Neuroradiology
Neuroradiology 16,244 - 245 (1978)
© by Springer-Verlag 1978
Estimation
o f t h e D y n a m i c C a r o t i d F l o w in P a t i e n t s w i t h N o r m a l R a d i o n u c l i d e C e r e b r a l P e r f u s i o n
Stanis~aw Rudnicki 1 , Helena Nielubowiczowa 2 , Teresa Kryst-Wid~gowska 2 , and Stanis~aw Zurowski 3 Postgraduate Medical School 1, Institute of Psychoneurology 2, Medical School of Warsaw3, Warsaw, Poland
Summary. Radioisotope angioscintigraphy following intravenous injection bolus of 99mTc-pertechnetate was performed in 49 patients with cerebrovascular disturbances. The region of interest placement on the sequential analog images of both middle cerebral and internal carotid arteries and time-activity curves were displayed on the video monitor. In 35 cases of this group we have noticed symmetrical cerebral perfusion and a significant difference between right and left internal carotid flow, and in 33 cases of which dynamic studies were made stenosis or occlusion of the extracranial part of the carotid internal artery was revealed by the X-ray angiography.
Radioisotope dynamic angioscintigraphy of the brain has become a common supplement to static scintigraphy [1, 2, 5]. The significance of radioisotope angioscintigraphy in diagnosis of the carotid artery obstruction is controversial [3,4]. The purpose of our paper was to evaluate the diagnostic significance of radionuclide angioscintigraphy in
comparison with studies of cerebral perfusion in cases with cerebrovascular disturbances. A 1-ml bolus containing about 15 mCi of 99mTcpertechnetate was injected into an antecubital vein. All patients were studied in anterior position with the Searle Pho/Gamma LFOV scintillation camera. The data were collected during 40 s, recorded in list mode, and processed using the Gamma 11 data-processing system based on the PDP 11/34 computer. Symmetrical rectangular, 2 x 2, regions of interest were selected at'the cumulative head image taking the areas of middle cerebral and of both internal carotid arteries. Four corresponding activity-time curves were computed taking a 1-s point-to-point time interval. Then the curves were smoothed by means of three-point weighted averaging algorithm to reduce the statistical fluctuation error. The curves obtained from brain hemisphere regions were conventionally used to estimate the brain perfusion. Then the internal carotid areas' curves displayed on the TV screen were analyzed, taking into consideration three parameters: initial slope of curve; peak-to-plateau activity ratio; and mean transit time.
Fig. 1. a The analog image with regions of interest placed in the middle cerebral areas. Time-activity curves generated from these areas. b Curves from both regions of interest superimposed. Normal cerebral perfusion study. Curves Smoothed by means of three-point weighted averaging algorithm to reduce the statistical fluctuation error
0028-3940/78/0016/0244/$01.00
S. Rudnicki et al.: Estimation of the Dynamic Carotid Flow
245
Fig. 2. a The analog image with regions of interest placed in areas of internal carotid arteries. Time-activity curves generated from these areas, time course 0-39 s. b Averaged time-activity curves, time course 0-16 s. Curves left and right side superimposed, c Curve from right internal carotid area, time course 0-16 s. Note the significant decreased build-up time in the right internal carotid region, d Curve from left internal carotid area, time course 0-16 s. Curves in b-d were smoothed by means of three-point weighted averaging algorithm to reduce the statistical fluctuation error
In most of 49 cases the curves corresponding to the cerebral regions were symmetrical, despite the results of the X-ray angiography, that proved the stricture or occlusion of the extracranial part of the internal carotid artery in 33 cases. However, a significant difference between right- and left-side parameters was noticed in 35 cases of internal carotid curve analysis (Figs. l a - 2d). We suggest that this examination of the internal carotid region gives more information of diagnostic value than is obtained by means of cerebral region study, especially in cases with normal and/or symmetrical cerebral perfusion.
2. DeLand, F.H.: Clinical application of cerebral dynamic perfusion studies. In: Dynamic studies with radioisotopes in medicine 1974. Proceedings of a Symposium. Knoxville, 1974. II, pp. 79-90. Vienna: International Atomic Energy Agency 1975 3. Itti, R., Planiol, T., Floyrac, R.: L'int6r~t des modules th6oriques pour l'interpr6tation des courbes de transit c6r6bral. In: Dynamic studies with radioisotopes in medicine 1974. Proceedings of a Symposium, Knoxville, 1974. II, pp. 19-34. Vienna: International Atomic Energy Agency 1975 4. Ihingran, S.G., Johnson, P.C.: Radionuclide angiography in the diagnosis of cerebrovascular disease. J. Nucl. Med. 14, 265-268 (1973) 5. Oldendorf, W.H., Kitano, M., Shimizu, S.: Evalu.ation of a simple technique for abrupt intravenous injection of radioisotope. J. Nucl. Med. 6,205-209 (1965)
References
T. Kryst-Wid~gowska, MD Department of Neuroradiology Institute cf Psychoneurology AI. Sobieskiego 1/9 02-957 Warszawa, Poland
1. Cowan, R.J., Maynard, C.D., Meschan, I., Janeway, R., Koji Shigano: Value of the routine use of the cerebral dynamic radioisotope study. Radiology 107, 111-116 (1973)
Neuroradiology 16,244 - 245 (1978)
© by Springer-Verlag 1978
Estimation
o f t h e D y n a m i c C a r o t i d F l o w in P a t i e n t s w i t h N o r m a l R a d i o n u c l i d e C e r e b r a l P e r f u s i o n
Stanis~aw Rudnicki 1 , Helena Nielubowiczowa 2 , Teresa Kryst-Wid~gowska 2 , and Stanis~aw Zurowski 3 Postgraduate Medical School 1, Institute of Psychoneurology 2, Medical School of Warsaw3, Warsaw, Poland
Summary. Radioisotope angioscintigraphy following intravenous injection bolus of 99mTc-pertechnetate was performed in 49 patients with cerebrovascular disturbances. The region of interest placement on the sequential analog images of both middle cerebral and internal carotid arteries and time-activity curves were displayed on the video monitor. In 35 cases of this group we have noticed symmetrical cerebral perfusion and a significant difference between right and left internal carotid flow, and in 33 cases of which dynamic studies were made stenosis or occlusion of the extracranial part of the carotid internal artery was revealed by the X-ray angiography.
