Read S J, Hirano T, Abbott D F, Sachinidis J I, Tochon-Danguy H J, Chan J G, Egan G F, Scott A M, Bladin C F, McKay W J, Donnan G A
Department of Neurology, Austin & Repatriation Medical Centre, Heidelberg, Vic, Australia.
Neurology. 1998 Dec;51(6):1617-21. doi: 10.1212/wnl.51.6.1617.
To show that PET with 18F-fluoromisonidazole (18F-FMISO) can detect peri-infarct hypoxic tissue in patients after ischemic stroke.
PET with (15)O-labeled oxygen and water is the only established method for identifying the ischemic penumbra in humans. We used PET with 18F-FMISO in patients after ischemic stroke to identify hypoxic but viable peri-infarct tissue likely to represent the ischemic penumbra, and to determine how long hypoxic tissues persist after stroke.
Patients with acute hemispheric ischemic stroke were studied using PET with 18F-FMISO either within 48 hours or 6 to 11 days after stroke onset. The final infarct was defined by CT performed 6 to 11 days after stroke. Tracer uptake was assessed objectively by calculating the mean activity in the contralateral (normal) hemisphere, then identifying pixels with activity greater than 3 SDs above the mean in both hemispheres. Positive studies were those with high-activity pixels ipsilateral to the infarct.
Fifteen patients were studied; 13 within 48 hours of stroke, 8 at 6 to 11 days, and 6 during both time periods. Hypoxic tissue was detected in 9 of the 13 patients studied within 48 hours of stroke, generally distributed in the peripheries of the infarct and adjacent peri-infarct tissues. None of the 8 patients studied 6 to 11 days after stroke exhibited increased 18F-FMISO activity. All 6 patients studied both early and late exhibited areas of increased activity during the early but not the late study.
PET with 18F-FMISO can detect peri-infarct hypoxic tissue after acute ischemic stroke. The distribution of hypoxic tissue suggests that it may represent the ischemic penumbra. Hypoxic tissues do not persist to the subacute phase of stroke (6 to 11 days).
证明正电子发射断层扫描（PET）联合18F-氟米索硝唑（18F-FMISO）能够检测缺血性脑卒中患者梗死灶周围的缺氧组织。
采用（15）O标记的氧和水进行PET检查是目前唯一已确立的用于识别人类缺血半暗带的方法。我们对缺血性脑卒中患者采用PET联合18F-FMISO检查，以识别可能代表缺血半暗带的缺氧但仍存活的梗死灶周围组织，并确定脑卒中后缺氧组织持续存在的时间。
对急性半球缺血性脑卒中患者，在卒中发作后48小时内或6至11天采用PET联合18F-FMISO进行研究。最终梗死灶通过卒中后6至11天进行的CT检查确定。通过计算对侧（正常）半球的平均活性，然后识别两个半球中活性高于平均值3个标准差以上的像素，客观评估示踪剂摄取情况。阳性研究是指梗死灶同侧有高活性像素的研究。
共研究了15例患者；13例在卒中后48小时内进行检查，8例在6至11天进行检查，6例在两个时间段均进行检查。在卒中后48小时内接受检查的13例患者中，有9例检测到缺氧组织，通常分布在梗死灶周边和相邻的梗死灶周围组织。在卒中后6至11天接受检查的8例患者中，均未表现出18F-FMISO活性增加。在早期和晚期均接受检查的6例患者中，所有患者在早期检查时均表现出活性增加区域，而在晚期检查时则未出现。
PET联合18F-FMISO能够检测急性缺血性脑卒中后梗死灶周围的缺氧组织。缺氧组织的分布表明其可能代表缺血半暗带。缺氧组织在卒中的亚急性期（6至11天）不会持续存在。
