title: Hypofixation and hyperfixation of 99mTc-hexamethyl propyleneamine oxime in subacute cerebral infarction.
abstract: The relationship between hypofixation and hyperfixation of 99mTc-hexamethyl propyleneamine oxime (99mTc-HMPAO) remains unclear. The purpose of this study was to compare 99mTc-HMPAO SPECT with regional cerebral blood flow (CBF) imaging using 133Xe inhalation in patients with subacute cerebral infarction and to investigate the behavior of 99mTc-HMPAO in the infarct area using dynamic SPECT.
  
  
  METHODS
  133Xe and consecutive 99mTC-HMPAO SPECT studies, the latter of which consisted of dynamic and static scanning, were performed on 51 patients (22 women, 29 men; age range, 40-83 y; mean age, 61 y) with cortical infarction in the middle cerebral artery territory 13-15 d after stroke onset. One region of interest (ROI) was drawn in the infarct area. The control ROI was mirrored to the contralateral side, and the same set of ROIs was applied to all SPECT studies. Fractional fixation of 99mTc-HMPAO in the infarct area was evaluated relatively as the ratio of the infarct-to-control region in 99mTc-HMPAO static tomograms/the ratio of the infarct-to-control region in CBF images using 133Xe inhalation and was classified as hyperfixation when this value was >1.1 and hypofixation when this value was <0.9. To investigate the behavior of 99mTc-HMPAO in the infarct area, the second (36-72 s after tracer injection) and eighth (252-288 s after tracer injection) of 8 dynamic scans were selected, and the washout rate was calculated using the formula: 1 - (mean count in the eighth scan/mean count in the second scan).
  
  
  RESULTS
  The infarct area showed hyperfixation of 99mTc-HMPAO when CBF in the area was 35 mL/100 g/min or less and showed hypofixation when CBF was >45 mL/U100 g/min. The washout rate was usually negative when CBF imaging using 133Xe inhalation was <20 mL/100 g/min but was positive when it was >45 mUL/100 g/min. The washout rate was negative when the infarct area showed hyperfixation of 99mTc-HMPAO but was positive when it showed hypofixation.
  
  
  CONCLUSIONS
  99mTc-HMPAO SPECT underestimates CBF in high-flow regions and overestimates CBF in low-flow regions of subacute cerebral infarction. 99mTc-HMPAO hypofixation and hyperfixation are associated with backdiffusion from the brain to blood and gradual accumulation of hydrophilic metabolites, respectively. Dynamic images should be useful for discriminating between 99mTc-HMPAO hypofixation and hyperfixation.
authors.affiliation: Department of Neurosurgery and Cyclotron Research Center, Iwate Medical University, Morioka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ogasawara
authors.forename: A
authors.initials: A
authors.lastname: Ogawa
authors.forename: K
authors.initials: K
authors.lastname: Koshu
authors.forename: H
authors.initials: H
authors.lastname: Konno
authors.forename: M
authors.initials: M
authors.lastname: Suzuki
authors.forename: T
authors.initials: T
authors.lastname: Yoshimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon; D014980:Xenon Radioisotopes
chemical_list: D019275:Radiopharmaceuticals; D014980:Xenon Radioisotopes; D019690:Technetium Tc 99m Exametazime