PET/SPECT imaging: from carotid vulnerability to brain viability.
BACKGROUND
Current key issues in ischemic stroke are related to carotid plaque vulnerability, brain viability, and timing of intervention. The treatment of ischemic stroke has evolved into urgent active interventions, as 'time is brain'. Functional imaging such as positron emission tomography (PET)/single photon emission computed tomography (SPECT) could improve selection of patients with a vulnerable plaque and evaluation of brain viability in ischemic stroke.


OBJECTIVE
To describe the current applications of PET and SPECT as a diagnostic tool in relation to ischemic stroke.


METHODS
A literature search using PubMed identified articles. Manual cross-referencing was also performed.


RESULTS
Several papers, all observational studies, identified PET/SPECT to be used as a tool to monitor systemic atheroma modifying treatment and to select high-risk patients for surgery regardless of the degree of luminal stenosis in carotid lesions. Furthermore, PET/SPECT is able to quantify the penumbra region during ischemic stroke and in this way may identify those patients who may benefit from timely intervention.


CONCLUSIONS
Functional imaging modalities such as PET/SPECT may become important tools for risk-assessment and evaluation of treatment strategies in carotid plaque vulnerability and brain viability. Prospective clinical studies are needed to evaluate the diagnostic accuracy of PET/SPECT.
Meerwaldt
Robbert
R
Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
Slart
Riemer H J A
RH
van Dam
Gooitzen M
GM
Luijckx
Gert-Jan
GJ
Tio
René A
RA
Zeebregts
Clark J
CJ
D001635:Bibliography of Medicine; D002545:Brain Ischemia / Q000175:diagnosis*; D016893:Carotid Stenosis / Q000175:diagnosis*; D006801:Humans; D049268:Positron-Emission Tomography; D015899:Tomography, Emission-Computed, Single-Photon