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Purpose: To evaluate the usefulness of three-dimensional CT angiography (CTA), in which contrast material is used to create reformations of dynamic scans, in the diagnosis and the preoperative evaluation of cerebral aneurysms., Methods: We used 3-D CTA to examine 65 patients with suspected or angiographically verified cerebral aneurysms. A blind study was performed to evaluate the diagnostic accuracy of 3-D CTA for cerebral aneurysms with the use of conventional angiography as the reference standard., Results: In 50 patients, conventional angiography revealed 73 cerebral aneurysms ranging from 2 to 32 mm in maximum diameter. Three of the 73 cerebral aneurysms were located outside the imaging volume of 3-D CTA. The sensitivities of the two neuroradiologists for the remaining 70 aneurysms were 67% and 70%, respectively. Although 3-D CTA depicted cerebral aneurysms 5 mm or larger with good accuracy, it was less useful for the detection of smaller aneurysms. For the evaluation of giant aneurysms, this technique elucidated the relationships among the aneurysm, surrounding arteries, and neighboring bone structure., Conclusion: Three-dimensional CTA is useful for the diagnosis of cerebral aneurysms with diameters of 5 mm or more. This technique is especially useful in the preoperative evaluation of giant aneurysms.

Purpose: To evaluate the differences between fludeoxyglucose F 18 (FDG) and L-methyl-11C-methionine (11C-methionine) as tracers for positron emission tomography (PET) in the evaluation of brain tumors., Methods: We analyzed 10 patients with histologically verified cerebral glioma or meningioma and 1 patient with a neuroradiologic diagnosis of low-grade glioma by using FDG, 11C-methionine, and PET. We qualitatively and quantitatively evaluated the extent and degree of accumulation of FDG and 11C-methionine in the tumor tissue., Results: Although PET with FDG depicted malignant tumors as a hot spot in all cases, it was not able to delineate the extent of the tumor. Conversely, PET with 11C-methionine outlined the tumors as areas of increased accumulation of 11C-methionine, regardless of the degree of malignancy., Conclusion: PET with FDG and with 11C-methionine can play complementary roles in the evaluation of brain tumors.

Objective: The purpose of our study was to compare the value of MR imaging with CT in the diagnosis of subarachnoid hemorrhage in the subacute and chronic stages (> 3 days after the hemorrhagic episode)., Materials and Methods: We performed 42 MR examinations using a 0.5-T unit in 37 patients with subarachnoid hemorrhage caused by a ruptured aneurysm. Examinations were done 4-75 days after the ictus. We obtained 40 T1-weighted, 11 proton density-weighted, 15 T2-weighted, and 28 moderately T2-weighted images. CT was also performed in all patients within 24 hr of the MR examination. Confirmation of the presence of subarachnoid hemorrhage at the time of the MR examination was made by CSF examination using lumbar puncture or surgical findings., Results: In the subacute and chronic stages, subarachnoid hemorrhage was seen as an area of high signal intensity on T1-weighted, proton density-weighted, T2-weighted, and moderately T2-weighted MR images in 63%, 90%, 25%, and 92% of cases, respectively. On CT scans, subarachnoid hemorrhage was seen as an area of high attenuation in only 46% of cases. Especially in the chronic stage, subarachnoid hemorrhage was seen as an area of high signal intensity more frequently by MR imaging than by CT (90% on T1-weighted images; 100% on proton density-weighted images; 25% on T2-weighted images; 100% on moderately T2-weighted images; and 10% on CT scans). High-signal-intensity subarachnoid hemorrhage was demonstrated by MR imaging until a maximum of 39 days after the ictus, whereas high-attenuation subarachnoid hemorrhage was demonstrated by CT until a maximum of 17 days after the ictus., Conclusions: Our findings show that MR imaging is superior to CT for the diagnosis of subacute and chronic subarachnoid hemorrhage. MR imaging is especially useful for the diagnosis of chronic subarachnoid hemorrhage.

MR in two patients with unusual widening of the Virchow-Robin spaces showed multiple cystic foci up to 2 cm in diameter along the perforating medullary arteries in the cerebral white matter, mainly in one cerebral hemisphere. These areas were of the same signal intensity as cerebrospinal fluid on all pulse sequences. In one patient, the cystic foci in the white matter were biopsied and histologically confirmed to be large Virchow-Robin spaces.

