Radionuclide Imaging in Ischemic Stroke

Radioactive tracers and applications of radioisotope studies in stroke evaluation are presented. Future perspectives using hybrid imaging are discussed.

Course ID: Q00423 Category:
Modalities: ,


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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 24, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.50
Procedures: 0.50
Head, Spine, and Musculoskeletal: 0.50

Magnetic Resonance Imaging: 0.50
Procedures: 0.50
Neurological: 0.50

Nuclear Medicine Technology: 2.25
Procedures: 2.25
Other Imaging Procedures: 2.25

Registered Radiologist Assistant: 1.00
Procedures: 1.00
Neurological, Vascular, and Lymphatic Sections: 1.00


  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


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. describe the xenon method of rCBF measurement
  5. describe the percentage of total basal oxygen consumption used by the brain
  6. list the vascular components of the CBV
  7. describe the average CBF to the gray matter
  8. describe the percentage of total-body glucose consumption used by the brain at rest
  9. indicate the brain-tissue partial oxygen pressure at which loss of consciousness occurs
  10. describe the time it takes for loss of consciousness to occur following stoppage of CBF
  11. list the characteristics of SPECT radiopharmaceuticals used for stroke evaluation
  12. list the SPECT radiopharmaceuticals used for imaging of CBF
  13. list the isotopes used in PET radiopharmaceuticals for stroke evaluation
  14. list the PET radiopharmaceuticals used for measuring CBF
  15. describe the final structure of the PET radiopharmaceutical used for evaluation of glucose metabolism
  16. identify the imaging modalities that produce morphologic images for coregistration with SPECT imaging
  17. compare the sensitivities of SPECT, PET and CT for detection of the presence and extent of stroke
  18. describe the effect of SPECT imaging on neurologic deficit scores
  19. indicate the level of decreased perfusion in brain tissue that represents the flow threshold for reversible functional failure
  20. identify the region of the brain with the potential for functional recovery without morphologic damage following acute ischemic stroke
  21. list the three regions within a disturbed vascular territory that can be classified by PET
  22. describe the difficulties with using SPECT perfusion studies in identifying hypoperfused tissue that is amenable to reperfusion therapy
  23. list the radiopharmaceuticals used for PET imaging of the ischemic penumbra
  24. compare the accuracies of MR DWI and PWI in identifying the ischemic penumbra and predicting infarcted tissue
  25. describe the use of the PET radiopharmaceutical 18F-fluoromisonidazole
  26. identify the radiopharmaceutical used to generate a penumbagram
  27. describe the limitations of 18F-fluoromisonidazole evaluation of the ischemic penumbra
  28. identify the vessel territory associated with malignant brain infarcts in 10% of patients
  29. be familiar with the proposed stages of hemodynamic compromise
  30. list the imaging techniques that can identify selective neuronal loss in the cortex resulting from exhausted metabolic reserve
  31. describe the brain regions that demonstrate significant reductions of CBF and metabolism following Infarct of the parietal and frontal lobes
  32. indicate the brain region most frequently affected by post-stroke aphasia in right-handed individuals with left hemispheric language dominance
  33. identify the best method for imaging the morphology of the brain in health and disease
  34. describe the advanced MR imaging technique used to evaluate the concentrations of defined substrates and chemicals
  35. identify the PET radiopharmaceutical that is part of an innovative strategy for imaging evaluation of angiogenesis