Methods for measurement of cerebral blood flow in man

A survey of the currently available methods for the measurement of cerebral blood flow in man is given. Many of the clinically important brain diseases such as tumors, stroke, brain trauma or epilepsy entail focal or regional flow alterations. Therefore a special emphasis is placed on methods allowing measurements of regional cerebral flow, rCBF. The intra-arterial 133Xenon injection method is now widely used as a standard method for rCBF measurement. It affords a good two-dimensional resolution when using a suitable dynamic gamma camera which allows a high counting rate to be recorded. But, due to the superposition of tissues the three-dimensional resolution is limited. This, in particular, means that smaller areas of ischemia (low flow) tend to be overlooked whereas local hyperemia is readily discerned. The 133Xenon inhalation method is less accurate, contaminated by extra-cerebral uptake, and insensitive both for detecting regional ischemia and regional hyperemia. The spatial resolution is also much more limited. For these reasons great caution must be exercised in interpreting the results. Methods yielding three-dimensional rCBF data will be needed in order to gain more precise information both on spatial localization and, especially, on ischemic areas. The most promising is computer-assisted axial tomography with freely diffusible radioactive isotopes or with x-rays using an intra-arterial injection of contrast. But, the available techniques are still too slow: in order to measure blood flow one "exposure" must be taken every second. Only a few methods give quantitative information of the blood flow in the human brain. This is mainly due to the inaccessibility of the brain within the skull and to the complexity of the cerebral arterial and venous systems. Before reviewing the various methods used in man, it should be mentioned, that much of the fundamental knowledge has been gained by methods only applicable to animals. Measurements of the diameter of the small arteries on the surface of the brain antedates even the classical studies of Roy and Sherrington (1890). This technique continues to be useful, modern technical improvements consisting of the use of micropipettes and a stereo microscope in combination with an image splitter and a television camera which allows the accurate assessment of diameter variations of a few percent [22]. Autoradiography of brain slices using diffusible indicators is the best quantitative method for measuring local blood flow in a great many parts of the brain [7, 45]. Microspheres are also being used, but it is still not quite clear that this technique gives reliable quantitative data in small masses of tissue [34, 41, 50].