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Hybrid Imaging in Cerebrovascular Disease: Ischemic Stroke

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Book cover PET-CT and PET-MRI in Neurology

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Abstract

Since the introduction of thrombolytic therapy as the basis of acute stroke treatment, neuroimaging has rapidly advanced to empower therapeutic decision making. Due to its ability to quantitatively measure important metabolic variables, PET was first used to distinguish the necrotic core following an ischemic cerebrovascular event from the surrounding tissue with reduced blood flow and reduced function but still viable and therefore potentially salvageable (penumbra). Using the [15O]-oxygen inhalation technique, absolute values of the cerebral blood flow were found that could distinguish the core from the penumbra with corresponding clinical outcomes; increased oxygen extraction fraction and normal oxygen metabolic rate could also distinguish core and penumbra. With the development of multiparametric computed tomography (CT) and magnetic resonance imaging (MRI), the role of PET became much more limited and restrained to some research protocols including either [18F]-fluoro-2-deoxy-D-glucose or receptor tracers to predict tissue necrosis after stroke. [11C]-flumazenil is a marker of cortical neuronal integrity and can reliably offer information for cortical ischemic injury. Another tracer that has been used in PET stroke imaging is [18F]-fluoromisonidazole, which binds preferentially to hypoxic but viable tissue in the periphery of the infarct or in close peri-infarct regions. PET with [18F]-fluoro-2-deoxy-D-glucose may be used to assess the vulnerability to rupture of carotid atherosclerotic plaques. MRI diffusion-weighted imaging is considered the most sensitive and accurate neuroradiological method for stroke detection and, associated with perfusion-weighted imaging, provides information on the functional status of the ischemic brain. It can also help to identify a response to thrombolytic and neuroprotective therapies. The simultaneous acquisition of both PET and MRI in modern PET/MR scanners may help to enhance the diagnostic values of the two modalities, and it should represent the optimal diagnostic approach in cerebrovascular diseases as stroke in the next future. The main limitation to the use of PET/MRI in stroke assessment would be the limited availability in most stroke centers, particularly in the emergency setting.

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Authors and Affiliations

  1. Department of Nuclear Medicine, S. Andrea Hospital, La Spezia, Italy

    Elisabetta Giovannini & Andrea Ciarmiello

  2. Institute of Radiology and Nuclear Medicine, Stadtspital Triemli, Zurich, Switzerland

    Giampiero Giovacchini

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  1. Elisabetta Giovannini
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  2. Giampiero Giovacchini
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Correspondence to Elisabetta Giovannini .

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  1. S. Andrea Hospital, Department of Nuclear Medicine, La Spezia, Italy

    Andrea Ciarmiello

  2. Department of Nuclear Medicine, Second University of Naples, Napoli, Italy

    Luigi Mansi

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Giovannini, E., Giovacchini, G., Ciarmiello, A. (2016). Hybrid Imaging in Cerebrovascular Disease: Ischemic Stroke. In: Ciarmiello, A., Mansi, L. (eds) PET-CT and PET-MRI in Neurology. Springer, Cham. https://doi.org/10.1007/978-3-319-31614-7_16

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  • DOI: https://doi.org/10.1007/978-3-319-31614-7_16

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