Relationship between residual cerebral blood flow and oxygen metabolism as predictive of ischemic tissue viability: sequential multitracer positron emission tomography scanning of middle cerebral artery occlusion during the critical first 6 hours after stroke in pigs

Sakoh, Masaharu; Østergaard, Leif; Røhl, Lisbeth; Smith, Donald F.; Simonsen, Claus Z; Sørensen, Jens Christian; Poulsen, Peter V.; Gyldensted, Carsten; Sakaki, Saburo; Gjedde, Albert

doi:10.3171/jns.2000.93.4.0647

Cited by 70 publications

(49 citation statements)

References 49 publications

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“…In the latter study, Marchal et al report that the upper limit of OEF beyond which acutely ischemic tissue was irreversibly injured was 40.73. Experimentally, a similar OEF 40.75 threshold has been reported (Sakoh et al, 2000). Arguably, defining ischemia at a different threshold, such as OEF 40.5, potentially would result in an alternative interpretation.…”

Section: Defining Ischemia After Traumatic Brain Injurymentioning

confidence: 81%

Metabolic Crisis without Brain Ischemia is Common after Traumatic Brain Injury: A Combined Microdialysis and Positron Emission Tomography Study

Vespa

Bergsneider

Hattori

et al. 2005

J Cereb Blood Flow Metab

565

402

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Brain trauma is accompanied by regional alterations of brain metabolism, reduction in metabolic rates and possible energy crisis. We hypothesize that microdialysis markers of energy crisis are present during the critical period of intensive care despite the absence of brain ischemia. In all, 19 brain injury patients (mean GCS 6) underwent combined positron emission tomography (PET) for metabolism of glucose (CMRglu) and oxygen (CMRO 2 ) and cerebral microdialysis (MD) at a mean time of 36 h after injury. Microdialysis values were compared with the regional mean PET values adjacent to the probe. Longitudinal MD data revealed a 25% incidence rate of metabolic crisis (elevated lactate/pyruvate ratio (LPR)440) but only a 2.4% incidence rate of ischemia. Positron emission tomography imaging revealed a 1% incidence of ischemia across all voxels as measured by oxygen extraction fraction (OEF) and cerebral venous oxygen content (CvO 2 ). In the region of the MD probe, PET imaging revealed ischemia in a single patient despite increased LPR in other patients. Lactate/pyruvate ratio correlated negatively with CMRO 2 (Po0.001), but not with OEF or CvO 2 . Traumatic brain injury leads to a state of persistent metabolic crisis as reflected by abnormal cerebral microdialysis LPR that is not related to ischemia.

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Section: Defining Ischemia After Traumatic Brain Injurymentioning

confidence: 81%

Metabolic Crisis without Brain Ischemia is Common after Traumatic Brain Injury: A Combined Microdialysis and Positron Emission Tomography Study

Vespa

Bergsneider

Hattori

et al. 2005

J Cereb Blood Flow Metab

565

402

View full text Add to dashboard Cite

show abstract

“…17 Although the present study is too small to determine the predictive power of irreversible levels (Ͻ7 mL/100 g per minute) of CBF, an extensive literature with quantitative methodologies provides a solid basis for believing that patients with flow levels in this range are not likely to benefit from treatment. 18,28,29 CTA has been demonstrated to be a quick and reliable way of determining the location of occlusion and extent of collateral flow. 30 Wildermuth et al 31 have proposed that patients should be selected for thrombolytic therapy on the basis of the identification of occlusion and the extent of leptomeningeal collateral circulation.…”

Section: Discussionmentioning

confidence: 99%

CT-Based Assessment of Acute Stroke: CT, CT Angiography, and Xenon-Enhanced CT Cerebral Blood Flow

Kilpatrick¹,

Yonas²,

Goldstein³

et al. 2001

Stroke

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Background and Purpose-Only a small percentage of acute-stroke patients receive thrombolytic therapy because of time constraints and the risks associated with thrombolytic therapy. We sought to determine whether xenon-enhanced CT (XeCT) cerebral blood flow (CBF) and/or CT angiography (CTA) in conjunction with CT can distinguish subgroups of acute ischemic stroke victims and thereby better predict the subgroups most likely to benefit and not to benefit from thrombolytic therapy. Methods-An analysis of 51 patients who had a CT, CTA, and stable XeCT CBF examination within 24 hours of stroke symptom onset was conducted. These initial radiographic studies and National Institutes of Health Stroke Scale score on admission were assessed to determine whether they could predict new infarction on follow-up CT or discharge disposition by use of the Fisher exact test to determine statistical significance. Results-Patients with no infarction on initial CT and normal XeCT CBF had significantly fewer new infarctions and were discharged home more often than those with compromised CBF. The same held true for patients with an open internal carotid artery and middle cerebral artery by CTA and normal CT compared with those with an occluded internal carotid artery and/or middle cerebral artery by CTA. Either was superior to CT and the National Institutes of Health Stroke Scale in prediction of outcome. Both enable the selection of a group of patients not identifiable by CT alone that would do well without being exposed to the risks of thrombolytic therapy. This study included too few patients to statistically assess the role of combining CTA and XeCT CBF information. Conclusions-The combination of CT, CTA, and Xe/CT CBF does define potentially significant subgroups of patients.The utility of this classification is supported by the observation that CTA and XeCT CBF are superior to CT alone in predicting infarction on follow-up CT and clinical outcome. This information may be useful in selecting patients for acute-stroke treatment.

