Abstract
A method for relative measurement of cerebral blood flow (CBF), oxygen extraction fraction (OEF), and metabolic rate of oxygen (CMRO2) using positron emission tomography (PET) without arterial sampling in patients with hyperacute ischemic stroke was presented.
Methods
The method requires two PET scans, one for H2 15O injection and one for15O2 inhalation, and calculates regional CBF, CMRO2, and OEF relative to those at the reference brain region by means of table-lookup method. In this study, we calculated “relative lookup-tables” which relate relative CBF to relative H2 15O count, relative CMRO2 to relative15O2 count, and relative OEF to relative15O2/H2 15O count. Two assumptions were applied to the lookup-table calculation: 1) In the reference region, CBF and OEF were assumed to be 50.0 ml/min/100ml and 0.40, respectively, 2) Cerebral blood volume (CBV) was assumed to be constant at 4.0 ml/100ml over the whole brain. Simulation studies were done to estimate the error of the present method derived from the assumptions.
Results
For relative CBF measurements, 20% variation in reference CBF gave about ±10% error for measured relative CBF at maximum. Changes in CBV caused relatively large errors in measured OEF and CMRO2 when relative CBF and OEF decreased. Errors for measured relative OEF caused by 50% variation in CBV were within ±8% at 0.8 of relative CBF and ±12% at 0.4 of relative CBF when relative OEF was greater than 1.0.
Conclusion
CBV effects caused larger errors in estimated OEF and CMRO2 in the region of the ischemie core with decreasing relative CBF and/or OEF but only slight errors in the region of “misery perfusion” with relative OEF values greater than 1.0. The present method makes PET measurements simpler than with the conventional method and increases understanding of the cerebral circulation and oxygen metabolism in patients with hyperacute stroke of several hours after onset.
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References
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke.N Eng J Med 1995; 333: 1581–1587.
Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS).JAMA 1995; 274; 1017–1025.
Shimosegawa E, Hatazawa J, Inugami A, Fujita H, Ogawa T, Aizawa Y, et al. Cerebral infarction within six hours of onset: prediction of completed infarction with technetium-99m-HMPAO SPECT.J Nucl Med 1994; 35: 1097–1103.
Ueda T, Hatakeyama T, Kumon Y, Sasaki S, Uraoka T. Evaluation of risk of hemorrhagic transformation in local intra-arterial thrombolysis in acute ischemic stroke by initial SPECT.Stroke 1994; 25: 298–203.
Ezura M, Takahashi A, Yoshimoto T. Evaluation of regional cerebral blood flow using single photon emission tomography for the selection of patients for local fibrinolytic therapy of acute cerebral embolism.Neurosurg Rev 1996; 19:231–236.
Ueda T, Sakaki S, Yuh WT, Nochide I, Ohta S. Outcome in acute stroke with successful intra-arterial thrombolysis and predictive value of initial single-photon emission-computed tomography.J Cereb Blood Flow Metab 1999; 19: 99–108.
Frackowiak RS, Lenzi GL, Jones T, Heather JD. Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using15O and positron emission tomography: theory, procedure, and normal values.J Comput Assist Tomogr 1980; 4: 727–736.
Herscovitch P, Markham J, Raichle ME. Brain blood flow measured with intravenous H2 15O: I. theory and error analysis.J Nucl Med 1983; 24: 782–789.
Kanno I, Iida H, Miura S, Murakami M, Takahashi K, Sasaki H, et al. A system for cerebral blood flow measurement using H2 15O autoradiographic method and positron emission tomography.J Cereb Blood Flow Metab 1987; 7: 143–153.
Mintun MA, Raichle ME, Martin WRW, Heroscovitch P. Brain oxygen utilization measured with O-15 radiotracers and positron emission tomography.J Nucl Med 1984; 25: 177–187.
Derdeyn CP, Videen TO, Simmons NR, Yundt KD, Fritsch SM, Grubb Jr RL, et al. Count-based PET method for predicting ischemic stroke in patients with symptomatic carotid arterial occlusion.Radiology 1999; 212: 499–506.
Derdeyn CP, Videen TO, Grubb Jr RL, Powers WJ. Comparison of PET oxygen extraction fraction methods for prediction of stroke risk.J Nucl Med 2001; 42: 1195–1197.
