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Positron Emission Tomography After Ischemic Brain Injury: Current Challenges and Future Developments

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Abstract

Positron emission tomography (PET) is widely used in clinical and animal studies, along with the development of diverse tracers. The biochemical characteristics of PET tracers may help uncover the pathophysiological consequences of cardiac arrest (CA) and ischemic stroke, which include cerebral ischemia and reperfusion, depletion of oxygen and glucose, and neuroinflammation. PubMed was searched for studies of the application of PET for “cardiac arrest,” “ischemic stroke,” and “targeted temperature management.” Available studies were included and classified according to the biochemical properties involved and metabolic processes of PET tracers, and were summarized. The mechanisms of ischemic brain injuries were investigated by PET with various tracers to elucidate the pathological process from the initial decrease of cerebral blood flow (CBF) to the subsequent abnormalities in energy and oxygen metabolism, to the monitoring of inflammation. In general, the trends of cerebral blood flow and oxygen metabolism after ischemic attack are not unidirectional but closely related to the time point of injury and recovery. Glucose metabolism after injury showed significant differences in different brain regions whereas global cerebral metabolic rate of glucose (CMRglc) declined. PET monitoring of neuroinflammation shows comparable efficacy to immunostaining. The technology of PET targeting in brain metabolism and the development of tracers provide new tools to track and evaluate the brain’s pathological changes after ischemic brain injury. Despite no existing evidence for an available PET-based prediction method, discoveries of new tracers are expected to provide more possibilities for the whole field.

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Funding

This study was partially supported by R01HL118084 and R01NS110387 from United States National Institutes of Health (both to XJ).

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Authors and Affiliations

  1. Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 43007, China

    Zhuoran Wang

  2. Department of Neurosurgery, University of Maryland School of Medicine, 10 South Pine Street, MSTF Building 823, Baltimore, MD, 21201, USA

    Zhuoran Wang, Conrad Mascarenhas & Xiaofeng Jia

  3. Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA

    Xiaofeng Jia

  4. Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA

    Xiaofeng Jia

  5. Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA

    Xiaofeng Jia

  6. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA

    Xiaofeng Jia

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  1. Zhuoran Wang
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Wang, Z., Mascarenhas, C. & Jia, X. Positron Emission Tomography After Ischemic Brain Injury: Current Challenges and Future Developments. Transl. Stroke Res. 11, 628–642 (2020). https://doi.org/10.1007/s12975-019-00765-0

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