Brain perfusion SPECT with 99mTC-ECD and serum neuron-specific enolase in patients with spontaneous subarachnoid haemorrhage and clinical vasospasm

Abstract

Aim: To estimate the association between single photon emission computed tomography (SPECT) imaging and neuro-specific enolase (NSE) serum level measurement in patients with subarachnoid haemorrhage (SAH) and also to present our experience in using these data for patient evaluation. Material and method: Thirty-five patients (18 female and 17 male, mean age 57.5 ± 11.9 y) with clinical findings of vasospasm after SAH underwent 99mTC-ECD SPECT imaging. In 23 out of the 35 patients, serum levels of NSE were assessed on admission. Brain perfusion was measured semi-quantitatively using symmetrical regions of interest, automatically drawn over cortical and subcortical structures on consecutive transverse slices. A summed perfusion defect score (SPDS) was used to' quantify the brain perfusion. Statistical analysis was carried out using the Kruskal-Wallis test, Mann-Whitney U test and ROC analysis, as appropriate. Results: Eighteen patients had abnormal SPECT studies. The patients were divided into three groups according to NSE levels. Group I comprised 13 patients with NSE values ≤ 15 ng/ml, group II comprised 7 patients with 15 ng/ml <NSE < 19 ng/ml, and group III comprised 3 patients with NSE ≥ 19 ng/ml. SPECT/SPDS data and NSE levels of groups II and I were positively linearly correlated (Spearman's coeff = 0.71, p<0.05), while group III clearly defines a separate population. The linear correlation between SPECT/SPDS and NSE was statistically significant (p<0.05). Very high NSE values were noticed in three patients who eventually died. Conclusion: Both SPECT abnormalities and high serum NSE concentration are potentially helpful in the evaluation of patients with SAH. ©Borgis