99Tcm-HMPAO cerebral scintigraphy and transcranial pulsed Doppler in acute intracranial hypertension in rabbits.

The purpose of this study was to compare transcranial Doppler sonography (TCD) and 99Tcm-HMPAO cerebral scintigraphy in detecting the effects of acute intracranial hypertension by pressure transmission using a previously validated model. In 20 New Zealand rabbits, cerebral blood flow velocities of basilar artery and carotid siphon were simultaneously monitored in baseline conditions and during acute intracranial hypertension by pressure transmission. This hypertension was induced by progressive steps of 5 mmHg, for a 5 min duration by elevating a saline infusion bottle connected to the subdural space. In baseline conditions, significant correlations were found between basilar artery resistive index and 99Tcm-HMPAO uptake in brain stem, r = 0.5 (p < 0.05) and posterior cerebral areas, r = 0.78 (p < 0.001). Severe intracranial hypertension equal to the diastolic arterial pressure with a cerebral perfusion pressure of 22.8 +/- 12.7 mmHg significantly decreased the basilar artery blood flow velocities and global 99Tcm-HMPAO cerebral uptake. At this level of intracranial pressure, few correlations between the two methods were observed. TCD detected relatively high blood-flow velocities in the carotid siphon appearing to result from proximal cerebral artery vasospasm. Transcranial pulsed Doppler provides data about haemodynamic changes such as hypoperfusion, vascular resistance increase in the basilar artery territory and vasospasm of the carotid siphon. 99Tcm-HMPAO scintigraphy, which has not yet been studied during intracranial hypertension, gave immediate information on local cerebral perfusion. Cerebral scintigraphy demonstrated a significant diffuse and heterogeneous decrease in cerebral blood flow, without dissociation between supratentorial and infratentorial territories, and tissue perfusion deficit owing to arterial vasospasm. TCD provides emergency investigation in patients with severe head injuries or hydrocephalus. 99Tcm-HMPAO complements TCD in cases of vasospasm and in determining an area of perfusion tissue deficit.