title: Significance of 99mTc-ECD SPECT in acute and subacute ischemic stroke: comparison with MR images including diffusion and perfusion weighted images.
abstract: 99mTc-ECD SPECT is valuable for the evaluation of cell viability and function. The purpose of the present study was to evaluate the significance of 99mTc-ECD brain SPECT in ischemic stroke. We compared 99mTc-ECD brain SPECT with perfusion and diffusion weighted images (PWI, DWI). Ten patients with acute and early subacute ischemic stroke were included in this prospective study. T2-weighted images (T2WI), DWI, PWI and 99mTc-ECD SPECT were obtained during both the acute/early subacute and late subacute stages. In the case of PWI, time to peak (TTP) and regional cerebral blood volume (rCBV) maps were obtained. The rCBV map and 99mTc-ECD SPECT images were compared in 8 lesions using DeltaAI. The asymmetry index (AI) was calculated as (Ci - Cc) X 200 / (Ci + Cc); where Ci is the mean number of pixel counts of an ipsilateral lesion and Cc is the mean number of pixel counts of the normal contralateral hemisphere. DeltaAI was defined as AIacute - AIsubacute in the ischemic core and periphery. PWI and 99mTc-ECD SPECT detected new lesions of the hyperacute stage or of evolving stroke more accurately than T2WI and DWI. 99mTc-ECD SPECT was able to localize the infarct core and peri-infarct ischemia in all lesions in both the acute and the subacute stages. DeltaAI was higher in the rCBV map than in the 99mTc-ECD SPECT images in the ischemic core (p = 0.063) and in the periphery (p = 0.091). In the 99mTc-ECD SPECT images, DeltaAI was higher in the ischemic core than in the periphery (p = 0.028). During the subacute stage, 99mTc-ECD SPECT detected all the lesions without the pseudonormalization seen in the MR images of 5/11 lesions. Based on this study, 99mTc-ECD SPECT is comparable to PWI in terms of its ability to detect acute stroke and is more useful than PWI in the case of subacute infarction.
authors.affiliation: Department of Diagnostic Radiology, Yonsei University College of Medicine, C.P.O. Box 8044, Seoul 120-752, Korea.
authors.forename: Hyun Sook
authors.initials: HS
authors.lastname: Kim
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Kim
authors.forename: Jong Doo
authors.initials: JD
authors.lastname: Lee
authors.forename: Eun Kee
authors.initials: EK
authors.lastname: Jeong
authors.forename: Tae Sub
authors.initials: TS
authors.lastname: Chung
authors.forename: Pyeong Ho
authors.initials: PH
authors.lastname: Yoon
authors.forename: Seung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Kim
authors.forename: Yong Kyu
authors.initials: YK
authors.lastname: Yoon
authors.forename: Bum Chun
authors.initials: BC
authors.lastname: Suh
authors.forename: Byung In
authors.initials: BI
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications*; D003545:Cysteine / Q000031:analogs & derivatives*; D004058:Diffusion; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010477:Perfusion; D019275:Radiopharmaceuticals; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C059659:technetium Tc 99m bicisate; D003545:Cysteine