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Hyperactivity of ^99mTc-HMPAO Within 6 Hours in Patients with Acute Ischemic Stroke

Departments of Radiology and Neurological Surgery, Ehime University School of Medicine, Ehime, Japan

View larger version (71K): [in a new window]   FIGURE 1. A 70-y-old woman (patient 1) with right hemiparesis and aphasia. (A) CT image obtained 1.5 h after onset shows no definite abnormal density. (B and C) SPECT images with HMPAO obtained 3 h after onset show area of hyperactivity in left temporal cortex with surrounding cortical hypoactivity. L/C of area of hyperactivity is 2.95 and that of area of hypoactivity is 0.33. (D) Angiogram (lateral view) of left internal carotid artery (ICA) obtained 3.5 h after onset (before treatment) shows middle cerebral artery (MCA) occlusion but spontaneous recanalization (i.e., capillary blush and early venous filling) in temporal region. (E) Angiogram (lateral view) of left ICA obtained 4.5 h after onset (after intraarterial thrombolysis) shows partial recanalization of left MCA. (F) CT image obtained 9 h after onset shows hemorrhagic transformation with extensive brain edema in left temporal region.

View larger version (68K): [in a new window]   FIGURE 2. A 64-y-old man (patient 3) with right hemiparesis and aphasia. (A) SPECT image obtained 2 h after onset shows remarkable hyperactivity in left basal ganglia with surrounding cortical hypoactivity in left middle cerebral artery (MCA) territory. L/C of area of hyperactivity is 2.64 and that of area of hypoactivity is 0.48. (B) Angiogram of left interrnal carotid artery (ICA) obtained 3 h after onset (before treatment) shows occlusion of distal horizontal portion of left MCA, whereas spontaneous recanalization (i.e., capillary blush) is seen in perforating arteries. (C) Angiogram of left ICA after intraarterial thrombolytic therapy shows complete recanalization of left MCA. (D) SPECT image obtained on day 3 shows normalized perfusion in left MCA territory. (E) CT image obtained on day 3 shows small and slightly decreased density area in left basal ganglia but cortex of left MCA territory is normal. (F) Follow-up SPECT image 3 mo later shows slightly decreased activity in left basal ganglia and cortex.