This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bowler, J.V. Articles by Steiner, T.J. Search for Related Content PubMed PubMed Citation Articles by Bowler, J.V. Articles by Steiner, T.J.

(Stroke. 1996;27:82-86.)
© 1996 American Heart Association, Inc.

Articles

Single-Photon Emission Computed Tomography Using Hexamethylpropyleneamine Oxime in the Prognosis of Acute Cerebral Infarction

J.V. Bowler, MD, MRCP; J.P.H. Wade, MD, FRCP; B.E. Jones, MSc; K. Nijran, PhD T.J. Steiner, MB, PhD

From the Regional Neurosciences Centre (J.V.B., J.P.H.W.) and the Departments of Nuclear Medicine (B.E.J., K.N.), Charing Cross Hospital, and the Academic Unit of Neuroscience (J.V.B., J.P.H.W., T.J.S.), Charing Cross and Westminster Medical School, London, UK.

Background and Purpose The role of single-photon emission CT (SPECT) in the prognosis of cerebral infarction is controversial, but most studies report that SPECT using a variety of radiopharmaceutical agents gives useful prognostic information. Only one study has questioned whether acute perfusion deficits independently add to a valid clinical prognostic score. This study was limited to middle cerebral artery territory infarcts and was negative. We present data on the prognostic utility of SPECT using ^99mTc–hexamethylpropyleneamine oxime (HMPAO) in cerebral infarction, unselected by site.

Methods Fifty consecutive unselected patients admitted to the hospital with acute cerebral infarction, of whom 10 died and 7 withdrew, had SPECT performed serially at onset and at 1 week and 3 months after stroke onset using ^99mTc-HMPAO and the NOVO 810 dedicated high-resolution head tomograph. Clinical severity at presentation and outcome was measured with the Canadian Neurological Scale and the Barthel Index. Infarct volumes were measured from both the SPECT and CT scans. The data for the 43 subjects who completed the study or died were evaluated to determine the most powerful prognostic measures. Predictors were the Canadian Neurological Scale score at onset and 1 week, the Barthel Index at 1 week, the CT infarct volume typically done between 3 and 7 days after stroke onset, and the infarct volumes at the first and second SPECT. Outcome measures were the Canadian Neurological Scale score and Barthel Index score at 3 months, scored as zero for those patients who died.

Results The clinical prognostic indicators correlated with the outcome measures, with coefficients between .617 and .821 (P<.0006 in all cases). The Canadian Neurological Scale score measured at 1 week was the best of these. Infarct volumes measured from SPECT correlated less well (coefficients between -.518 and -.683, P<.0019 in all cases). CT infarct volume was the poorest predictor. Although SPECT infarct volumes predicted outcome, they did so less well than clinical examination. Spontaneous infarct reperfusion did not affect outcome.

Conclusions Although the measurement of infarct volume on SPECT using ^99mTc-HMPAO provides a predictor of stroke outcome, it is not a better predictor than the Canadian Neurological Scale score.

Key Words: cerebral infarction • tomography, emission-computed • prognosis

This article has been cited by other articles:

				J V Bowler, J P H Wade, B E Jones, K S Nijran, and T J Steiner Natural history of the spontaneous reperfusion of human cerebral infarcts as assessed by 99mTc HMPAO SPECT J. Neurol. Neurosurg. Psychiatry, January 1, 1998; 64(1): 90 - 97. [Abstract] [Full Text]