Identifying hypoxic tissue after acute ischemic stroke using PET and 18F-fluoromisonidazole

S. J. Read, T. Hirano, D. F. Abbott, J. I. Sachinidis, H. J. Tochon-Danguy, J. G. Chan, G. F. Egan, A. M. Scott, C. F. Bladin, W. J. McKay, G. A. Donnan

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To show that PET with 18F-fluoromisonidazole (18F-FMISO) can detect peri-infarct hypoxic tissue in patients after ischemic stroke. Background: PET with 15O-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. Methods: 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. Results: 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. Conclusions: 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).

Original languageEnglish
Pages (from-to)1617-1621
Number of pages5
JournalNeurology
Volume51
Issue number6
DOIs
Publication statusPublished - 1 Jan 1998

Cite this

Read, S. J., Hirano, T., Abbott, D. F., Sachinidis, J. I., Tochon-Danguy, H. J., Chan, J. G., ... Donnan, G. A. (1998). Identifying hypoxic tissue after acute ischemic stroke using PET and 18F-fluoromisonidazole. Neurology, 51(6), 1617-1621. https://doi.org/10.1212/WNL.51.6.1617
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. / Identifying hypoxic tissue after acute ischemic stroke using PET and 18F-fluoromisonidazole. In: Neurology. 1998 ; Vol. 51, No. 6. pp. 1617-1621.
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title = "Identifying hypoxic tissue after acute ischemic stroke using PET and 18F-fluoromisonidazole",
abstract = "Objective: To show that PET with 18F-fluoromisonidazole (18F-FMISO) can detect peri-infarct hypoxic tissue in patients after ischemic stroke. Background: PET with 15O-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. Methods: 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. Results: 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. Conclusions: 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).",
author = "Read, {S. J.} and T. Hirano and Abbott, {D. F.} and Sachinidis, {J. I.} and Tochon-Danguy, {H. J.} and Chan, {J. G.} and Egan, {G. F.} and Scott, {A. M.} and Bladin, {C. F.} and McKay, {W. J.} and Donnan, {G. A.}",
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Read, SJ, Hirano, T, Abbott, DF, Sachinidis, JI, Tochon-Danguy, HJ, Chan, JG, Egan, GF, Scott, AM, Bladin, CF, McKay, WJ & Donnan, GA 1998, 'Identifying hypoxic tissue after acute ischemic stroke using PET and 18F-fluoromisonidazole' Neurology, vol. 51, no. 6, pp. 1617-1621. https://doi.org/10.1212/WNL.51.6.1617

Identifying hypoxic tissue after acute ischemic stroke using PET and 18F-fluoromisonidazole. / 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.

In: Neurology, Vol. 51, No. 6, 01.01.1998, p. 1617-1621.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Identifying hypoxic tissue after acute ischemic stroke using PET and 18F-fluoromisonidazole

AU - Read, S. J.

AU - Hirano, T.

AU - Abbott, D. F.

AU - Sachinidis, J. I.

AU - Tochon-Danguy, H. J.

AU - Chan, J. G.

AU - Egan, G. F.

AU - Scott, A. M.

AU - Bladin, C. F.

AU - McKay, W. J.

AU - Donnan, G. A.

PY - 1998/1/1

Y1 - 1998/1/1

N2 - Objective: To show that PET with 18F-fluoromisonidazole (18F-FMISO) can detect peri-infarct hypoxic tissue in patients after ischemic stroke. Background: PET with 15O-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. Methods: 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. Results: 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. Conclusions: 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).

AB - Objective: To show that PET with 18F-fluoromisonidazole (18F-FMISO) can detect peri-infarct hypoxic tissue in patients after ischemic stroke. Background: PET with 15O-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. Methods: 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. Results: 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. Conclusions: 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).

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Read SJ, Hirano T, Abbott DF, Sachinidis JI, Tochon-Danguy HJ, Chan JG et al. Identifying hypoxic tissue after acute ischemic stroke using PET and 18F-fluoromisonidazole. Neurology. 1998 Jan 1;51(6):1617-1621. https://doi.org/10.1212/WNL.51.6.1617