We serially examined a patient with Creutzfeldt-Jakob disease using fludeoxyglucose F 18 and positron emission tomography. Marked cerebral hypometabolism reflected clinical deterioration in the early stages of Creutzfeldt-Jakob disease when no parenchymal abnormalities were present on MR imaging.

We report preliminary results applying fluid-attenuated inversion-recovery (FLAIR) sequences to three patients with acute subarachnoid hemorrhage. Acute subarachnoid hemorrhage could be clearly demonstrated as areas of high signal intensity on FLAIR sequences in all patients. These preliminary results suggest that with FLAIR sequences one could reliably diagnose acute subarachnoid hemorrhage.

The degree of collateral circulation in patients with unilaterally chronic internal carotid artery occlusion was estimated by mean transit time of contrast material in rapid sequence carotid angiography (Angiographic MTT), and compared with cerebral blood flow and oxygen metabolism measured by PET. In normal density region on X-ray CT, a significant negative correlation was observed between Angiographic MTT and cerebral blood flow (CBF). This indicates that cerebral blood flow can be estimated by Angiographic MTT. It has been reported that the ratio of cerebral blood volume (CBV) to CBF (CBV/CBF), i.e., mean transit time determined by PET well agreed with OEF, and is good indicator for brain circulation reserve. In this study, no significant correlation was observed between Angiographic MTT and CBV/CBF. However, a significant positive correlation was observed between Angiographic MTT and oxygen extraction fraction (OEF), and no significant correlation was observed between Angiographic MTT and oxygen consumption rate (CMRO2). These indicates that Angiographic MTT may be indicator for brain circulation reserve.

The regional brain uptake of 99mTc-N,N'-(1,2-ethylenediyl)bis-L-cysteine diethyl ester (99mTc-bicisate) measured by single photon emission computed tomography (SPECT) was compared with the regional CBF and CMRO2 measured by positron emission tomography in patients with cerebrovascular disease. Nine patients with the diagnosis of cerebral ischemic disorders (n = 7) or cerebral hemorrhage (n = 2) were studied. 99mTc-Bicisate brain uptake correlated with CBF and CMRO2. However, 99mTc-bicisate uptake did not reflect CBF in the single lesion showing luxury perfusion, which seemed to resemble a CMRO2 image. Though quantitative analysis showed the nonlinear correspondence of 99mTc-bicisate brain uptake with CBF and CMRO2, this correspondence could be corrected into a more linear relationship using a correction factor. 99mTc-Bicisate washout from the brain had no correlation to CBF and CMRO2. This diffuse decreasing washout rate was approximately 15% during the first hour after injection. By using the lipophilic fraction of arterial blood and a linearized correction of 99mTc-bicisate SPECT images, the feasibility of obtaining a factor-related CBF and CMRO2 was suggested from our data. These results suggested that 99mTc-bicisate had good characteristics for routine clinical use with SPECT to display the brain function in patients with neurological disorders.

Objective: MR imaging has a high sensitivity for detecting ischemic brain parenchyma. The aim of this study was to evaluate the changes in the signal intensity of infarcted brain parenchyma on MR images obtained within the first 3 hr after the onset of signs and symptoms in patients with embolic cerebral infarction., Materials and Methods: We studied MR images of 16 patients who had a diagnosis of embolic cerebral infarction (highly probable according to criteria of the National Institute of Neurological and Communicative Disorders and Stroke). T1-weighted, T2-weighted, and proton density-weighted MR images were obtained within 3 hr after the onset of symptoms. Two neuroradiologists who had no knowledge of the diagnoses reviewed the MR images of these 16 patients and 20 control subjects in random order and evaluated signal-intensity changes in the gray and white matter., Results: On proton density-weighted images, the central and cortical gray matter showed increased signal intensity in 63-69% and 88-94% of the patients, respectively. No abnormalities of the brain parenchyma were apparent on T1-weighted and T2-weighted images obtained within 3 hr after the onset of symptoms. The adjacent white matter appeared hyperintense on long TR images in only a few cases., Conclusion: An increased signal intensity in the gray matter on proton density-weighted images was the most characteristic parenchymal change seen on MR images of the brain obtained within 3 hr after embolic cerebral infarction.