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“…Functional and molecular cerebral imaging Recently, swine have been used as experimental models for brain imaging studies using PET (Smith et al, 1998;Danielsen et al, 2000 and2001b;Ishizu et al, 2000;Sakoh et al, 2000b;Cumming et al, 2001;Dall et al, 2002;Andersen et al, 2005), MRI (Sakoh et al, 2000a;Watanabe et al, 2001;Jelsing et al, 2005;Duhaime et al, 2006) and functional MRI (Fang et al, 2005 and. Functional MRI has been used to evaluate the maturation of the brain in minipig from the early postnatal period to 6 months old.…”

Section: Brain Imaging and Neurosurgery In Pigmentioning

confidence: 99%

The pig model in brain imaging and neurosurgery

Sauleau

Lapouble

Val‐Laillet

et al. 2009

Animal

206

178

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The pig model is increasingly used in the field of neuroscience because of the similarities of its brain with human. This review presents the peculiarities of the anatomy and functions of the pig brain with specific reference to its human counterpart. We propose an approximate mapping of the pig's cortical areas since a comprehensive description of the equivalent of Brodmann's areas is lacking. On the contrary, deep brain structures are received more consideration but a true three-dimensional (3D) atlas is still eagerly required. In the second section, we present an overview of former works describing the use of functional imaging and neuronavigation in the pig model. Recently, the pig has been increasingly used for molecular imaging studies using positron emission tomography (PET). Indeed, the large size of its brain is compatible with the limited spatial resolution of the PET scanner built to accommodate a human being. Similarly, neuronavigation is an absolute requirement to target deep brain areas in human and in pig since the surgeon cannot rely on external skull structures for zeroing the 3D reference frame. Therefore, a large body of methodological refinements has been dedicated to image guided surgery in the pig model. These refinements allow now a millimetre precision: an absolute requirement for basal nuclei targeting. In the third section, several examples of ongoing studies in our laboratory were presented to illustrate the intricacies of using the pig model. For both examples, after a brief description of the scientific context of the experiment, we present, in detail, the methodological steps required to achieve the experimental goals, which are specific to the porcine model. Finally, in the fourth section, the anatomical variations depending on the breed and age are discussed in relation with neuronavigation and brain surgery. The need for a digitized multimodality brain atlas is also highlighted.Keywords: pig, neuroimaging, single photon emission tomography, neuronavigation, deep brain stimulation ImplicationsThe pig model is increasingly used in the field of neuroscience because of the similarities of its brain with human. Indeed, aside from the rodent model there is a critical need for a large animal model ethically acceptable, i.e. excluding non-human primates. In this review we present some experiments dealing with the various procedures achievable in the pig model ranging from image-guided brain surgery to functional brain imaging studies. The recent advances in functional imaging data processing pointed out our partial knowledge of pig brain neuro-anatomy and the requirement for a digitalized atlas matching MRI (magnetic resonance imaging) and histological resources. IntroductionSwine have been used extensively as a model of human in biomedical researches such as cardiovascular, metabolic and transplantation (Phillips et al., 1982;Larsen and Rolin, 2004;Imai et al., 2006;Groth, 2007). In the last decade, an increasing number of studies in the field of neuroscience has been reported (Lind et ...

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Relationship between residual cerebral blood flow and oxygen metabolism as predictive of ischemic tissue viability: sequential multitracer positron emission tomography scanning of middle cerebral artery occlusion during the critical first 6 hours after stroke in pigs

Abstract: The relationship between the residual CBF and both oxygen metabolism and extraction is critical to the evolution of metabolic deficiency and lesion size after stroke.

Cited by 70 publications

References 49 publications

Metabolic Crisis without Brain Ischemia is Common after Traumatic Brain Injury: A Combined Microdialysis and Positron Emission Tomography Study

Metabolic Crisis without Brain Ischemia is Common after Traumatic Brain Injury: A Combined Microdialysis and Positron Emission Tomography Study

CT-Based Assessment of Acute Stroke: CT, CT Angiography, and Xenon-Enhanced CT Cerebral Blood Flow

The pig model in brain imaging and neurosurgery

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