Technetium 99m HMPAO scanning in patients with subarachnoid haemorrhage: a preliminary study

Technetium 99m hexamethylpropylene amine oxime (HMPAO) is an agent which, when injected intravenously, gives images which reflect cerebral blood flow. Seven patients who had suffered subarachnoid haemorrhage were examined by cerebral angiography and by 99Tcm HMPAO scanning. The two studies were compared and in six cases there was evidence of decreased cerebral perfusion in relation to the ruptured aneurysm causing the subarachnoid haemorrhage. In one case no cause for the haemorrhage was demonstrated angiographically, and the HMPAO study was normal. In two of the six cases, spasm of the cerebral artery distal to the ruptured aneurysm was seen angiographically and it appears that 99Tcm HMPAO scanning does not correlate with gross arterial spasm but reflects smaller degrees of cerebral underperfusion not demonstrable by angiography. The results demonstrate a relationship between local decreased cerebral perfusion and ruptured cerebral aneurysm and may be of use in determining which aneurysm has bled in patients who have more than one aneurysm demonstrated angiographically.