Nuclear Medicine Cerebral Perfusion Imaging: Clinical Protocols, Quantitative Interpretation, and Pharmacologic Considerations for Radiologists and Pharmacists
Abstract
Background: Cerebral perfusion imaging is a cornerstone of neurodiagnostic practice, offering physiologic insights into cerebral blood flow that structural imaging cannot provide. Nuclear medicine techniques—primarily SPECT and PET—enable functional mapping of perfusion and metabolism, aiding diagnosis in stroke, epilepsy, dementia, and other neurologic disorders.
Aim: To review clinical protocols, quantitative interpretation, and pharmacologic considerations in nuclear medicine cerebral perfusion imaging, emphasizing interprofessional collaboration between radiologists and pharmacists.
Methods: This narrative review synthesizes consensus guidelines, physiologic principles, and tracer pharmacokinetics relevant to SPECT and PET imaging. It examines radiopharmaceutical properties, acquisition protocols, quantitative strategies, and pharmacologic challenge testing, particularly acetazolamide-based cerebrovascular reserve assessment.
Results: Lipophilic SPECT tracers (Tc99m-ECD, Tc99m-HMPAO) provide stable perfusion “snapshots,” enabling ictal epilepsy localization and cerebrovascular reserve evaluation. PET offers absolute quantification of cerebral blood flow and metabolism using O-15 and F-18 tracers, though logistical constraints limit routine use. Pharmacologic challenges reveal exhausted autoregulatory capacity in chronic occlusive disease, guiding revascularization decisions. Nuclear perfusion imaging demonstrates clinical utility in brain death confirmation, stroke risk stratification, dementia differentiation, and functional assessment after trauma.
Conclusion: Nuclear medicine cerebral perfusion imaging delivers unique physiologic data that complement structural imaging, influencing diagnosis, risk assessment, and therapeutic planning. Optimal outcomes depend on standardized protocols, careful patient preparation, and coordinated teamwork to ensure safety and interpretive validity.
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Copyright (c) 2025 Al Anoud Abdullah Raheel Al Anzi, Mahasen Fawaza Alharbi, Watin Hutayl H. Al-Shammari, Sheam Saeed Hussain, Budur Mohammed Alanazi, Samarah Adel Basakran, Nouf Derea Alkahtani, Manal Awad Alahmari, Eman Abdullah Alturki, Sara Aman Farj Alsediri, Dalal Munays Al-Qahtani, Raghad Yasir Abuzaid, Faisal Alqahtani
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