Quantitative, non-invasive cerebral blood flow measurements with non-diffusible tracers using a heart-rate-dependent recirculation correction--application in carotid surgery.

A general method is described for computation of blood flow from time-activity curves using intravenous injection of the non-diffusible radio-tracer technetium pertechnetate. A technique of recirculation correction is adopted which predicts the start and end of recirculation depending on the patient's heart rate. This method allows one to clearly separate the first transit from the following recirculation. A correction for bolus dispersion of the intravenously injected tracer is also used. The evaluation of cerebral dynamic perfusion studies in 126 unselected adult patients resulted in a normal CBF of 44.5 ml/min/100 g +/- 5% and a decreased CBF of less than 40 ml/min/100 g. The presented method was also applied for flow measurement on the neck vessels. A good correlation between values obtained from these regions and the corresponding cerebral hemispheres was found. The method was also tested in 40 patients with angiographically proven neck vessel stenosis and in 15 patients before and after surgery of carotid stenosis. The results prove that the haemodynamic relevance of carotid stenosis on cerebral blood flow can be quantified. The accuracy of the method is estimated better than 5% for cerebral blood flow values and better than 15% for blood flow values gained over the neck vessel regions.