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Clinical Significance of Increased Uptake of HMPAO on Brain SPECT Scans in Acute Stroke
Author(s) -
Alexandrov Andrei V.,
Ehrlich Lisa E,
Bladin Christopher F.,
Black Sandra E.
Publication year - 1996
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon199663150
Subject(s) - medicine , stroke (engine) , perfusion , ischemia , perfusion scanning , nuclear medicine , single photon emission computed tomography , spect imaging , emission computed tomography , intracerebral hemorrhage , clinical significance , brain ischemia , radiology , cardiology , subarachnoid hemorrhage , mechanical engineering , engineering
Single‐photon emission computed tomography (SPECT) with 99m technetium‐hexamethylpropylamineoxirne (HMPAO) non‐invasively shows brain perfusion in patients after acute stroke. However, the clinical significance of the increased HMPAO uptake remains unclear. In this study, consecutive patients with hemispheric hemorrhagic and ischemic stroke admitted to the hospital were evaluated prospectively. The increased uptake of HMPAO was determined by visual analysis of SPECT images. The pathogenic mechanism of ischemic stroke was determined using the clinical and computed tomography (CT) criteria including the Toronto Embolic Scale. Of the 500 consecutive patients with acute hemispheric stroke, SPECT was performed in 458 at a mean time of 5 ± 7 days after the onset of symptoms. A strong association was found between SPECT perfusion patterns and pathogenic subtypes of stroke ( p < 0.0001). Thus, in 95% of patients with intracerebral hemorrhage the focal absence of perfusion was found, and 26% of lacunar infarctions presented with a normal SPECT appearance. The mean volume of lacunar lesions that did not produce significant abnormalities on SPECT was 2.5 ± 1.2 ml. Increased HMPAO uptake was associated with a cardioembolic mechanism of stroke: High and mixed perfusion patterns were present subacutely in 29% of patients with cardioembolic stroke, compared to 15% of patients with other types of ischemic stroke (p ≤ 0.0006). The increased uptake of HMPAO on SPECT as determined by visual analysis is associated with a cardioembolic mechanism of cerebral ischemia, which could be explained by glutathione‐mediated trapping of the tracer during reperfusion and later in newly developed granulation tissue. HMPAO‐SPECT may help in early management decisions since it indicates stroke pathogenesis and evolution.