A method for the continuous measurement of cerebral blood flow in man by means of radioactive krvoton (Kr79)

The measurement of blood flow in humans using radioactive tracers

Since the first description of the movement of blood around the body by William Harvey, the accurate measurement of blood velocity has provided a major challenge for medical science. This review looks at the contribution made by techniques using radioactive tracers. Initially consideration is given to the fundamental problem of how to measure the amount of radiotracer in an organ with sufficient accuracy, using both single-photon and positron-emitting tracers. The various models used to link tracer behaviour with blood flow are then discussed and the article closes with a detailed review of the clinical applications of blood flow measurements.

Reference values for resting blood flow to organs of man

The lack of a reliable quantitative description of blood flow in man has hampered the development of accurate biokinetic models of essential elements, drugs, imaging agents, and carcinogens. In this paper we review and analyse data on blood flow and identify representative percentages of cardiac output and absolute blood flow rates to organs and tissues of man for use as reference values for biokinetic models. To keep the review and analysis to a manageable size we have limited attention to the resting state and have suggested reference values for absolute and relative flow rates only for adult males and females.

XIII. Cerebral circulation and metabolism in stroke. Cerebral circulation and metabolism in stroke study group

An understanding of the cerebral circulation is so fundamental to comprehension of the pathogenesis of stroke that cerebral blood flow and metabolism merit review in this series of reports. The authors recognize that the research described here is very technical in nature and may appear to have little practical application to clinical medicine. Nevertheless, these matters are basic to the development of precise methods for the measurement of regional cerebral blood flow in man which could be used to monitor the therapy of stroke with greater success than is possible at present.

Validation of jugular venous flow as an index of total cerebral blood flow

Values of total cerebral blood flow in man measured by the indicator dilution method are compared with values of total internal jugular venous flow measured by the thermal dilution method. Except in the case of an extremely labile cerebral hemodynamic state, the results agree within the accuracy of the two methods, suggesting that for the supine patient total internal jugular venous flow provides a good index of total cerebral flow.

The relatively short measurement time associated with nondiffusible indicators (dye or thermal dilution) facilitates detection of transient changes in total CBF or differential jugular flow that would tend to be averaged out with diffusible indicator methods.

A mathematical analysis of the potential errors in the computation of total flow using the average of bilateral jugular venous dilution curves from a unilateral internal carotid injection is presented. This error can be partially corrected if the ratio of flow in one internal jugular to total flow is known.

An analysis of potential computational errors under nonsteady state flow conditions (change in flow during the period between alternate carotid injections) is presented. Such flow changes can effect substantial errors in the computation of individual hemispheric or internal jugular flow and smaller errors in the computation of total flow.

Newer techniques of cerebral blood flow measurement

A variety of methods for measuring cerebral blood flow have been developed in the past 25 years since Kety and Schmidt developed their method based on the Fick principle. None of the currently used methods approaches the clinical ideal, since none of the techniques are accurate, reproducible and noninvasive. Most accurate techniques involve catheterization of internal carotid artery and/or jugular vein with those attendant risks. There has been considerable enhancement of our understanding of the pathophysiology of cerebral circulation, particularly in the areas of brain injury and disordered systemic metabolism, but the clinical usefulness of the test at the present time is limited.

EQUATIONS FOR MEASURING BLOOD FLOW BY EXTERNAL MONITORING OF RADIOISOTOPES

It is possible by external monitoring alone to measure blood flow per unit volume through any vascular bed accessible to external monitoring of the radioactive tracer if the tracer input function or if the quantity of tracer entering the system is known. The methods proposed exploit the fact that the mean transit time through the system is the flow per unit volume of distribution of tracer. The equations are free of assumptions that require solutions as exponentials or any other specified frequency function of transit times.

If the input function is known, measurement of the concentration of tracer in blood leaving the part sensed by the external detector, combined with external detection of radioactivity, can lead to measurement of absolute blood flow.

A preliminary report of experimental and clinical observations upon cervical carotid artery blood flow

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