Jones T, Chesler DA, Ter-Pogossian MM. The continuous inhalation of Oxygen-15 for assessing regional oxygen extraction in the brain of man.Br J Radiol 1976; 49: 339–343.
Kanno I, Lammertsma AA, Heather JD, Gibbs JM, Rhodes CG, Clark JC, et al. Measurement of cerebral blood flow using bolus inhalation of C15O2 and positron emission tomography: Description of the method and its comparison with the C15O2 continuous inhalation method.J Cereb Blood Flow Metab 1984; 4: 224–234.
Kety SS. The theory and applications of the exchange of inert gas at the lungs and tissues.Pliarmacol Rev 1951; 3: 1–41.
Iida H, Jones T, Miura S. Modeling approach to eliminate the need to separate arterial plasma in oxygen-15 inhalation positron emission tomography.J Nucl Med 1993; 34: 1333–1340.
Iida H, Miura S, Kanno I, Ogawa T, Uemura K. A new PET camera for noninvasi ve quantitation of physiological functional parametric images: Headtome-V-Dual. In: Myers R, Cunningham V, Bailey D, Jones T, eds.Quantification of Brain Function Using PET. San Diego, CA; Academic Press, 1996:57–61.
Ito H, Kanno I, Ibaraki M. Hatazawa J. Effect of aging on cerebral vascular response to PaCO2 changes in humans as measured by positron emission tomography.J Cereb Blood Flow Metab 2002; 22: 997–1003.
Ito H, Kanno I, Shimosegawa E, Tamura H, Okane K, Hatazawa J. Hemodynamic changes during neural deactivation in human brain: A positron emission tomography study of crossed cerebellar diaschisis.Ann Nucl Med 2002; 16:249–254.
Baron JC, Bousser MG, Rey A, Guillard A, Comar D, Castaigne P. Reversal of focal “misery-perfusion syndrome” by extra-intracranial arterial bypass in hemodynamic cerebral ischemia.Stroke 1981; 12: 454–459.
Martin WRW, Powers WJ, Raichle ME. Cerebral blood volume measured with inhaled C15O and positron emission tomography.J Cereb Blood Flow Metab 1987; 7: 421–426.
Lammertsma AA, Jones T. Correction for the presence of intravascular oxygen-15 in steady-state technique for measuring regional oxygen extraction ratio in the brain: 1. Description of the model.J Cereb Blood Flow Metab 1983; 3: 416–424.
Lammertsma AA, Wise RJS, Heather JD, Gibbs JM, Leenders KL, Frackowiak RSJ, et al. Correction for the presence of intravascular oxygen-15 in steady-state technique for measuring regional oxygen extraction ratio in the brain: 2. Results in normal subjects and brain tumour and stroke patients.J Cereb Blood Flow Metab 1983; 3: 425–431.
Pantano P, Baron JC, Crouzel P, Collard P, Sirou P, Samson Y. The15O continuous-inhalation method: Correction for intravascular signal using C15O.Eur J Nucl Med 1985; 10: 387–391.
Powers WJ, Grubb RL, Raichle ME. Physiological responses to focal cerebral ischemia in humans.Ann Neurol 1984; 16: 546–552.
Hatazawa J, Shimosegawa E, Toyoshima H, Ardekani BA, Suzuki A, Okudera T, et al. Cerebral blood volume in acute brain infarction: A combined study with dynamic susceptibility contrast MRI and99mTc-HMPAO-SPECT.Stroke 1999; 30: 800–806.
Derdeyn CP, Videen TO, Yundt KD, Fritsch SM, Carpenter DA, Grubb RL, et al. Variability of cerebral blood volume and oxygen extraction: stage of cerebral hemodynamic impairment revisited.Brain 2002; 125: 595–607.
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Ibaraki, M., Shimosegawa, E., Miura, S. et al. PET measurements of CBF, OEF, and CMRO2 without arterial sampling in hyperacute ischemic stroke: Method and error analysis. Ann Nucl Med 18, 35–44 (2004). https://doi.org/10.1007/BF02985612
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DOI: https://doi.org/10.1007/BF02985612