior cerebral arterial territory).

View larger version (101K): [in a new window]   FIGURE 5. The example in this study, man (age, 22 y) with left occipital infarction. (A) Radionuclide venography demonstrated thyroid with Valsalva maneuver and patent deep veins accompanied by developed collaterals (L, left). (B) On day 17 MRI indicated high-intensity area in left occipital area and on day 19 MR angiography showed signal loss in distal portion of left posterior cerebral artery. (C) On day 12 99mTc-MAA showed defect in left occipital area (arrow), where 99mTc-HMPAO brain SPECT revealed hyperfixation on day 10 and hypoperfusion on day 23. MRA = MR angiography; PCA = posterior cerebral artery; T1 WI = T1-weighted image; T2 WI = T2-weighted image.