Effect of Body Temperature on the Radionuclide Evaluation of Cerebral Blood Flow

Changes in regional cerebral blood flow (rCBF) may reflect physiological correlates of the disease state. In neuro-imaging studies, some diseases have frequently been reported to be associated with reduced or increased rCBF. In a previous study we had shown evidence of heat induced vasoconstriction of the carotid artery, which is the main vessel supplying blood to the brain. This vasoconstriction may lead to a decrease in cerebral blood flow in hyperthermic patients. Most radionuclide studies used to assess cerebral blood flow are routinely performed without taking into consideration patients' body temperature. In this regard it may be noted that results of radionuclide cerebral perfusion studies may be affected by hyperthermia, which could lead to false positive studies or misinterpretation of results when they are performed on patients suffering from various cerebrovascular diseases. The objective of the present study was to investigate the importance of body temperature and its effect on the results of radionuclide cerebral perfusion studies. Cerebral blood flow was assessed using Tc-99m hexamethylpropyleneamineoxime (Tc-99m HMPAO) imaging. Baseline scintigraphic images of the brain were obtained in 10 rabbits using a gamma camera equipped with a low energy parallel hole and high resolution collimator interfaced with a computer. Repeat brain studies were performed on the same rabbits at 3 and 6 days after raising the body temperature by 2 deg. C and 4 deg. C respectively using the same imaging protocol. The counts per pixel were determined on control and hyperthermia images. The uptake of Tc-99m HMPAO in the brain was found to be significantly reduced following hyperthermia implying reduction in blood flow. This decrease in cerebral perfusion appears to be variable from region to region, being more in the cerebral hemispheres, frontal areas (olfactory lobes) than in the cerebellum. Based on the results, the authors conclude that a rise in body temperature might alter regional cerebral blood flow and hence the final results of a radionuclide cerebral blood flow study. Therefore it is recommended that body temperature should be considered as one of the factors while interpreting a cerebral blood flow study, and as far as possible such studies should be conducted on patients in normothermic conditions to avoid misleading results. It is hoped that the results of our study would encourage researchers to carry out further studies on humans. (author)