Detection of misery perfusion in the cerebral hemisphere with chronic unilateral major cerebral artery steno-occlusive disease using crossed cerebellar hypoperfusion: comparison of brain SPECT and PET imaging

• Published in: European journal of nuclear medicine and molecular imaging 2013-10, Vol.40 (10), p.1573-1581
• Main Authors: Matsumoto, Yoshiyasu, Ogasawara, Kuniaki, Saito, Hideo, Terasaki, Kazunori, Takahashi, Yoshihiro, Ogasawara, Yasushi, Kobayashi, Masakazu, Yoshida, Kenji, Beppu, Takaaki, Kubo, Yoshitaka, Fujiwara, Shunrou, Tsushima, Eiki, Ogawa, Akira
• Format: Article
• Language: English
• Subjects: Adult; Aged; Brain; Cardiology; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - physiopathology; Case-Control Studies; Cerebellum - blood supply; Cerebellum - diagnostic imaging; Cerebral Cortex - blood supply; Cerebral Cortex - diagnostic imaging; Cerebrovascular Circulation; Circulatory system; Female; Humans; Imaging; Infarction, Middle Cerebral Artery - diagnostic imaging; Infarction, Middle Cerebral Artery - physiopathology; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; Oncology; Original; Original Article; Orthopedics; Perfusion Imaging; Positron-Emission Tomography; Radiology; Stroke; Tomography, Emission-Computed, Single-Photon; Veins & arteries
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-013-2463-2

Purpose In patients with unilateral internal carotid or middle cerebral artery (ICA or MCA) occlusive disease, the degree of crossed cerebellar hypoperfusion that is evident within a few months after the onset of stroke may reflect cerebral metabolic rate of oxygen in the affected cerebral hemisphere relative to that in the contralateral cerebral hemisphere. The aim of the present study was to determine whether the ratio of blood flow asymmetry in the cerebellar hemisphere to blood flow asymmetry in the cerebral hemisphere on positron emission tomography (PET) and single photon emission computed tomography (SPECT) correlates with oxygen extraction fraction (OEF) asymmetry in the cerebral hemisphere on PET in patients with chronic unilateral ICA or MCA occlusive disease and whether this blood flow ratio on SPECT detects misery perfusion in the affected cerebral hemisphere in such patients. Methods Brain blood flow and OEF were assessed using 15 O-PET and N -isopropyl- p -[ 123 I]iodoamphetamine ( 123 I-IMP) SPECT, respectively. All images were anatomically standardized using SPM2. A region of interest (ROI) was automatically placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres using a three-dimensional stereotaxic ROI template, and affected-to-contralateral asymmetry in the MCA territory or contralateral-to-affected asymmetry in the cerebellar hemisphere was calculated. Sixty-three patients with reduced blood flow in the affected cerebral hemisphere on 123 I-IMP SPECT were enrolled in this study. Results A significant correlation was observed between MCA ROI asymmetry of PET OEF and the ratio of cerebellar hemisphere asymmetry of blood flow to MCA ROI asymmetry of blood flow on PET ( r  = 0.381, p =  0.0019) or SPECT ( r  = 0.459, p  = 0.0001). The correlation coefficient was higher when reanalyzed in a subgroup of 43 patients undergoing a PET study within 3 months after the last ischemic event ( r  = 0.541, p =  0.0001 for PET; r  = 0.609, p