Local Interrelationships of Cerebral Oxygen Consumption and Glucose Utilization in Normal Subjects and in Ischemic Stroke Patients: A Positron Tomography Study

Abstract

Summary: With the use of positron emission tomog raphy (PET) and the 150 steady-state- [ISF]fluorode oxyglucose combined method, the local interrelationships between the cerebral metabolic rate for oxygen (CMR02) and the cerebral metabolic rate for glucose (CMRGlc) were investigated in control subjects and in stroke pa tients. In addition to the classic in vivo autoradiographic approach, a kinetic method was used to measure CMRGlc because it was expected to be more reliable in cerebral ischemia. In control subjects local coupling be tween CBF, CMR02, and CMRGlc was confirmed, and acceptable values for the CMR02/CMRGlc ratio were found; the latter, however, was lower in white matterThe recent development of independent methods for measuring in the human brain the rates of ox ygen consumption (CMR0 2 ) and glucose utilization (CMRGlc) using positron emission tomography (PET) has revived the study of the coupling be tween CMR0 2 and CMRGlc, previously restricted to the whole brain only (Finkle stein et aI., 1981; Baron et aI., 1982; Rhodes et aI., 1982). Such in vivo studies may help us understand better the con ditions required for the occurrence and the prog nostic significance of enhanced anaerobic glycol ysis in cerebral ischemia.Address correspondence and reprint requests to Dr. Baron at Service Hospitalier Frederic Joliot, CEA Departement de Biol ogie, 91406 Orsay, France.Abbreviations used: CBV, Cerebral blood volume; CMRGlc, cerebral metabolic rate for glucose; CMR02, cerebral metabolic rate for oxygen; CT, computerized tomography; GlcAV, arterio venous glucose difference; ICA, internal carotid artery; MR, metabolic ratio; OEF, oxygen extraction fraction; OM, orbito meatal; PET, positron emission tomography.140 than in gray. Uncoupling between CMR02 and CMRGlc was observed in all stroke patients, suggesting that (1) enhanced anaerobic glycolysis occurred both in reper fused recent infarcts and in chronically ischemic tissue, and (2) substrates other than blood-borne glucose were being oxidized at the borders of recent infarcts. However, methodological uncertainties presently make such obser vations only tentative. Finally, a coupled depression of CMRO, and CMRGlc was found in the contralateral cer ebellu m . Key Words: Cerebral glucose utilization-Ce rebral oxygen consumption-Oxygen-IS -Positron emission tomography. METHODS AND PATIENTS MethodsThe steady-state oxygen-IS method of measuring CBF and CMR02 (Jones et aI., 1976) was combined with the [ISF]fluorodeoxyglucose eSFDG) technique for measuring CMRGlc (Phelps et aI., 1979; Reivich et aI., 1979). A detailed account of the combined measurement has been given earlier (Baron et aI., 1982). Briefly, consecutive continuous inhalation of trace amounts of CI502 and 1502 was performed first. Once completed, 16 min (eight pe riods) were allowed to elapse before rapid (=20 s) intra venous injection of IsFDG (3-8 mCi). Generally, three contiguous head levels, parallel to the orbitomeatal (OM) line, were studied. The coincidence photons were col lected by an EC...

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