IMP is a flow tracer due to a large first pass extraction fraction and high affinity in the brain, but significant clearance from the brain causes change of distribution when the scan start time is delayed. The purpose of the present study is to develop a new method to rapidly calculate a quantitative CBF image by taking into account for the clearance effects. A dynamic SPECT scan was performed on 5 subjects (4 patients with cerebral infarction and 1 normal volunteer) following slow intravenous infusion of 123I-IMP. The arterial input function was obtained by frequent blood sampling and by measuring an octanol extraction ratio for each sample. Firstly, non-linear least square fitting (NLS) was performed to investigate the tracer kinetics of 123I-IMP. The 3 compartment model analysis yielded negligibly small k3 (retaining rate constant) (0.0056 +/- 0.0128 (ml/ml/min)), and consistent k1 (transport rate constant) with those determined by 2 compartment model (2CM) analysis (r = 0.96, p < 0.001). In addition, k1 was consistent with CBF measured by 15O water PET technique. These observations suggested validity of using 2CM for describing the IMP tracer kinetics. Secondly, a weighted integration (WI) technique has been implemented to calculate rapidly images of CBF and partition coefficient (Vd). The WI technique yielded values of CBF (k1) and Vd (k1/k2). They were confirmed to be consistent with those determined by NLS technique (CBF; r = 0.99, p < 0.001, Vd; r = 0.99, p < 0.001), and calculated k1 agreed well with PET CBF (r = 0.91, p < 0.001). We observed changed Vd in infarcted patients. This supports an importance for calculating of Vd image. Vd image will provide additional clinical information because 123I-IMP binding mechanism may be related to cell viability.

The authors examined 50 patients with cerebral glioma with use of positron emission tomography (PET) and L-[methyl]-[11C]methionine to assess the grade of malignancy and the extent of cerebral glioma. Carbon-11 methionine was highly accumulated in the lesion in 31 of 32 patients with high-grade glioma and 11 of 18 patients with low-grade glioma. The rate of uptake of C-11 methionine in high-grade glioma was significantly higher than in low-grade glioma (P < .001). However, in individual cases it was difficult to evaluate the grade of malignancy only from the degree of C-11 methionine accumulation. In most cases, the area of increased accumulation of C-11 methionine did not correspond to the abnormalities seen at computed tomography (CT). Surgical intervention confirmed that methionine PET delineated the extent of cerebral glioma more clearly than did CT. The authors concluded that methionine PET has greater utility in assessing the extent rather than the grade of malignancy of cerebral glioma.

We have developed a new method to quantitate regional cerebral blood flow (CBF) using 123I-IMP and SPECT. This technique requires two SPECT scans and one blood sampling. Based on the 2 compartment model (influx; k1 and outflux; k2), a table between k2 and ratio of 1st scan counts/2nd scan counts was calculated, and a table look up procedure yielded a unique pair of k1 (CBF) and distribution volume (Vd = k1/k2) for each region of interest (ROI). The arterial input function was obtained by one point blood sampling to calibrate the standard input function, which has been obtained from the previous study on 12 subjects. This method was applied to 5 subjects including 1 healthy volunteer and 4 patients with cerebral infarction, and the regional CBF results were compared with those measured by H2(15)O PET technique. Optimized scan time combination was 40, 180 min which provided the best correlation with H2(15)O-CBF. The Vd values obtained in infarcted regions were significantly smaller than those in normal regions, suggesting the importance of measuring Vd for each ROI.

