Prediction of the final infarct volume within 6 h of stroke using single photon emission computed tomography with technetium-99m hexamethylpropylene amine oxime.
BACKGROUND
A simple method to predict the final infarct volume within 6 h of onset of hemispheric ischemic stroke based on the measurement of cerebral blood flow (CBF) using single photon emission computed tomography (SPECT) with techneticum-99m hexamethylpropylene amine oxime ((99m)Tc-HMPAO) was investigated in a clinical model involving patients without definite early reperfusion or clinical recovery.


METHODS
A group of 16 patients (group 1) was used to establish the methodology, which was then validated in a second group of 14 patients (group 2). The final infarct volume was defined using computed tomography (CT) performed at least 7 days after stroke. The relative CBF threshold value, expressed as a percentage of the mean contralateral hemispheric value, which most closely estimated the final infarct size on coregistered CT was established for each patient.


RESULTS
The mean threshold CBF value for group 1 was 63.7%. When this value was used to predict infarct size in group 2, a close correlation was observed between the actual and the estimated sizes (r = 0.973, p < 0.0001). This value was not time dependent.


CONCLUSIONS
If no significant early reperfusion or clinical recovery occurs, a CBF threshold value of 63.7% on (99m)Tc-HMPAO SPECT performed within 6 h of stroke onset will reliably predict the final infarct size.
Department of Neurology, Austin & Repatriation Medical Centre, Melbourne, Australia.
T
T
Hirano
S J
SJ
Read
D F
DF
Abbott
A E
AE
Baird
M
M
Yasaka
B
B
Infeld
P A
PA
Barber
S M
SM
Davis
W J
WJ
McKay
G A
GA
Donnan
D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D019690:Technetium Tc 99m Exametazime; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime