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Interference of Scalp and Skull with External Measurements of Brain Isotope Content: Part 1

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Interference of Scalp and Skull with External Measurements of Brain Isotope Content: Part 1 INTERFERENCE OF SCALP AND SKULL WITH EXTERNAL MEASUREMENTS OF BRAIN ISOTOPE CONTENT: PART 1. ISOTOPE CONTENT OF SCALP AND SKULL William H. Oldendorf and Youichi lisaka Wadsworth Hospital, Veterans Administration Center and UCLA Center for the Health Sciences, Los Angeles, California Although interference from overlying tissues com a 180-cn tube distance. Correction for linear mag plicates all organ counting, it is to be expected that nification was made. superimposed scalp and skull tissue isotope will be An estimate of the skull and scalp volume cover a particularly important source of error in quantita ing the hemispheres, rostral to a plane passing tive studies of brain because of the very low con through the orbital roofs and internal occipital pro centration most tracers achieve in brain tissue due tuberance, was made by considering the skull and to the blood-brain barrier. Experimental animal and scalp to be hemispheric surfaces whose mean radii radiographic human studies were undertaken to de and thicknesses were calculated from radiographic fine the magnitude of scalp and skull isotope content measurements at the reference points indicated in relative to brain for two brain-scanning agents, rep Fig. 1. The volume of cranial cavity rostral to this resentative of small and large labeled molecules. plane was estimated by calculating the hemispheric Such an estimate requires a knowledge of the tissue volume using the mean interior radius of the skull. isotope concentrations and the relative weights of This approximates the brain volume rostral to the the cranial tissue compartments. Tissue volumes and floor of the anterior and middle cranial fossae and weights of brain, scalp and skull were estimated from the tentorium cerebelli. postmortem radiography in ten humans. The o9mTc@ The estimated volumes will be only approximate pertechnetate and 1311-IHSAcontent of rabbit whole because of the irregular shape of the skull, but they blood, scalp, skull, brain and muscle were defined will provide some basis for estimating the absolute as a function of time. In a separate study blood vol isotope content of these cranial tissues. Some of the umes of the animal tissues were calculated using inferior portion of the temporal lobes will be cx 125Ifl45A and its contribution to each total tissue cluded from these estimates. count was estimated. Isotope distribution in animal tissues. New Zealand From these animal and human data, the extent of white rabbits (3—4kg) were given 100—200 @Ciof scalp and skull interference with external-brain iso o9mTc..pertechnetate or 20 @@Ciof 131I-IHSA intra tope measurements was estimated for clinical studies venously.* At various intervals afterwards the ani using collimation designed for total cranial counting. mats were decapitated after pentobarbital anesthesia. However, the basic data is applicable to other count The radioactivity per unit weight of tissue was deter ing geometries. A technique for minimizing the scalp mined in whole blood, calvarial scalp, lumbar skin, and skull isotope contribution is presented. lumbar paraspinous muscle, brain and calvarial skull. Cerebrospinal fluid (CSF) was obtained by cisternal METHODS Radiographic estimation of human cranial tissue Received June 5, 1968; revision accepted Sept. 23, 1968. volumes. To estimate the volumes of the cranial For reprints contact: W. H. Oldendorf, Wadsworth V.A. cavity, calvarial skull and scalp in humans, radio Hospital, V.A. Center, Wilshire and Sawtelle Blvds., Los graphs were taken of ten unembalmed male human Angeles, Calif. 90073. C mmTc was obtained from a commercial mMo cow and heads postmortem. Separate radiographic exposure @9-IHSA and ‘9-IHSA from Abbott Laboratorie@. The techniques for skull and scalp detail were used with IHSA contained less than 2% dialyzable @9 or @1. Volume 10, Number 4 177 OLDENDORF AND ITSAKA FIG. 1. Cross.sectionshows points (heavy arrows) at which skull and scalp thickness were measured on radiographs. Only tissues rostral to heavy line were considered. puncture just before decapitation. The hair was clipped from the scalp and skin specimens. TABLE1. PERCENTAGEOF CRANIALTISSUE Correction for tissue blood content was obtained VOLUMESAND WEIGHTSESTIMATED in ten animals by intravenous injection of 125I-IHSA RADIOGRAPHICALLYIN MAN made 1 mm before decapitation as discussed by Percent.matedageEstimatedweightweightvolumeEsti Matthews (1 ) . It was assumed that at the end of 1 min (at decapitation) the radiolabel was confined