Technetium-99m ethyl cysteinate dimer (ECD) has recently developed for SPECT imaging in assessment of cerebral perfusion. We evaluated the arterial blood clearance and the regional brain uptake of Tc-99m ECD compared with the regional CBF measured by PET in patients with cerebrovascular disease. Nine patients with diagnosis of cerebral ischemic disorders (N = 7) and cerebral hemorrhage (N = 2) were studied. PET study was performed with HEADTOME IV by O-15 steady state inhalation method. Immediately after the PET study, 555-740 MBq (5-20 mCi) of Tc-99m ECD was injected intravenously. After injection arterial blood sampling was performed sequentially, and we separated lipophilic fraction from whole blood using ethyl acetate in two cases. The SPECT imaging with Tc-99m ECD (ECD-SPECT) was started 5 min (first imaging) and 60 min (second imaging) after the administration using a high resolution ring type SPECT system (HEADTOME II). Several ROIs were placed on practically the same anatomical location on both SPECT and PET images. Clearance of the tracer in arterial whole blood and lipophilic fraction was rapid. Concerning to the distribution pattern of ECD-SPECT images there was no differences between the 1st imaging and the 2nd imaging, although about 15% of diffuse decrease of Tc-99m ECD uptake was shown in the 2nd images. The brain distribution of ECD-SPECT was comparable to the pattern of CBF image by PET. The regional relative counts of ECD-SPECT corresponded closely to the CBF value by PET, but it was no linear correlation between brain uptake of ECD-SPECT and PET-CBF.(ABSTRACT TRUNCATED AT 250 WORDS)

Using positron emission tomography (PET), cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were measured in 32 healthy volunteers aged from 27 to 67 years. In bilateral putamen, left supratemporal, left infrafrontal and left parietal cortices, CMRO2 showed a significant decline during aging. The age-related decline of CBF was seen only at the left superior temporal cortex. The mean CMRO2 was significantly lower in the elder group (over 51 years old) than in the younger group (under 50 years old), whereas no significant difference in mean CBF between the two groups. The poor correlation of CBF to the age could be explained partly by the fact that CBF is easily influenced by the physiological, psychological and/or environmental factors. The age-related changes of CMRO2 were more marked in the association cortices of the left hemisphere than in that of the right hemisphere.

Magnetic resonance imaging of subarachnoid hemorrhage (SAH) due to aneurysm rupture was evaluated in relation to CT findings in nine patients. Six patients were studied within 3 days and the other three patients were studied 4 to 6 days from the ictus of SAH using a 0.5 Tesla superconducting unit. In all of the patients, hematoma in the subarachnoid space and ventricles was demonstrated by the proton density-weighted spin echo sequence, which showed that bloody cerebrospinal fluid (CSF) had a higher signal intensity than brain tissue or normal CSF. Magnetic resonance imaging was more sensitive in detecting SAH and more informative as to the site of the ruptured aneurysm than CT. Despite some limitations in applying it to patients with acute SAH, magnetic resonance imaging has clear advantages in the diagnosis of SAH.

Cardiac PET elicits an accurate relationship between myocardial blood flow (MBF) and tissue viability, which is evaluated by myocardial FDG uptake (MFU). To differentiate reversible tissue from necrotic tissue after the ischemic event, we from necrotic tissue after the ischemic event, we measured absolute MBF and MFU in patients with myocardial infarction. The MBF obtained by O-15 water and dynamic PET was accurately corrected by employing a tissue fraction (a) for the partial volume effect, including wall-motion effect. MFU was also corrected by using the tissue fraction. The subjects consisted of 5 patients with non-Q-wave infarction and 7 patients with Q-wave infarction. The regions of interest were selected from the infarcted area, each corresponding to regions with Q-wave or non-Q-wave. The MBFs in regions with Q wave (0.36 +/- 0.14 ml/min/g) were lower than those without Q wave (0.74 +/- 0.29 ml/min/g) (p less than 0.005). MFUs in regions without Q-wave (0.061 +/- 0.028) were higher than those with Q-wave (0.038 +/- 0.017) (p less than 0.05). The highest threshold of MBF in regions where Q-wave was detected was 0.55 ml/min/g. It is concluded that we will able to find the threshold of electrophysiological dysfunction in the infarcted region with this method.

