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Age-specific cerebral perfusion in 4- to 15-year-old children: a high-resolution brain SPET study using 99mTc-ECD
H Barthel1, M Wiener, C Dannenberg
1Department of Nuclear Medicine, University of Leipzig, Germany.
Insights
Normal local cerebral blood flow (lCBF) differs significantly between children and adults. Age-specific normal ranges for perfusion imaging are essential for accurate pediatric brain diagnostics, particularly for children aged 4-10 and 11-15 years.
Area of Science:
- Neuroscience
- Radiology
- Pediatric Imaging
Background:
- Establishing normal ranges for local cerebral blood flow (lCBF) is crucial for diagnosing cerebrovascular diseases.
- Previous studies have focused on adult populations, leaving a gap in understanding pediatric lCBF variations.
Purpose of the Study:
- To determine if adult normal ranges for lCBF are applicable to children aged 4-15 years.
- To investigate age-related changes in lCBF within the pediatric population.
Main Methods:
- Technetium-99m ethyl cysteinate dimer single-photon emission tomography (SPECT) was used to measure lCBF in 23 children (4-15 years) and 10 adults (27-56 years).
- Regional cerebral blood flow was quantified relative to cerebellar counts, and uptake per injected dose was analyzed.
- Correlations between age and relative local count density were examined in various cortical and subcortical regions.
Main Results:
- Children exhibited significantly higher relative cortical activity than adults, especially in left parietal, frontal, and temporal areas, and the cingulate cortex.
- Cerebral activity uptake per injected dose showed a significant inverse correlation with age in children (r = -0.77, P<0.001).
- Relative local count density in cortical regions also demonstrated inverse correlations with age, with differences noted between younger (4-10 years) and older (11-15 years) pediatric subgroups.
Conclusions:
- There are distinct age-related differences in normal lCBF between children (4-15 years) and adults.
- Age-adjusted normal flow maps are necessary for the diagnostic application of perfusion agents in pediatric populations.
- Separate normal ranges for lCBF should be established for children aged 4-10 and 11-15 years to ensure accurate interpretation of brain perfusion imaging.
Abstract:
This study addresses the question of whether the normal range for distribution of local cerebral blood flow (lCBF) in adults can be transferred to the 4- to 15-year-old age group. Twenty-three children (age: 4-15 years; mean 11+/-3 years, group I) and 10 adults (age: 27-56 years; mean 45+/-10 years, group II) without evidence of cerebrovascular disease or other brain diseases underwent technetium-99m ethyl cysteinate dimer single-photon emission tomography. Counts in cortical and subcortical regions of interest (ROIs) were related to those in cerebellar ROIs (= 100%). Relative cortical activity in group I exceeded that in group II, particularly in left parietal (107.6%+/-9.8% vs 84.1%+/-12.4%), left frontal (97. 7%+/-6.7% vs 79.4%+/-8.9%) and left temporal areas (99.7%+/-7.4% vs 84.9%+/-10.1%) and in the cingulate cortex (112.1%+/-9.1% vs 95. 9%+/-10.1%, P<0.05). Cerebral activity uptake per injected dose was inversely correlated with age in 19 children of group I (r = -0.77, P<0.001). In group I, there was also an inverse correlation between age and the relative local count density in the parietal (r = -0.42 to -0.57), frontal (r = -0.48), temporal (r = -0.42 to -0.58) and occipital cortex (r = -0.44). In these cortical regions relative counts differed when subgroups of children aged 4-10 and 11-15 years were analysed. It is concluded that there are systematic differences between 4- to 15-year-old children and adults with regard to normal lCBF. Diagnostic use of perfusion agents has to consider age-adjusted normal flow maps; normal ranges should be determined separately for the age groups 4-10 and 11-15 years.