| Correlation of 99mTc-DTPA SPECT of the blood-brain barrier with neurologic outcome after acute stroke. | |
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MedLine Citation:
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PMID: 14660714 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We conducted a study on humans to determine whether quantitative evaluation of blood-brain barrier (BBB) breakdown using the (99m)Tc-diethylenetriaminepentaacetic acid ((99m)Tc-DTPA) SPECT technique at the peak time of stroke evolution can predict neurologic outcome. METHODS: Thirty consecutive patients with acute stroke of the middle cerebral artery occurring >24 h and <48 h before admission were included in the study. Each patient underwent a complete neurologic examination according to the Scandinavian stroke score at 72 h after the stroke (S1) and again at 30 d (S2). The difference between initial and late scores was calculated (Delta S) and used to evaluate the change in neurologic status. A CT scan was obtained on all patients to determine the volume of stroke. The integrity of the BBB was evaluated using (99m)Tc-DTPA brain SPECT. A quantitative index of BBB disruption was defined as the ratio of the mean counts/pixel in the infarcted region compared with the mean counts/pixel in the contralateral nonaffected hemisphere. SPECT perfusion imaging was also performed with (99m)Tc-hexamethylpropyleneamine oxime ((99m)Tc-HMPAO) at 24 h after the (99m)Tc-DTPA study. The relative perfusion in the infarct region was expressed as the percentage of contralateral perfusion. RESULTS: The mean (99m)Tc-DTPA disruption index was 6.8 +/- 6.9 (range, 1-26.2). Seven patients (23%) had no BBB disruption. Statistical analysis showed that the disruption index was negatively correlated with Delta S (r = -0.423, P < 0.02). A disruption index of <2.5 was associated with a significantly better neurologic outcome (mean Delta S, 17.5 +/- 9.5) compared with patients with an index of >2.5 (mean Delta S, -0.85 +/- 4.97, P < 0.0001) with a sensitivity of 95% and a specificity of 89%. S2 was significantly correlated with S1 (r = 0.738, P < 0.001) and with Delta S (r = 0.656, P < 0.001). Perfusion abnormalities on the (99m)Tc-HMPAO SPECT studies ranged between 12% and 90% (mean, 37.6% +/- 17.8%) compared with those on the contralateral nonaffected side. No correlation was found between (99m)Tc-HMPAO uptake and Delta S, infarct volume by CT, or disruption index. The CT volume measurements were negatively correlated with S2 (r = -0.560, P < 0.004) but not with Delta S. CONCLUSION: (99m)Tc-DTPA SPECT of the BBB combined with quantitative analysis in patients with acute stroke is significantly related to clinical outcome, with a distinct prognostic cutoff threshold of 2.5. The use of this radionuclide brain SPECT technique represents a unique application of conventional nondiffusible brain agents. |
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Authors:
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Mordechai Lorberboym; Yair Lampl; Menahem Sadeh |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: Journal of nuclear medicine : official publication, Society of Nuclear Medicine Volume: 44 ISSN: 0161-5505 ISO Abbreviation: J. Nucl. Med. Publication Date: 2003 Dec |
Date Detail:
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Created Date: 2003-12-08 Completed Date: 2004-03-08 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0217410 Medline TA: J Nucl Med Country: United States |
Other Details:
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Languages: eng Pagination: 1898-904 Citation Subset: IM |
Affiliation:
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Department of Nuclear Medicine, Sackler Faculty of Medicine, Edith Wolfson Medical Center, Tel Aviv University, Tel Aviv, Israel. mvlorber@internet-zahav.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Blood-Brain Barrier / metabolism, radionuclide imaging* Female Humans Infarction, Middle Cerebral Artery / complications, diagnosis, metabolism, radionuclide imaging Male Middle Aged Nervous System Diseases / diagnosis*, etiology Neurologic Examination / methods Predictive Value of Tests Prognosis Radiopharmaceuticals / diagnostic use, pharmacokinetics Severity of Illness Index Statistics as Topic Stroke / complications, diagnosis, metabolism, radionuclide imaging* Technetium Tc 99m Pentetate / diagnostic use*, pharmacokinetics Tomography, Emission-Computed, Single-Photon / methods* |
| Chemical | |
Reg. No./Substance:
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0/Radiopharmaceuticals; 65454-61-7/Technetium Tc 99m Pentetate |
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