We studied 15 patients clinically suspected to have recurrent brain tumor or radiation injury, using positron emission tomography (PET) with 18F-fluorodeoxyglucose (18FDG) and L-methyl-11C-methionine (11C-Met). PET with 11C-Met (Met-PET) clearly delineated the extent of recurrent brain tumor as focal areas of increased accumulation of 11C-Met, and was useful for early detection of recurrent brain tumor. PET with 18FDG (FDG-PET) showed focal 18FDG-hypermetabolism in one patient with malignant transformation of low grade glioma, and demonstrated its usefulness for evaluation of malignant transformation. 18FDG-hypometabolism was observed in all patients with radiation injury, but was also found in one patient with recurrent malignant brain tumor. 11C-Met uptake in 3 patients with radiation injury was similar to that of the normal cortical tissue. FDG-PET can be used to initially exclude recurrent brain tumor which is seen as 18FDG-hypermetabolism. The combined use of Met-PET in addition to FDG-PET can improve the accuracy of differentiation of recurrent brain tumor with 18FDG-hypometabolism from radiation injury.

The cervical carotid Doppler velocity is determined by the cardiovascular function, hemodynamic characteristics of proximal vascular beds, the carotid artery, and the distal vascular beds, i.e., cerebral circulation. If the former three factors remain constant, cervical carotid Doppler velocimetry reflects the cerebral circulation. The purpose of this report is to study whether the cervical carotid Doppler velocimetry reflects cerebral circulation or not. Parameters measured by the common carotid Doppler velocimetry were compared with cerebral blood flow (CBF) in the internal carotid arterial distribution measured by positron emission tomography (PET) in 50 patients, aged from 33 to 72 years old (mean: 56.5 +/- 8.6). These subjects were 14 with cerebral infarction, 12 with no abnormality (normal volunteers), 5 with brain tumor, 2 with normal pressure hydrocephalus, 3 with spinocerebellar degeneration, and so on. CBF was measured by the 15O-gas steady state method or H2(15)O autoradiographic method using a HEADTOME III scanner. Subsequently, pulsed Doppler flow velocimetry of the common carotid artery was performed using a RT-3600 scanner which employed a 5-MHz transducer, and systolic velocity (SV), diastolic velocity (DV), mean velocity (MV), and pulsatility index (PI) were measured. Cerebral angiography was performed in every patient except for normal volunteers, and it demonstrated no evidence of stenoocclusive lesions in the cervical carotid artery. X-ray computed tomogram (CT) was also performed in all patients. We compared CBF in the internal carotid arterial distribution with SV, DV, MV, and PI.(ABSTRACT TRUNCATED AT 250 WORDS)

The changes of cerebral blood flow (CBF) and metabolism of normal brain tissue after surgery, radiation, and chemotherapy in brain tumor patients were measured by positron emission tomography (PET). The subjects consisted of 6 men and 3 women, and were from 11 to 62 years old. Those were four patients with glioblastomas, one patient with malignant oligodendroglioma, one patient with astrocytoma grade II, one patient with astrocytoma grade III, one patient with pontine glioma, one patient with pineal germinoma. Seven patients were operated and pathohistologically diagnosed. Two patients with pineal germinoma and pontine glioma were not operated and radiologically diagnosed. Of 7 operated patients, first PET was performed before operation in 3 patients, and from 10 to 16 days after operation in 4 patients. Following first PET, the patients were treated with irradiation (1 case), or with both irradiation and chemotherapy (8 cases). The total radiation dose for tumor was from 59 to 61 Gy distributed in a period of 6-8 weeks. Whole brain irradiation was performed up to 30 or 40 Gy, with a remaining dosimetry (20-30 Gy focused on the tumor field. Chemotherapy consisted of intravenous administration of ACNU and oral administration of FT-207. Second PET was performed 1 month after therapy (9 cases), and third PET was performed from 4 to 24 months after therapy (6 cases). Fourth PET was performed in 2 patients (22 and 35 months after therapy), and fifth PET was performed in one patient (35 months after therapy).(ABSTRACT TRUNCATED AT 250 WORDS)

Sequential measurements of local cerebral glucose metabolism were performed in a case with Creutzfeldt-Jakob disease. The diagnosis was based on the characteristic clinical symptoms and EEG. Cerebral glucose metabolism (CMRGlc) was measured by positron emission tomography (PET) and 18F-fluorodeoxyglucose. CMRGlc was decreased to about 45% of the normal value. At that time, X-ray CT revealed little brain atrophy. The decrease of CMRGlc was prominent in cerebral cortices, but the metabolic decrease was slight in striatal body, cerebellum, and brainstem. The motor cortex and occipital lobe showed relatively preserved metabolism among the cerebral cortices. Six months after the first PET measurement, X-ray CT showed marked brain atrophy. Decrease of cerebral glucose metabolism advanced furthermore. However, the progress of the decrease was relatively small in the basal ganglia, brainstem, and cerebellar nucleus. These findings differ from the findings that was known by pathological study. These results suggest that measurement of CMRGlc by PET is useful for the early detection and for understanding of the pathophysiology of this disease.

