on March 20, 2003
Published online before print March 20, 2003, doi: 10.1161/01.STR.0000062902.94892.F5
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Submitted on October 16, 2002
From the Departments of Nuclear Medicine (H-C.S., H-S.B.), Neurology (K.H.C., B.C.K.), and Diagnostic Radiology (J-J.S.), Chonnam National University Hospital, Gwangju, South Korea; Department of Nuclear Medicine (C-G.K.), Wonkwang University Hospital, Iksan, South Korea; and Department of Nuclear Medicine (D.J.Y., E.E.K.), University of Texas MD Anderson Cancer Center, Houston, Tex. * To whom correspondence should be addressed. E-mail: hsbom{at}chonnam.ac.kr.
Background and Purpose--We hypothesized that technetium-99m-ethylene dicysteine-metronidazole (99mTc-EC-MN) localizes to brain tissue that is hypoxic but viable. This study prospectively evaluated the relationship between neurological outcome and uptake of 99mTc-EC-MN in peri-infarcted regions of the brain. Methods--Eight patients with acute ischemic stroke in the territory of the left middle cerebral artery underwent 99mTc-EC-MN and 99mTc-ethyl cysteinate dimer (ECD) brain SPECTs on the same day during the subacute stage (10.3±2.5 days). The infarct volumes from 99mTc-ECD images (IVECD), infarct volumes from diffusion-weighted MRI images (IVDW), and hypoxic volume (HV) from 99mTc-EC-MN images were calculated. The net infarct volume (NIVECD) was defined as IVECD minus HV. The National Institutes of Health Stroke Scale scores were measured on admission and days 1, 3, 7, and 30. Results--IVECD was greater than IVDW. The lesion-to-normal count-density ratios of 99mTc-EC-MN ranged from 1.80 to 5.96. HV was 60.2±65.2 cm3, and the mean percent HV was 24.5±28.1% of IVECD. NIVECD was 162.6±133.4 cm3 and was significantly smaller than IVECD. NIVECD was significantly correlated with National Institutes of Health Stroke Scale score at 1 month and was a significant predictor of neurological deficit at 1 month. Conclusions--99mTc-EC-MN brain SPECT can detect hypoxic tissue after acute ischemic stroke and, in combination with 99mTc-ECD brain SPECT, is useful in predicting neurological outcome in ischemic stroke patients.
Accepted on October 29, 2002
Prognostication of Recovery in Patients With Acute Ischemic Stroke Through the Use of Brain SPECT With Technetium-99m--Labeled Metronidazole
Ho-Chun Song MD;
Key words: cerebral infarction • metronidazole • prognosis • technetium compounds • tomography, emission computed
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