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Muacevic A, Adler JR. Does Advanced Imaging Aid in the Preoperative Evaluation of Patients With Moyamoya Disease? Cureus 2022; 14:e29816. [PMID: 36337792 PMCID: PMC9622031 DOI: 10.7759/cureus.29816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background Moyamoya disease is characterized by progressive nonatherosclerotic stenosis and eventual occlusion of the supraclinoid cerebral arteries with the associated development of abnormal collateral vessels. Treatment of moyamoya disease revolves around restoring cerebral blood flow (CBF) distal to the steno-occlusive disease. Numerous modalities can be used to assess hemodynamic parameters. We sought to determine the impact of preoperative imaging on surgical decision-making. Methods A retrospective review was performed of all patients seen with the diagnosis of moyamoya. Patients were grouped on presentation based on CT/MRI findings of infarction, hemorrhage, or normal. Patients who did not have all of the preoperative tests were excluded. Preoperative radiological results were dichotomized as either normal or abnormal. Results During a five-year period, 34 patients with moyamoya met the inclusion criteria. All patients had an abnormal magnetic resonance angiography (MRA) Non-invasive Optimal Vessel Analysis (NOVA; VasSol, Inc, River Forest, IL). Three patients had normal initial MRI. All symptomatic patients had abnormal preoperative workup and underwent revascularization, as all were found to have abnormal single photon emission computed tomography (SPECT). The only occasion where the decision for surgery or type of surgery was influenced by imaging findings was in patients with nonclassical or minimal symptoms. Conclusion Although hemodynamic imaging studies can aid in establishing a preoperative baseline of CBF and cerebral vascular reserve (CVR) for follow-up studies, the true implication of these tests in the preoperative evaluation of clearly symptomatic moyamoya patients is debatable. In asymptomatic/mildly symptomatic patients, hemodynamic studies are necessary to determine the need for treatment. For symptomatic patients, surgery can be performed without an exhaustive and costly preoperative hemodynamic evaluation.
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Zhang S, Cao Y, Ren R, Qi J, Chen Y, Li Y. Effects of Cervical Rotatory Manipulation on Hemodynamics and Plaque Stability of Atherosclerotic Internal Carotid Artery in Rabbits. J Manipulative Physiol Ther 2022; 45:261-272. [PMID: 35907659 DOI: 10.1016/j.jmpt.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effects of cervical rotatory manipulation (CRM) on hemodynamics and plaque stability of atherosclerotic internal carotid artery (ICA) in rabbits. METHODS Forty rabbits were randomly divided into 4 groups: (1) internal carotid atherosclerosis (ICAS) rabbits treated with CRM (ICAS-CRM group); (2) ICAS rabbits treated without CRM (ICAS group), (3) Normal-CRM group (normal rabbits treated with CRM), and (4) blank control group. In the ICAS-CRM group and ICAS group, the ICAS model was induced by ICA balloon injury combined with a high-fat diet for 12 weeks. CRM was applied to rabbits in the ICAS-CRM and the Normal-CRM groups. During the study, an ultrasonography examination was performed for detecting plaque and hemodynamics on the ICAs. At the end of the study, all atherosclerotic ICAs were removed for histological and immunohistochemical detection. RESULTS The hemodynamics (especially end-diastolic velocity, resistance index, and pulsatility index) through the ICAs were adversely affected by atherosclerosis while not adversely affected by CRM. Compared with the ICAS group, the micro-vessel density and average integrated optical densities of macrophages in the ICAS-CRM group were significantly increased. Compared to the ICAS group, in the ICAS-CRM group, the atherosclerosis was more serious, and the tunica intima was more unstable. CONCLUSIONS Although CRM did not affect the hemodynamic index of ICA, it was observed to decrease the stability of severe ICAS plaques in rabbits, which may increase the plaque vulnerability.
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Affiliation(s)
- Shaoqun Zhang
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China, Shenzhen, Guangdong, China
| | - Yafei Cao
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China, Shenzhen, Guangdong, China
| | - Ruxia Ren
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Ji Qi
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Yili Chen
- Wang Jing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yikai Li
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China.