Ten patients with low grade glioma were examined with positron emission tomography (PET) using 11C-methyl-L-methionine (11C-Met). In 4 cases, follow-up study was performed after radiation therapy. 11C-Met uptake index was calculated by sequential arterial blood sampling and PET image on 45 minutes after injection. The tumor was clearly seen in the images, and uptake index in the tumor lesion was higher than that in the normal cortex. The uptake of 11C-Met was observed in a recurrent lesion that was confirmed by operation. 11C-Met uptake indices were decreased in the tumor lesions after radiation therapy. From these results PET with 11C-Met is a useful clinical tool for diagnosis of low grade gliomas.

Absolute myocardial blood flow (MBF) and myocardial FDG uptake (MFU) in the fasting state were determined in 5 patients who underwent aorto-coronary bypass operation, using O-15 water, F-18 fluoro-deoxyglucose and dynamic PET before and after the operation. In the patent graft region, MBF was increased from 0.59 +/- 0.17 ml/min/g to 0.77 +/- 0.14 ml/min/g (p less than 0.05). Mean MBF was increased from 0.69 +/- 0.22 ml/min/g to 0.83 +/- 0.18 ml/min/g (p less than 0.05). MFU in the fasting state was significantly decreased in high MFU region compared with low MFU region (p less than 0.005). Quantitative evaluation of MBF and MFU before aorto-coronary bypass operation was quite useful to determine adequate indication of the operation.

Sequential positron emission tomography (PET) and single photon emission tomography (SPECT) were performed in an 11-year-old girl who was clinically diagnosed as acute disseminated encephalomyelitis (ADEM). She had fever, stupor, loss of sight and left hemiparesis on admission to our hospital. X-ray CT (XCT) demonstrated a hypodense lesion in the right fronto-parietal white matter. In the 1st PET study, CBF and CMRO2 were reduced in both hemispheric white and gray matter, particularly in the right fronto-parietal lesion. The XCT abnormality was improved in the subsequent scan when the patient had improved except visual disturbance. When visual disturbance was worsened again, and a new hypodense lesion was appeared in the left frontal white matter on XCT, the 2nd PET study was performed. CBF and CMRO2 were recovered except the left frontal white and gray matter. SPECT study was also performed and the image was almost similar to CBF image of PET scan. The changes and distributions of CBF and CMRO2 were related to her symptoms and clinical course. Reduced CBF and CMRO2 of whole brain is thought to be characteristic of ADEM. From the experiences of this case, PET measurements is useful for the understanding of neuronal functional abnormalities of ADEM, and is more useful for the detection of recovery or relapsing process than XCT.

To clarify the kinetics of N-isopropyl [123I]p-iodoamphetamine (IMP) in the brain, 2-compartment analysis was applied for brain SPECT with 57-minute dynamic scan in 9 subjects. The model consisted of blood component and brain tissue component. Two transfer rate constants were defined; k1 showed the rate from the blood to the brain tissue, and k2 was that of back diffusion. The late scan was performed 210 minutes after the tracer injection. Suitable k values best fitting to the dynamic data were determined for all regions of interest. Predicted regional cerebral activity at 210 minutes using 57-minute dynamic data was well agreed with measured activity. These showed the kinetics of IMP in the brain was well described by the 2-compartment model. The partition coefficient (k1/k2 ratio) was as large as about 35, and almost constant in the various brain structures including hypoperfused areas. These findings indicated that the initial IMP images reflected the reasonable CBF distribution, which gave relatively reliable CBF values even if using microsphere model.

