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(Stroke. 2003;34:982.)
© 2003 American Heart Association, Inc.

Original Contributions

Prognostication of Recovery in Patients With Acute Ischemic Stroke Through the Use of Brain SPECT With Technetium-99m—Labeled Metronidazole

Ho-Chun Song, MD; Hee-Seung Bom, MD; Ki Hyun Cho, MD; Byeong Chae Kim, MD; Jeong-Jin Seo, MD; Chang-Guhn Kim, MD; David J. Yang, PhD E. Edmund Kim, MD

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.

Correspondence to Hee-Seung Bom, MD, PhD, Department of Nuclear Medicine, Chonnam National University Hospital, 8 Hak-Dong, Dong-Gu, Gwangju 501-757, Korea. 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 (IV_ECD), infarct volumes from diffusion-weighted MRI images (IV_DW), and hypoxic volume (HV) from ^99mTc-EC-MN images were calculated. The net infarct volume (NIV_ECD) was defined as IV_ECD minus HV. The National Institutes of Health Stroke Scale scores were measured on admission and days 1, 3, 7, and 30.

Results— IV_ECD was greater than IV_DW. 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 IV_ECD. NIV_ECD was 162.6±133.4 cm³ and was significantly smaller than IV_ECD. NIV_ECD 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.

Key Words: cerebral infarction • metronidazole • prognosis • technetium compounds • tomography, emission computed

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