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Ogasawara K, Fujiwara S, Chida K, Terasaki K, Sasaki M, Kubo Y. Reduction in amyloid β deposition on 18F-florbetapir positron emission tomography with correction of cerebral hypoperfusion after endarterectomy for carotid stenosis. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2019; 9:316-320. [PMID: 31976161 PMCID: PMC6971482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
The process of amyloid β (Aβ) deposition in sporadic Alzheimer's disease remains unclear. However, hypoperfusion due to vascular pathology may precede Aβ deposition, as suggested by data from animal models and autopsy tissue from Alzheimer's disease patients. In this exploratory study, we examined the hypotheses that chronic cerebral hypoperfusion due to severe atherosclerotic stenosis of the internal carotid artery (ICA) increases Aβ deposition in the affected cerebral hemisphere and that correction of cerebral hypoperfusion after carotid endarterectomy (CEA) in such patients reduces Aβ deposition. Four patients with cerebral hemispheric hypoperfusion due to unilateral ICA stenosis (≥80%) and without episodes of carotid territory ischemic symptoms or infarcts in the bilateral cerebral hemispheres underwent brain perfusion single-photon emission computed tomography (SPECT) and Aβ deposition positron emission tomography (PET) with 18F-florbetapir before and after CEA. The asymmetry ratio of the radioactive counts in the affected cerebral hemisphere relative to that in the contralateral cerebral hemisphere was calculated on SPECT and PET images. In all four patients, the SPECT-perfusion asymmetry ratio was ≤0.81 before surgery and ≥0.90 after surgery. The PET-Aβ deposition asymmetry ratio ranged from 0.98 to 1.01 before surgery. The value in two patients remained at ≥0.97 after surgery, and in the other two patients, the value decreased to ≤0.91 after surgery. These findings suggested that chronic cerebral hypoperfusion due to severe atherosclerotic stenosis of the ICA does not increase Aβ deposition in the affected cerebral hemisphere, but correction of cerebral hypoperfusion after CEA often reduces Aβ deposition.
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Affiliation(s)
- Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical UniversityMorioka, Iwate, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical UniversityMorioka, Iwate, Japan
| | - Kohei Chida
- Department of Neurosurgery, Iwate Medical UniversityMorioka, Iwate, Japan
| | - Kazunori Terasaki
- Cyclotron Research Center, Iwate Medical UniversityMorioka, Iwate, Japan
| | - Makoto Sasaki
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical UniversityMorioka, Iwate, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical UniversityMorioka, Iwate, Japan
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Tomoeda H, Mikasa K, Chihara S, Sawada K, Tanaka H. Prediction of Postoperative Cerebral Infarction after Cardiovascular Surgery Using Quantitative Measurement of Cerebral Blood Flow with Brain Single-Photon Emission Computed Tomography. Ann Vasc Dis 2018; 11:511-519. [PMID: 30637007 PMCID: PMC6326055 DOI: 10.3400/avd.oa.18-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Prediction of postoperative cerebral infarction after cardiovascular surgery is difficult. The present study investigated whether quantitative evaluation of preoperative cerebral blood flow used in the Japanese EC-IC Bypass Trial (JET) study is useful for the prediction of postoperative cerebral infarction after cardiovascular surgery. First, patients were divided into two groups based on preoperative cerebral blood flow. In an evaluation using preoperative imaging, patients with good or mildly decreased preoperative cerebral blood flow, divided into clinical stage I or II by quantitative evaluation showed no postoperative cerebral infarction. However, 24% of patients with poor cerebral blood flow who were categorized as clinical stage II, experienced postoperative cerebral infarction. The incidence rate was not statistically significantly different when the groups were compared. Second, patients were divided into two groups based on the anatomical area of the brain affected corresponding to clinical stage II. Patients with a 10% and greater brain involvement had a significantly higher incidence of postoperative cerebral infarction (38%) compared to others (0%, p<0.01). This method may be useful for the prediction of postoperative cerebral infarction after cardiovascular surgery, but a further prospective study is needed. (This is a translation of J Jpn Coll Angiol 2017; 57: 125–133.)
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Affiliation(s)
- Hiroshi Tomoeda
- Department of Cardiovascular Surgery, Chikugo City Hospital, Chikugo, Fukuoka, Japan
| | - Keita Mikasa
- Department of Surgery, Iizuka City Hospital, Iizuka, Fukuoka, Japan
| | - Shingo Chihara
- Department of Cardiovascular Surgery, Yokokura Hospital, Miyama, Fukuoka, Japan
| | - Kentaro Sawada
- Department of Surgery, Saiseikai Futsukaichi Hospital, Chikushino, Fukuoka, Japan
| | - Hiroyuki Tanaka
- Department of Cardiovascular Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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SHIMADA Y, KOJIMA D, YOSHIDA J, KOBAYASHI M, YOSHIDA K, FUJIWARA S, OGASAWARA K. Transient Symptomatic Downregulation of Cortical Neurotransmitter Receptor Function Due to Cerebral Hyperperfusion after Arterial Bypass Surgery for a Patient with Ischemic Moyamoya Disease. Neurol Med Chir (Tokyo) 2018; 58:481-484. [PMID: 30369534 PMCID: PMC6236211 DOI: 10.2176/nmc.cr.2018-0143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/20/2018] [Indexed: 11/20/2022] Open
Abstract
Cerebral hyperperfusion syndrome following arterial bypass surgery is known as a surgical complication of moyamoya disease (MMD). How cerebral hyperperfusion affects neural function and causes neurological deficits remains unknown. We report here a case with cerebral hyperperfusion syndrome after arterial bypass surgery for ischemic MMD. Chronological changes of brain perfusion and central benzodiazepine receptor biding potential were observed using single-photon emission computed tomography. A 20-year-old woman with ischemic MMD underwent arterial bypass surgery. Six days later, cerebral hyperperfusion syndrome developed. During this syndrome, contralateral-to-ipsilateral cerebellar asymmetry of blood flow and a decrease in central benzodiazepine receptor binding potential in the area with hyperperfusion were observed. Four months later, these two findings resolved and a neurological examination revealed no abnormal signs. Cerebral hyperperfusion after arterial bypass surgery for ischemic MMD may lead to transient, reversible reduction of cerebral metabolism and downregulation of cortical neurotransmitter receptor function, resulting in transient neurological deficits.
