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KMID : 0311120020430020211
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Yonsei Medical Journal
2002 Volume.43 No. 2 p.211 ~ p.222
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Significance of 99mTc-ECD SPECT in Acute and Subacute Ischemic Stroke: Comparison with MR Images Including Diffusion and Perfusion Weighted Images
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Dong Ik Kim/Hyun Sook Kim
Dong Ik Kim/Jong Doo Lee/Eun Kee Jeong/Tae Sub Chung/Pyeong Ho Yoon/Seung Koo Lee/Eun Ju Kim/Yong Kyu Yoon/Bum Chun Suh/Byung In Lee
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Abstract
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99mTc-ECD SPECT is valuable for the evaluation of cell viability and function. The purpose of the present study was to evaluate the significance of 99mTc-ECD brain SPECT in ischemic stroke. We compared 99mTc-ECD brain SPECT with perfusion and diffusion weighted images (PWI, DWI). Ten patients with acute and early subacute ischemic stroke were included in this prospective study. T2-weighted images (T2WI), DWI, PWI and 99mTc-ECD SPECT were obtained during both the acute/early subacute and late subacute stages. In the case of PWI, time to peak (TTP) and regional cerebral blood volume (rCBV) maps were obtained. The rCBV map and 99mTc-ECD SPECT images were compared in 8 lesions using Δ AI. The asymmetry index (AI) was calculated as (Ci - Cc) × 200 / (Ci + Cc); where Ci is the mean number of pixel counts of an ipsilateral lesion and Cc is the mean number of pixel counts of the normal contralateral hemisphere. Δ AI was defined as AIacute - AIsubacute in the ischemic core and periphery. PWI and 99mTc-ECD SPECT detected new lesions of the hyperacute stage or of evolving stroke more accurately than T2WI and DWI. 99mTc-ECD SPECT was able to localize the infarct core and peri-infarct ischemia in all lesions in both the acute and the subacute stages. Δ AI was higher in the rCBV map than in the 99mTc-ECD SPECT images in the ischemic core (p = 0.063) and in the periphery (p = 0.091). In the 99mTc-ECD SPECT images, Δ AI was higher in the ischemic core than in the periphery (p = 0.028). During the subacute stage, 99mTc-ECD SPECT detected all the lesions without the pseudonormalization seen in the MR images of 5/11 lesions. Based on this study, 99mTc-ECD SPECT is comparable to PWI in terms of its ability to detect acute stroke and is more useful than PWI in the case of subacute infarction.
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KEYWORD
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