Usefulness of an Automatic Quantitative Method for Measuring Regional Cerebral Blood Flow Using 99mTc Ethyl Cysteinate Dimer Brain Uptake Ratio

Document Type: Technical note

Authors

1 Department of Radiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukoka, Japan

2 Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan

3 Fujifilm RI Pharma Co., Ltd., Tokyo, Japan

4 Department of Medical Imaging, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

Abstract

 Objective(s): Improved brain uptake ratio (IBUR), employing 99mTc-ethyl cysteinate dimer (99mTc-ECD), is an automatic non-invasive method for quantitatively measuring regional cerebral blood flow (rCBF). This method was developed by the reconstruction of the theory and linear regression equation, based on rCBF measurement by H215O positron emission tomography. Clarification of differences in rCBF values obtained by Patlak plot (PP) and IBUR method is important for clinical diagnosis during the transition period between these methods. Our purpose in this study was to demonstrate the relationship between rCBF values obtained by IBUR and PP methods and to evaluate the clinical applicability of IBUR method.
Methods: The mean CBF (mCBF) and rCBF values in 15 patients were obtained using the IBUR method and compared with PP method values.
Results: Overall, mCBF and rCBF values, obtained using these independent techniques, were found to be correlated (r=0.68). The mCBF values obtained by the IBUR method ranged from 18.9 to 44.9 ml/100g/min, whereas those obtained by the PP method ranged from 34.7 to 48.1 ml/100g/min. The rCBF values obtained by the IBUR method ranged from 16.3 to 60.2 ml/100g/min, whereas those obtained by the PP method were within the range of 26.7-58.8 ml/100g/min.
Conclusion: The ranges of mCBF and rCBF values, obtained by the IBUR method, were approximately 60% lower than those obtained by the PP method; therefore, this method can be useful for diagnosing lower flow area. Re-analysis of prior PP data, using the IBUR method, could be potentially useful for the clinical follow-up of rCBF.
 
 
 

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  1. Newberg AB, Wintering N, Khalsa DS, Roggenkamp H, Waldman MR. Meditation effects on cognitive function and cerebral blood flow in subjects with memory loss: a preliminary study. J Alzheimers Dis. 2010;20(2):517-26.
  2. Yonekura Y, Ishizu K, Okazawa H, Tanaka F, Hattori N, Sadato N et al. Simplified quantification of regional cerebral blood flow with 99mTc-ECD SPECT and continuous arterial blood sampling. Ann Nucl Med. 1996; 10(2):177-83.
  3. Matsuda H, Yagishita A, Tsuji S, Hisada K. A quantitative approach to technetium-99m ethyl cysteinate dimmer: a comparison with technetium- 99m hexamethyl propylene amine oxime. Eur J Nucl Med. 1995; 22:633-7.
  4. Ishizu K, Yonekura Y, Magata Y, Okazawa H, Fukuyama H, Tanaka F, et al. Extraction and retention of technetium-99m-ECD in human brain: dynamic SPECT and oxygen-15-water PET studies. J Nucl Med. 1996; 37(10): 1600-4.
  5. Tsuchida T, Sadato N, Yonekura Y, Yamamoto K, Waki A, Sugimoto K, et al. Quantification of regional cerebral blood flow with continuous infusion of technetium-99m-ethyl cystemate dimer. J Nucl Med. 1997; 38: 1699-702.
  6. Miyazaki Y, Kinuya S, Hashimoto M, Satake R, Inoue H, Shio- zaki J, et al. Brain uptake ratio as an index of cerebral blood flow obtained with 99mTc-ECD. Kaku Igaku. 1997; 34(1): 49–52.
  7. Odano I, Ohkubo M, Yokoi T. Noninvasive quantification of cerebral blood flow using 99mTc- ECD and SPECT. J Nucl Med. 1999; 40(10): 1737-44.
  8. Ito S, Tkaki A, Inoue S, Tomiguchi S, Shiraisgi S, Akiyama Y, et al. Improvement of the 99mTc-ECD brain uptake ratio (BUR) method for measurement of cerebral blood flow. Ann Nucl Med. 2012; 26(4): 351–8.
  9. Inoue S, Kabuto T, Masunaga S, Souma T, Takaki A, Hosoya T, et al. Determination of the optimal ROI setting position of the input function for the ⁹⁹mTc-ethyl cysteinate dimmer brain uptake ratio method. Nihon Hoshasen Gijutsu Gakkai Zasshi. 2012; 68(3): 269-76.
  10. Osanai S, Inamura T, Yanaoka H, FukudaI, Minakawa M, Fukui K. Numerical Simulation of Flow in Aortic Arch under Extracorporeal Circulation. J Jpn Coll Angiol. 2008; 48: 313–8.
  11. Minakawa M, Fukuda I, Yamazaki J, Fukui, K, Yanaoka, H, Inamura, T. Effect of cannula shape on aortic wall and flow turbulence: hydrodynamic study during extracorporeal circulation in mock thoracic aorta. Artif Organs. 2007; 31: 880-6.
  12. Masunaga S, Uchiyama Y, Ofuji A, Nagaoka R, Tomimatsu T, Iwata T, et al. Development of an automatic ROI setting program for input function determination 99mTc-ECD non-invasive cerebral blood flow quantification. Phys Med. 2014; 30:513-21.
  13. Takeuchi R, Yonekura Y, Matsuda H, Konishi J. Usefulness of a three-dimensional stereotaxic ROI template on anatomically standardised 99mTc-ECD SPET. Eur J Nucl Med Mol Imaging. 2002; 29:331-41.
  14. Matsuda H, Tsuji S, Shuke N, Sumiya H, Tonami N, Hisada K. Noninvasive measurementsof regional cerebral blood flow using technetium-99m hexamethylpropylene amine oxime. Eur J Nucl Med. 1993, 20: 39l-401.
  15. Lassen NA, Andersen AR, Friberg L, Paulson OB. The retention of [99mTc]-d,l-HM-PAO in the human brain after intracarotid bolus injection: a kinetic analysis. J Cereb Blood Flow Metab. 1988; 8(6):13-22.