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(Stroke. 1997;28:976-980.)
© 1997 American Heart Association, Inc.

Articles

Sensitivity and Specificity of ^99mTc-HMPAO SPECT Cerebral Perfusion Measurements During the First 48 Hours for the Localization of Cerebral Infarction

A.E. Baird, FRACP, PhD; M.C. Austin; Dip Appl Sci; W.J. McKay, FRACP; G.A. Donnan, MD, FRACP

From the Departments of Neurology (A.E.B., G.A.D.) and Nuclear Medicine (M.C.A., W.J.M.), Austin and Repatriation Medical Centre, Heidelberg; and the Department of Medicine, University of Melbourne (A.E.B., G.A.D.), Victoria, Australia.

Correspondence to Professor G.A. Donnan, Department of Neurology, Austin and Repatriation Medical Centre, Heidelberg, Victoria 3084, Australia.

Background and Purpose There is no routinely used method for imaging the location of the extent and severity of cerebral tissue perfusion changes during the first hours of ischemic stroke, the period during which therapeutic intervention is most likely to be successful. Cerebral perfusion measurements with single-photon emission CT (SPECT) may potentially provide this information rapidly and noninvasively. In this study, the sensitivity and specificity of ^99mTc–hexamethylpropyleneamine oxime (HMPAO) SPECT cerebral perfusion measurements during the first 48 hours of cerebral ischemia for the localization of cerebral infarction were determined.

Methods One hundred and four patients with acute ischemic stroke underwent ^99mTc-HMPAO SPECT and CT scanning during the first 48 hours. In each patient, the location of the SPECT perfusion abnormality was compared with the location of infarction on a second brain CT acquired at a mean of 8 days after stroke.

Results During the first 48 hours of ischemic stroke, the sensitivity of ^99mTc-HMPAO SPECT in locating the site of infarction was 79% (110/139), and the specificity was 95% (362/381). SPECT was more sensitive in the localization of the vascular territory of cortical infarction (sensitivity, 93%) than pure subcortical infarcts (sensitivity, 47%). During the first 48 hours, SPECT was significantly more sensitive than brain CT (sensitivity of brain CT during the first 48 hours, 35%; P<.001, Mann-Whitney U test).

Conclusions HMPAO SPECT measurement provides a widely available and practical technique of locating cerebral ischemia acutely and demonstrates high sensitivity and specificity within the first 48 hours for the localization of the vascular territory of cerebral infarction. It is most sensitive for cortical ischemia but is limited by its resolution in the subcortex, particularly of white matter perfusion changes.

Key Words: cerebral blood flow • cerebrovascular disorders • diagnostic imaging • perfusion • tomography, emission computed

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