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Feasibility of 62Cu-ATSM PET for evaluation of brain ischaemia and misery perfusion in patients with cerebrovascular disease

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Abstract

Purpose

[62Cu]Diacetyl-bis(N 4-methylthiosemicarbazone) (62Cu-ATSM) was used to evaluate brain haemodynamic impairment in patients with cerebrovascular disease (CVD) as a simplified evaluation method. The tracer distribution was compared with haemodynamic parameters obtained by 15O positron emission tomography (PET).

Methods

Ten patients with major cerebral arterial occlusive disease (aged 66 ± 7 years) underwent PET with 62Cu-ATSM and 15O tracers (15O-water, 15O2 and C15O). Seven healthy volunteers also underwent 62Cu-ATSM PET as normal controls. After the injection of 62Cu-ATSM, 20-min dynamic PET data acquisition was started. Early- and delayed-phase images of 62Cu-ATSM were obtained by averaging the initial 3-min and the last 10-min frame data, which were used for perfusion and retention images. Cerebral blood flow (CBF), blood volume, metabolic rate of oxygen (CMRO2) and oxygen extraction fraction (OEF) were measured by 15O-gas and water studies and compared with early- and delayed-phase 62Cu-ATSM images and delayed to early (D/E) ratio. Regional values were compared after all parametric images were coregistered to individual MRI. The asymmetry index (AI) was also calculated for OEF and Cu-ATSM D/E ratio, and diagnostic ability for detecting misery perfusion was compared.

Results

In the affected hemisphere of the patients, the mean values of haemodynamic parameters were CBF = 33.8 ± 5.9 ml/100 g per min, CMRO2 = 2.6 ± 0.3 ml/100 g per min and OEF = 48 ± 7%. Standardized uptake values (SUVs) for 62Cu-ATSM in early and delayed phases were 2.00 ± 0.13 and 1.04 ± 0.09 in the ipsilateral hemisphere and 2.13 ± 0.14 and 1.04 ± 0.08 in the contralateral hemisphere, respectively. The early-phase 62Cu-ATSM images corresponded well to CBF images, and the D/E ratio images were similar to OEF images. Regional values obtained from D/E ratio images were significantly correlated with regional OEF. AIs of OEF and D/E ratio showed a significant correlation and diagnostic ability of misery perfusion was slightly better in AI of D/E ratio than that of OEF.

Conclusion

Dynamic PET acquisition with 62Cu-ATSM provided information on CBF distribution and local elevation of OEF in patients with chronic CVD. The findings of the present study showed the feasibility of the noninvasive molecular imaging method for diagnosing misery perfusion with a single venous tracer injection.

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Acknowledgements

The authors wish to thank Dr. Tsuneo Saga, Dr. Toshimitsu Fukumura and other staff at the Molecular Imaging Center, National Institute of Radiological Sciences. The authors also thank the staff of Biomedical Imaging Research Center, University of Fukui, Fukui for clinical and technical support. This study was partly funded by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (17209041, 17209040, 20249055), and 21st Century COE Program (Medical Science).

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Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medical Sciences, Fukui, Japan

    Makoto Isozaki, Yoshikazu Arai & Ken-ichiro Kikuta

  2. Biomedical Imaging Research Center, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan

    Yasushi Kiyono, Takashi Kudo, Tetsuya Mori, Rikiya Maruyama & Hidehiko Okazawa

  3. Research and Education Program for Life Science, University of Fukui, Fukui, Japan

    Yasushi Kiyono & Hidehiko Okazawa

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  1. Makoto Isozaki
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Correspondence to Hidehiko Okazawa.

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Isozaki, M., Kiyono, Y., Arai, Y. et al. Feasibility of 62Cu-ATSM PET for evaluation of brain ischaemia and misery perfusion in patients with cerebrovascular disease. Eur J Nucl Med Mol Imaging 38, 1075–1082 (2011). https://doi.org/10.1007/s00259-011-1734-z

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  • DOI: https://doi.org/10.1007/s00259-011-1734-z

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