title: Brain SPECT in neonates following extracorporeal membrane oxygenation: evaluation of technique and preliminary results.
abstract: Extracorporeal membrane oxygenation (ECMO) is a life-saving procedure in neonates with refractory respiratory failure that has been used at our institution since 1985. In an attempt to study its clinical value, regional cerebral blood flow (rCBF) alterations were measured using SPECT and 99mTc-HMPAO in 13 newborns following ECMO. Eight infants were studied after ECMO with reanastomosis of the right common carotid artery (RCCA), two with the permanent ligation of the RCCA, and three after veno-venous ECMO. Brain SPECT was technically satisfactory in all newborns using a triple-head SPECT system. Altered rCBF was found in 7 of 13 infants. In five newborns, there was a decrease in rCBF within the ipsilateral hemisphere, and in one infant, contralateral hemisphere was involved. In one infant, there was bilateral hemispheric involvement. The infant underwent cardiopulmonary resuscitation prior to ECMO and exhibited clinical features of hypoxicischemic encephalopathy at the time of SPECT. Only 2 of 13 newborns demonstrated morphologic changes on neuroimaging modalities such as cranial ultrasonography, computed tomography and magnetic resonance imaging. Our study demonstrates that: (1) functional brain imaging is feasible in neonates after ECMO; (2) SPECT has potential for demonstrating rCBF deficits not detectable by neuroanatomic imaging modalities; and (3) SPECT has potential clinical value in long-term follow-up of neurodevelopmental outcome after ECMO.
authors.affiliation: Division of Nuclear Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107.
authors.forename: C H
authors.initials: CH
authors.lastname: Park
authors.forename: A R
authors.initials: AR
authors.lastname: Spitzer
authors.forename: H J
authors.initials: HJ
authors.lastname: Desai
authors.forename: J J
authors.initials: JJ
authors.lastname: Zhang
authors.forename: L J
authors.initials: LJ
authors.lastname: Graziani
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D002560:Cerebrovascular Circulation; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed
chemical_list: D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime