Radionuclide Imaging in Ischemic Stroke

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Nuclear Medicine Technology: 1.50
Procedures: 1.50
Other Imaging Procedures: 1.50

Outline

1. Introduction
2. Physiologic Variables Affected in Ischemic Stroke
3. Radioactive Tracers Used in Stroke
4. Applications of Radioisotope Studies in Stroke
   1. Detection of Ischemic Lesion
   2. Identification of the Ischemic Penumbra
   3. Noninvasive Imaging of the Penumbra
5. Radioisotope Imaging as a Surrogate Marker for Treatment Efficiency and for Selection of Patients for Special Therapeutic Strategies
6. Microglial Activation as an Indicator of Inflammation
7. Hemodynamic and Metabolic Reserve in Arterial Occlusive Disease
8. Deactivation of Remote Tissue (Diaschisis
9. Activation Studies in Stroke Patients
10. Conclusion and Future Perspectives

Objectives

Upon completion of this course, students will:

1. define the term malignant as it applies to brain infarction
2. identify the gas used in the first quantitative method of measuring CBF
3. list the radioactive gases used for imaging studies of rCBF
4. list the vascular components of the CBV
5. describe the percentage of total-body glucose consumption used by the brain at rest
6. describe the time it takes for loss of consciousness to occur following stoppage of CBF
7. list the characteristics of SPECT radiopharmaceuticals used for stroke evaluation
8. list the isotopes used in PET radiopharmaceuticals for stroke evaluation
9. describe the final structure of the PET radiopharmaceutical used for evaluation of glucose metabolism
10. compare the sensitivities of SPECT, PET and CT for detection of the presence and extent of stroke
11. describe the effect of SPECT imaging on neurologic deficit scores
12. identify the region of the brain with the potential for functional recovery without morphologic damage following acute ischemic stroke
13. describe the difficulties with using SPECT perfusion studies in identifying hypoperfused tissue that is amenable to reperfusion therapy
14. compare the accuracies of MR DWI and PWI in identifying the ischemic penumbra and predicting infarcted tissue
15. describe the use of the PET radiopharmaceutical ¹⁸F-fluoromisonidazole
16. identify the vessel territory associated with malignant brain infarcts in 10% of patients
17. list the imaging techniques that can identify selective neuronal loss in the cortex resulting from exhausted metabolic reserve
18. indicate the brain region most frequently affected by post-stroke aphasia in right-handed individuals with left hemispheric language dominance
19. identify the best method for imaging the morphology of the brain in health and disease
20. identify the PET radiopharmaceutical that is part of an innovative strategy for imaging evaluation of angiogenesis