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Affiliation(s)
- Yasuyoshi SHIMADA
- Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
| | - Daigo KOJIMA
- Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
| | - Jun YOSHIDA
- Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
| | - Masakazu KOBAYASHI
- Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
| | - Kenji YOSHIDA
- Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
| | - Shunrou FUJIWARA
- Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
| | - Kuniaki OGASAWARA
- Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
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Chen DW, Zheng J, Shi J, Yin YW, Song C, Yang F, Zhang YQ, Ma LN. Assessment of the Cerebral Hemodynamic Benefits of Carotid Artery Stenting for Patients with Preoperative Hemodynamic Impairment Using Cerebral Single Photon Emission Computed Tomography (SPECT) and Carbon Dioxide Inhalation. Med Sci Monit 2018; 24:5398-5404. [PMID: 30074982 PMCID: PMC6087634 DOI: 10.12659/msm.909401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effects of carotid artery angioplasty and carotid artery stenting (CAS) on cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) in patients with preoperative cerebrovascular hemodynamic impairment. MATERIAL AND METHODS Seventeen patients with unilateral severe internal carotid artery (ICA) stenosis and ipsilateral CVR impairment underwent CAS. CBF and CVR were measured by single photon emission computed tomography (SPECT) with inhalation of carbon dioxide (CO2) one week before and three months after CAS. Sixty-eight ROIs in the middle cerebral artery (MCA) territory were analyzed in 17 patients. RESULTS Before CAS, CVR was impaired in all ROIs. CBF was impaired in 16 ROIs (23.5%). The percentage of ROIs with impaired CBF was significantly increased in patients with ≥90% carotid artery stenosis (p=0.047) without collateral flow through the circle of Willis (p=0.005). CAS significantly increased CVR in ROIs with a normal preoperative CBF and impaired CVR, indicating mild hemodynamic impairment (0.9±6.7% vs. 4.9±8.6%) (p=0.014). CAS significantly increased CBF in ROIs with preoperative impaired CBF and impaired CVR, indicating severe hemodynamic impairment (79.1±7.5% vs. 86.7±10.0%) (p<0.001). Following CAS, ROIs with normal CBF and impaired CVR had a significantly increased percentage of improved CVR (p=0.047); ROIs with impaired CBF and impaired CVR had a significantly increased percentage of improved CBF (p=0.027). CONCLUSIONS The severity of preoperative hemodynamic impairment, which is related to the degree of carotid artery stenosis and cerebral collateral flow, may influence hemodynamic benefits by CAS.
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Affiliation(s)
- Da-Wei Chen
- Department of Neurology, Air Force General Hospital of the Chinese Peoples' Liberation Army, Beijing, China (mainland)
| | - Jin Zheng
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Jin Shi
- Department of Neurology, Air Force General Hospital of the Chinese Peoples' Liberation Army, Beijing, China (mainland)
| | - Yang-Wei Yin
- Department of Neurology, Air Force General Hospital of the Chinese Peoples' Liberation Army, Beijing, China (mainland)
| | - Chen Song
- Department of Neurology, Air Force General Hospital of the Chinese Peoples' Liberation Army, Beijing, China (mainland)
| | - Fen Yang
- Department of Neurology, Air Force General Hospital of the Chinese Peoples' Liberation Army, Beijing, China (mainland)
| | - Ying-Qian Zhang
- Department of Neurology, Air Force General Hospital of the Chinese Peoples' Liberation Army, Beijing, China (mainland)
| | - Lu-Na Ma
- Positron Emission Tomography (PET) Center, Air Force General Hospital of the Chinese Peoples' Liberation Army, Beijing, China (mainland)
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Validation of scatter limitation correction to eliminate scatter correction error in oxygen-15 gas-inhalation positron emission tomography images. Nucl Med Commun 2018; 39:936-944. [PMID: 29985832 DOI: 10.1097/mnm.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE High levels of radioactivity inside a facemask cause scatter correction (SC) errors that appear as photopenic artifacts on quantitative oxygen-15 (O) gas-inhalation positron emission tomography (PET) images. The present study aimed to validate the ability of scatter limitation correction (SLC) to eliminate SC errors in O gas-inhalation PET images acquired from patients and a phantom. MATERIALS AND METHODS We analyzed the SC errors in phantom images and calculated parametric images of the cerebral blood flow (CBF), cerebral blood volume, oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2). Phantoms comprised a cylinder and paper with radioactivity to simulate a facemask during (O)O2 gas inhalation. Parametric images were calculated from O gas-inhalation PET images of ten participants. All PET data were reconstructed using conventional SC as model-based SC and SLC. Images acquired from the phantoms and parametric images were assessed visually and quantitatively in the presence and absence of SC error. RESULTS SC error was evident in images derived from the paper phantom and at the slice level of the cerebellum in CBF, OEF, and CMRO2 images. The radioactivity concentration in the cylindrical phantom with the paper phantom significantly improved with SLC. The SLC also increased the quantitative indices of CBF, OEF, and CMRO2 by 23.8, 42.2, and 44.4%, respectively. CONCLUSION SLC visually eliminated the SC error and increased the quantitative parameters on O gas-inhalation images derived from a phantom and from patients.