The oxygen extraction fraction (OEF) at maximally vasodilated tissue in patients with chronic cerebrovascular disease was evaluated using positron emission tomography. The vascular responsiveness to changes in PaCO2 was measured by the H2(15)O autoradiographic method. It was correlated with the resting-state OEF, as estimated using the 15O steady-state method. The subjects comprised 15 patients with unilateral or bilateral occlusion and stenosis of the internal carotid artery or middle cerebral artery or moyamoya disease. In hypercapnia, the scattergram between the OEF and the vascular/responsiveness to changes in PaCO2 revealed a significant negative correlation in 11 of 19 studies on these patients, and the OEF at the zero cross point of the regression line with a vascular responsiveness of 0 was 0.53 +/- 0.08 (n = 11). This OEF in the resting state corresponds to exhaustion of the capacity for vasodilation. The vasodilatory capacity is discussed in relation to the lower limit of autoregulation.

An investigation was carried out to study the changes in the cerebral metabolic rate for glucose (CMRGlc) after high-dose methotrexate infusion (HD-MTX) in leukemic children, compared with the rate before such treatment. This is the first report on the relation between HD-MTX and the CMRGlc. An infusion of HD-MTX significantly reduced the glucose metabolism. It is suggested that this depression of the CMRGlc may have been associated with acute neurotoxicity of MTX. Measurement of the CMRGlc may be of value in detecting neurotoxicity of MTX. The reasons for these metabolic alterations need further investigation.

We investigated cerebral blood flow and metabolism, and cerebral vascular response in 9 patients with cerebrovascular Moyamoya disease or unilateral Moyamoya phenomenon using positron emission tomography (PET). The subjects consisted of 5 men and 4 women, and were from 9 to 60 years old. Five patients had bilateral occlusion in the carotid fork with Moyamoya vessels (fulfilled the criteria of cerebrovascular Moyamoya disease), and four patients had unilateral Moyamoya phenomenon. The PET scanner used was the HEADTOME III, of which spatial resolution in clinical use was 10 mm full width at half-maximum (FWHM) in the image plane. Cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), cerebral oxygen extraction fraction (OEF), and cerebral blood volume (CBV) were measured in resting state by the 15O-labelled gases steady state method in every patient and 22 normal controls (17 men and 5 women, and from 26 to 64 years old). Consecutively cerebral vascular responses were measured by H215O autoradiographic method in resting state, hypercapnia, hypocapnia, and hypertension. Forced hypercapnia, hypocapnia, and hypertension were achieved by 7% CO2 inhalation, hyperventilation, and venous infusion of angiotensin II, respectively. CMRO2 of the whole brain was significantly lower in patients than in normal controls (p less than 0.05), and CBV of the lentiform nucleus significantly increased in patients (p less than 0.01). This reflected Moyamoya vessels in the basal ganglionic regions. In 3 of 5 patients with bilateral Moyamoya vessels, CBF and CMRO2 in the symptomatic cerebral hemisphere were lower than that in the nonsymptomatic hemisphere.(ABSTRACT TRUNCATED AT 250 WORDS)

Using positron computed tomography (PCT) and the 15O labeled gas steady-state inhalation technique, regional cerebral blood flow (rCBF), cerebral oxygen consumption (rCMRO2), and oxygen extraction fraction (rOEF) can be measured quantitatively in humans. We quantitatively examined the relationship between focal ischemic lesions and intact regions as detected by X-ray CT in such areas as the territory of the contralateral middle cerebral artery (MCA), thalami, pons, and cerebellar hemispheres. Twenty-three PCT measurements in 13 patients with unilateral ischemic infarction in the MCA territory as detected by X-ray CT were performed. Remote effects from cerebral infarction of the MCA territory were observed in the contralateral MCA territory, ipsilateral thalamus, brainstem, and contralateral cerebellar hemisphere. Slight depression of rCBF and rCMRO2 was also observed in the contralateral thalamus and ipsilateral cerebral hemisphere; rOEF was normal in these areas. Though the depression of rCBF and rCMRO2 due to remote effects was detected in all periods, it was mildly observed 0 to 6 days after onset. The reduction of rCBF and rCMRO2 due to remote effects was less than the morphological as well as the functional threshold. The phenomenon is probably caused by neuronal deactivation, and the regions with depressed blood flow and metabolism may be in a "resting" state.