Applications of Nitroimidazole In Vivo Hypoxia Imaging in Ischemic Stroke

• Published in: Stroke (1970) Vol. 39; no. 5; pp. 1629 - 1637
• Main Authors: TAKASAWA, Masashi, MOUSTAFA, Ramez Reda, BARON, Jean-Claude
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-05-2008
• Subjects: Animals; Biological and medical sciences; Brain - metabolism; Brain - pathology; Brain - physiopathology; Brain Neoplasms - diagnosis; Brain Neoplasms - pathology; Brain Neoplasms - physiopathology; Diagnostic Imaging - methods; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Hypoxia-Ischemia, Brain - diagnosis; Hypoxia-Ischemia, Brain - pathology; Hypoxia-Ischemia, Brain - physiopathology; Ligands; Medical sciences; Models, Animal; Nervous system (semeiology, syndromes); Neurology; Nitroimidazoles - pharmacokinetics; Predictive Value of Tests; Stroke - diagnosis; Stroke - pathology; Stroke - physiopathology; Vascular diseases and vascular malformations of the nervous system; Cerebral infarction; Stroke; Oxygen; Nervous system diseases; Cardiovascular disease; imaging; Cerebral disorder; ischemia; Vascular disease; Central nervous system disease; nitroimidazole; Brain ischemia; Hypoxia; Positron emission tomography; Cerebrovascular disease; PET; Emission tomography
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/strokeaha.107.485938

Nitroimidazole imaging is a promising contender for noninvasive in vivo mapping of brain hypoxia after stroke. However, there is a dearth of knowledge about the behavior of these compounds in the various pathophysiologic situations encountered in ischemic stroke. In this article we report the findings from a systematic review of the literature on the use of the nitroimidazoles to map hypoxia after stroke.
We describe the characteristics of nitroimidazoles as imaging tracers, their pharmacology, and results of both animal and clinical studies during and after focal cerebral ischemia. Findings in brain tumors are also presented to the extent that they enlighten results in stroke. Early results from application of kinetic modeling for quantitative measurement of tracer binding are briefly discussed.
Based on this literature review, nitroimidazole hypoxia imaging agents are of considerable interest in stroke because they appear, both in animal models and in humans, to specifically detect the severely hypoxic viable tissue, but not the reperfused nor the necrotic tissue. To fully realize this potential in stroke, however, formal validation by concurrent measurement of tissue oxygen tension, together with development of novel ligands with faster distribution kinetics, faster clearance from normal tissue, and well-defined trapping mechanisms, are important goals for future investigations.