Prognostication of Recovery in Patients With Acute Ischemic Stroke Through the Use of Brain SPECT With Technetium-99m—Labeled Metronidazole

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Abstract
Background and Purpose— We hypothesized that technetium-99m-ethylene dicysteine-metronidazole ( 99m Tc-EC-MN) localizes to brain tissue that is hypoxic but viable. This study prospectively evaluated the relationship between neurological outcome and uptake of 99m Tc-EC-MN in peri-infarcted regions of the brain. Methods— Eight patients with acute ischemic stroke in the territory of the left middle cerebral artery underwent 99m Tc-EC-MN and 99m Tc-ethyl cysteinate dimer (ECD) brain SPECTs on the same day during the subacute stage (10.3±2.5 days). The infarct volumes from 99m Tc-ECD images (IV ECD ), infarct volumes from diffusion-weighted MRI images (IV DW ), and hypoxic volume (HV) from 99m Tc-EC-MN images were calculated. The net infarct volume (NIV ECD ) was defined as IV ECD minus HV. The National Institutes of Health Stroke Scale scores were measured on admission and days 1, 3, 7, and 30. Results— IV ECD was greater than IV DW . The lesion-to-normal count-density ratios of 99m Tc-EC-MN ranged from 1.80 to 5.96. HV was 60.2±65.2 cm 3 , and the mean percent HV was 24.5±28.1% of IV ECD . NIV ECD was 162.6±133.4 cm 3 and was significantly smaller than IV ECD . NIV ECD was significantly correlated with National Institutes of Health Stroke Scale score at 1 month and was a significant predictor of neurological deficit at 1 month. Conclusions— 99m Tc-EC-MN brain SPECT can detect hypoxic tissue after acute ischemic stroke and, in combination with 99m Tc-ECD brain SPECT, is useful in predicting neurological outcome in ischemic stroke patients.