Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Instagram
  • Listen to CMAJ podcasts
CMAJ Specialty Spotlight: Nuclear Medicine Neurology

SPECT in cerebrovascular disease

Andrei V. Alexandrov and John W. Norris
CMAJ November 02, 1999 161 (9) 1135;
Andrei V. Alexandrov
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
John W. Norris
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

Technology: Single-photon emission computed tomography (SPECT)

Use: Brain SPECT uses a fast rotating gamma camera to detect photons emitted by tracer molecules trapped in brain tissue.1 Modern cameras with multiple receivers ("heads") improve the resolution to 7-8 mm and allow a scanning time of about 20 minutes. Quantitative measurement of regional cerebral blood flow is possible with xenon-133.2 Two technetium-99m-based tracers are currently in use: hexamethylpropyleneamine oxime and ethyl cysteinate dimer. However, these agents are suitable only for semiquantitative measurement of brain perfusion because they provide a relative flow distribution with reference to the cerebellum.2 These agents are retained in the brain tissues for a relatively long time; therefore, scanning can be delayed up to a few hours, and the images will still represent brain perfusion at the time of tracer injection.

In addition to investigation of cerebrovascular disease, SPECT has been used to investigate epilepsy and cerebral degenerative disease.[2, 3] New applications include selective receptor-binding tracers. We will describe the clinical application of SPECT in patients with cerebrovascular disease.

History: SPECT was introduced in the 1970s to measure regional cerebral blood flow noninvasively using radioactive isotopes.1 This new technology emerged to improve spatial resolution of gamma cameras and the imaging qualities of radiopharmaceutical tracers. Clinical multicentre trials were performed to establish the utility of each tracer for specific clinical applications, including stroke and dementia,[3–5] and this technology is currently in widespread clinical use.

Promise: SPECT is performed in patients with cerebrovascular disease to localize the ischemic lesion, to predict lesion volume, early deterioration and stroke outcome, to evaluate the capacity of brain arterioles to dilate after intravenous injection of acetazolamide and to monitor thrombolysis-induced reperfusion (Figure), surgical interventions and other therapies.[2–5] SPECT can also help in the differential diagnosis of degenerative diseases by showing decreased tracer uptake in the frontal or temporal lobes specific to various forms of cognitive disorder.[2, 3]

Figure
  • Download figure
  • Open in new tab
  • Download powerpoint

Figure. SPECT scans, showing greater reperfusion (arrows) in patients with acute ischemic stroke given recombinant tissue plasminogen activator (right) than in those given placebo (left) at 24 hours after therapy. (Reprinted from Grotta and Alexandrov,6 with permission.)

Problems: SPECT is an ancillary test to CT or MRI in select patients. CT is required for initial diagnostic workup of patients with cerebrovascular disease and stroke. MRI offers advantages of both structural and perfusion imaging. SPECT shows only perfusion linked to a single tracer distributed in the brain.4 Although good-resolution SPECT can be accomplished within 25 minutes, it cannot replace CT when investigating patients with acute stroke, because time is an issue.4

Prospects: SPECT can be used in select patients with focal cerebral ischemia in addition to CT or MRI to determine:[3–5] the location and mechanism of ischemic damage; brain perfusion changes after vasodilatory stimuli to identify patients with exhausted collateralization capacity in the presence of carotid occlusion; and brain perfusion changes after therapies to improve cerebral blood flow. New technologies of white cell labelling may help to identify intracranial thrombosis using brain SPECT. In patients with cerebral degenerative disease, SPECT can further improve the differential diagnosis, particularly with the new selective receptor-binding tracers.

Competing interests: None declared.

References

  1. 1.↵
    Lassen NA, Sveinsdottir E, Kanno I, Stokely EM, Rommer P. A fast moving, single photon emission tomograph for regional cerebral blood flow studies in man. J Comput Assist Tomogr 1978;2:661-2.
    OpenUrlCrossRef
  2. 2.↵
    Olsen TS, Lassen NA. Single photon emission tomography (SPECT) in cerebrovascular disease. In: Welch KMA, Caplan LR, Reis DJ, Siesjo BK, Weir B, editors. Primer on cerebrovascular diseases. San Diego: Academic Press; 1997. p. 634-6.
  3. 3.↵
    Masdeu JC, Brass LM, Holman BL, Kushner MJ. Brain single-photon emission computed tomography. Neurology 1994;44:1970-7.
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    Alexandrov AV, Masdeu JC, Devous MD, Black SE, Grotta JC. Brain single-photon emission CT with HMPAO and safety of thrombolytic therapy in acute ischemic stroke. Stroke 1997;28:1830-4.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    Brass LM, Walovitch R, Leveille JJ, Marchand L, Hellman RS, Tikofsky RS, et al. The role of single-photon emission computed tomography brain imaging with 99mTc-bisicate in localization and definition of mechanism of ischemic stroke. J Cereb Blood Flow Metab 1994;14:91-8.
    OpenUrl
  6. 6.↵
    Grotta JC, Alexandrov AV. TPA-associated reperfusion after acute stroke demonstrated by SPECT. Stroke 1998;29:429-32.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

CMAJ
Vol. 161, Issue 9
2 Nov 1999
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
SPECT in cerebrovascular disease
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
SPECT in cerebrovascular disease
Andrei V. Alexandrov, John W. Norris
CMAJ Nov 1999, 161 (9) 1135;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
SPECT in cerebrovascular disease
Andrei V. Alexandrov, John W. Norris
CMAJ Nov 1999, 161 (9) 1135;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • References
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

Similar Articles

Collections

  • Topics
    • Imaging
    • Stroke

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected]

CMA Civility, Accessibility, Privacy

 

Powered by HighWire