Radioisotope dynamic angioscintigraphy of the brain has become a common supplement to static scintigraphy [1, 2, 5]. The significance of radioisotope angioscintigraphy in diagnosis of the carotid artery obstruction is controversial [3,4]. The purpose of our paper was to evaluate the diagnostic significance of radionuclide angioscintigraphy in
comparison with studies of cerebral perfusion in cases with cerebrovascular disturbances. A 1-ml bolus containing about 15 mCi of 99mTcpertechnetate was injected into an antecubital vein. All patients were studied in anterior position with the Searle Pho/Gamma LFOV scintillation camera. The data were collected during 40 s, recorded in list mode, and processed using the Gamma 11 data-processing system based on the PDP 11/34 computer. Symmetrical rectangular, 2 x 2, regions of interest were selected at'the cumulative head image taking the areas of middle cerebral and of both internal carotid arteries. Four corresponding activity-time curves were computed taking a 1-s point-to-point time interval. Then the curves were smoothed by means of three-point weighted averaging algorithm to reduce the statistical fluctuation error. The curves obtained from brain hemisphere regions were conventionally used to estimate the brain perfusion. Then the internal carotid areas' curves displayed on the TV screen were analyzed, taking into consideration three parameters: initial slope of curve; peak-to-plateau activity ratio; and mean transit time.
Fig. 1. a The analog image with regions of interest placed in the middle cerebral areas. Time-activity curves generated from these areas. b Curves from both regions of interest superimposed. Normal cerebral perfusion study. Curves Smoothed by means of three-point weighted averaging algorithm to reduce the statistical fluctuation error
0028-3940/78/0016/0244/$01.00
S. Rudnicki et al.: Estimation of the Dynamic Carotid Flow
245
Fig. 2. a The analog image with regions of interest placed in areas of internal carotid arteries. Time-activity curves generated from these areas, time course 0-39 s. b Averaged time-activity curves, time course 0-16 s. Curves left and right side superimposed, c Curve from right internal carotid area, time course 0-16 s. Note the significant decreased build-up time in the right internal carotid region, d Curve from left internal carotid area, time course 0-16 s. Curves in b-d were smoothed by means of three-point weighted averaging algorithm to reduce the statistical fluctuation error
In most of 49 cases the curves corresponding to the cerebral regions were symmetrical, despite the results of the X-ray angiography, that proved the stricture or occlusion of the extracranial part of the internal carotid artery in 33 cases. However, a significant difference between right- and left-side parameters was noticed in 35 cases of internal carotid curve analysis (Figs. l a - 2d). We suggest that this examination of the internal carotid region gives more information of diagnostic value than is obtained by means of cerebral region study, especially in cases with normal and/or symmetrical cerebral perfusion.
2. DeLand, F.H.: Clinical application of cerebral dynamic perfusion studies. In: Dynamic studies with radioisotopes in medicine 1974. Proceedings of a Symposium. Knoxville, 1974. II, pp. 79-90. Vienna: International Atomic Energy Agency 1975 3. Itti, R., Planiol, T., Floyrac, R.: L'int6r~t des modules th6oriques pour l'interpr6tation des courbes de transit c6r6bral. In: Dynamic studies with radioisotopes in medicine 1974. Proceedings of a Symposium, Knoxville, 1974. II, pp. 19-34. Vienna: International Atomic Energy Agency 1975 4. Ihingran, S.G., Johnson, P.C.: Radionuclide angiography in the diagnosis of cerebrovascular disease. J. Nucl. Med. 14, 265-268 (1973) 5. Oldendorf, W.H., Kitano, M., Shimizu, S.: Evalu.ation of a simple technique for abrupt intravenous injection of radioisotope. J. Nucl. Med. 6,205-209 (1965)
References
T. Kryst-Wid~gowska, MD Department of Neuroradiology Institute cf Psychoneurology AI. Sobieskiego 1/9 02-957 Warszawa, Poland
1. Cowan, R.J., Maynard, C.D., Meschan, I., Janeway, R., Koji Shigano: Value of the routine use of the cerebral dynamic radioisotope study. Radiology 107, 111-116 (1973)