ofPercent.ofofCranialcranialageofcranialtotaltissuetissuescranialtissuescranialcompartments(cc)volume(gm)tissues to the blood pool of the tissues and that reason ably complete intravascular mixing had occurred. The 125I-IHSA content of whole blood, scalp, lum Calvarial scalp 232 ±50 15.0 232 13.0 bar skin, lumbar paraspinous muscle, brain and Calvarial skull 254 ± 36 16.0 457 25.8 calvarial skull was determined and used to calculate Cranial cavity 1,083 ±85 69.0 1,083 61.1 the percent blood volume in each tissue specimen. Total 1,569 ±65 100.0 1772 100.0 The counts of 125I-IHSA per gram of tissue di Tissueweights were estimated from tissue volumesassum vided by the counts per gram of blood multiplied by ing a soft.tissue density of 1 and a bone density of 1.8. Skull probably has a density somewhat less than this be 100 was taken as the percentage of tissue which was cause of its numerous diploe. blood. The percentage is assumed to remain constant throughout any one experiment. The contribution of blood isotope to the tissue count will remain con stant if the blood concentration remains constant. TABLE2. RADIOGRAPHICESTIMATIONOF There is a small error resulting from the use of a CRANIAL SKULLAND SCALP VOLUMES IN MAN plasma label such as IHSA since this will define the AveragethicknessAverageVolume(1) plasma content of the tissue. Because the plasma of:skullof:radius (r) of:(V) volume of a tissue does not accurately represent its scalp(mm)scalpskull scalpskull whole-blood volume due to the lowered microcircu (cmi)5.96(mm)(cm) (cm)(cmi) latory hematocrit, the estimation of tissue blood Average 4.858.26 8.83254 232 volume from tissue blood-plasma content relative Standard to a whole-blood specimen will result in a somewhat deviation ±0.69 ±1.06 ±0.18 ±0.15 ±36 ±49 high estimation of tissue blood content. To correct S Each average represents results of ten studies as shown for this would require equal labeling of red cells and in Fig. 1. plasma, and this was not done here. RESULTS The percent isotope content of oomTc@pertechne@ tate and 131I-IHSA in scalp, skull, brain, lumbar The tissue volumes of human scalp, skull and skin, muscle and CSF relative to blood as a function cranial cavity determined postmortem by radio of time after injection is shown in Fig. 2A and 2B graphic measurements are shown in Fig. 1. The and in Table 3. The ratio of isotope concentrations percentage of total cranial tissue volume and weight in scalp and skull to brain is indicated in Fig. 3 and made up of scalp, skull and brain is given in Table Table 4. I . The averages for skull and scalp thicknesses are No correction for blood content has been made shown in Table 2. in Figs. 2 and 3 and Tables 3 and 4. Since these 178 JOURNAL OF NUCLEAR MEDICINE ISOTOPE CONTENT OF SCALP AND SKULL TABLE3. PERCENTAGETISSUERADIOACTIVITYRELATIVETO WHOLEBLOODOF 99mTc@PERTECHNETATE* AND ‘311-IHSAt(TISSUE/BLOOD x 100) @@mTc.pertechnetateTissue5mm1hr2 hrWhole hr6 hr24 blood100.0100.0100.0100.0100.0Scalp34.2 ±7.2Lumbar ± 7.358J± 6.546.4 ± 7.854.3 ±12.069.1 ±10.2Muscle5.5skin27J ± 7.553.8± 7.043.0 ± 8.947.6 ±3.651.3 ±2.5Skull14.0 ± 1.08.1± 0.66.3 ± 1.37.8 ±1.66.9 ±6.8Brain2.2 ± 5.131J± 2.1283 ± 6.525.4 ±8.334.3 ±1.3CSF0.17 ± 0.333± 0.83.3 ± 0.44.6 ±1.94.8 ±[email protected]± 0.050.51± 0.050.46 ± 0.170.52 ±0.210.37 mm1hr2 hr24 hr48 hr Whole blood 100.0 100.0 100.0 100.0 100.0 Scalp 5.6 ± 1.2 8.3 ± 3.7 11.9 ± 4.5 24.8 ± 4.4 32.2 ± 33 Lumbar skin 3.1 ± 0.1 4.3 ± 0.1 18.1 ± 5.3 27.2 ± 9.9 Muscle 2.2 ± 1.4 2.5 ± 1.0 1.8 ± 03 4.8 ± 1.8 5.4 ± 1.0 Skull (6.0 ± 1.0) 14.0 ± 4.9 20.3 ± 1.2 Brain 1j ± 0.3 2.5 ± 0.2 2.3 ± 0.1 2.5 ± 0.6 2.1 ± 0.3 CSF 0.05 ± 0.04 0.16 ± 0.50 1.05 ± 0.13 033 ± 0.16 0.80 ± 0.17 C Each figure represents an average of five animals. Isotope was injected (100—200 MCi), the animals decapitated at vari@ ous time intervals thereafter and the activity/unit weight of tissue determined. t Eachfigure representsan averageof five animals.Isotopewas injected(20 tCi), the animalsdecapitatedat various time intervals thereafter and activity/unit weight of tissue determined. AND131I-IHSATissueTABLE 4. RATIO OF TISSUECOUNT/BRAIN COUNT OF B9mTc@PERTECHNETATE 6hr24hrScalp 5mm‘@‘Tc-pedechnetatei hr 2hr 16.5 ± 2.0 ± 2.3 13.9 ± 2.0 13.2 ± 3.2 ± 1.8 Skull 6.0 ± 1.9 8.8 ± 1.1 8.8 ± 1.6 6.8 ± 3.6 6.5 ± 1.4 Muscle0.4Tissue 2.7 ± 0.216.3 2.3 ± 0.4 1.9 ± 0.3 1.9 ± 0.513.1 1.2 ± hrScalp 10 [email protected] 1 hr 2 hr 24 hr48 3.3 ± 1.1 ± 1.2 5.1 ± 1.8 10.4 ± 1.5 ± 2.8 Skull 3.7 ± 0.6 — — 6.4 ± 2J 10.3 ± 0.5 Muscle 1.3 ± 0.82J0.5TABLE 0.9 ± 0.5 0.8 ± 0.3 1.8 ± 0.715.5 2.6 ± 1251.IH5A*Tissue 5.TISSUE BLOOD CONTENT OF SkullBrain% ScalpSkin Muscle 0.09C blood volume 1.56 ±0.130.92 ± 0.07 0.56 ± 0.04 6.00 ± 0.331.80 ± Ten animals: 10 @&Ci/injection.
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