[en] We used the end-tidal concentration of xenon-133 (air curve) to estimate the profile of its arterial concentration in calculating cerebral blood flow. We examined the effects of pulmonary disease and artificial ventilation on the air curve and the calculated cerebral blood flow. We studied the relation between arterial and end-tidal xenon activities in 19 subjects, of whom 15 had pulmonary dysfunction. The t 1/2 of the declining phases of the arterial and air curves were used to express their shapes. The mean +/- SD reference t 1/2 from 15 normal volunteers was 26.8 +/- 8.4 seconds. The mean +/- SD t 1/2 s of the air and arterial curves from the 15 patients with pulmonary dysfunction were 10.4 +/- 2.9 and 33.8 +/- 10.9 seconds. The degree of pulmonary dysfunction (expressed as the pulmonary shunt percentage) correlated with distortion of the air curve. Substituting the arterial for the air curve, mean calculated cerebral blood flow (as the initial slope index) increased from 40 to 61 for the 12 patients with chronic obstructive pulmonary disease. The degree of underestimation of cerebral blood flow using the air curve correlated with the pulmonary shunt percentage. Our work confirms the problems of estimating cerebral blood flow in subjects with pulmonary dysfunction

[en] The limitations of 2-dimensional isotope techniques in the study of focal cerebral ischemia were investigated using the intra-carotid 133 xenon injection method and a 254 multidetector scintillation camera. To make sure that the detectors ''look'' directly on infarcted areas, only patients with infarcts involving cortical surface structures were included in the study. Eleven such patients were found among 43 consecutive patients with completed stroke, all investigated with CT-scan. The blood supply to the infarcted areas was evaluated using 3 different approaches: 1) The first minute washout of 133 xenon (rCBF), 2) the initial distribution of isotope during the first 5 sec and 3) the cumulated counts recorded during 15 min. Compton scatter and the ''look through phenomenon'' were responsible for the majority of counts recorded from the infarcted areas and the blood flow recorded was found to be grossly overestimated and much more influenced by the blood flow in the surroundings than in the ischemic area itself. However, using the 3 approaches, infarcted areas were always disclosed by our equipment. It is concluded that 2-dimensional isotope technique is not reliable for quantifying focal ischemic lesions. The method should be limited to the qualitative demonstration of the ischemic lesions for which it is fully reliable