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Wagatsuma K, Oda K, Miwa K, Inaji M, Sakata M, Toyohara J, Ishiwata K, Sasaki M, Ishii K. Effects of a novel tungsten-impregnated rubber neck shield on the quality of cerebral images acquired using 15O-labeled gas. Radiol Phys Technol 2017; 10:422-430. [PMID: 28823084 DOI: 10.1007/s12194-017-0414-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
The present study aimed to validate the effects of a novel tungsten-impregnated rubber neck shield on the quality of phantom and clinical 15O-labeled gas positron emission tomography (PET) images. Images were acquired in the presence or absence of a neck shield from a cylindrical phantom containing [15O]H2O (phantom study) and from three individuals using [15O]CO2, [15O]O2 and [15O]CO gas (clinical study). Data were acquired in three-dimensional (3D) mode using a Discovery PET/CT 710. Values for cerebral blood flow, cerebral blood volume, oxygen extraction fraction, and cerebral metabolic rate of oxygen with and without the neck shield were calculated from 15O-labeled gas images. Arterial radioactivity and count characteristics were evaluated in the phantom and clinical studies. The coefficient of variance (CV) for the phantom study and the standard deviation (SD) for functional images were also analyzed. The neck shield decreased the random count rates by 25-59% in the phantom and clinical studies. The noise equivalent count rate (NECR) increased by 44-66% in the phantom and clinical studies. Random count rates and NECR in [15O]CO2 images significantly differed with and without the neck shield. The improvement in visual and physical image quality with the neck shield was not observed in the phantom and clinical studies. The novel neck shield reduced random count rate and improved NECR in a 3D PET study using 15O-labeled gas. The image quality with the neck shield was similar to that without the neck shield.
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Affiliation(s)
- Kei Wagatsuma
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-1, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.,Department of Health Sciences, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Keiichi Oda
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-1, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.,Faculty of Health Science, Hokkaido University of Science, Sapporo, Japan
| | - Kenta Miwa
- School of Health Science, International University of Health and Welfare, Ohtawara, Japan
| | - Motoki Inaji
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-1, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.,Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Muneyuki Sakata
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-1, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Jun Toyohara
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-1, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Kiichi Ishiwata
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-1, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.,Institute of Cyclotron and Drug Discovery Research, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan.,Department of Biofunctional Imaging, Fukushima Medical University, Fukushima, Japan
| | - Masayuki Sasaki
- Department of Health Sciences, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Kenji Ishii
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-1, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
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Optimal Brain 99mTc-Ethyl Cysteinate Dimer SPECT Imaging and Analysis to Detect Misery Perfusion on 15O PET Imaging in Patients With Chronic Occlusive Disease of Unilateral Major Cerebral Artery. Clin Nucl Med 2017; 42:499-505. [PMID: 28481786 PMCID: PMC5464751 DOI: 10.1097/rlu.0000000000001670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Misery perfusion is defined as marginally sufficient cerebral blood supply relative to cerebral metabolic demand. The aim of the present study was to determine the optimal brain Tc-ethyl cysteinate dimer (ECD) SPECT imaging and analysis to detect misery perfusion on O PET imaging in patients with chronic occlusive disease of unilateral internal carotid or middle cerebral artery (MCA). METHODS For 97 patients, cerebral blood flow, cerebral metabolic rate of oxygen, and oxygen extraction fraction were measured using O PET; Tc-ECD SPECT was performed using dynamic scanning with a scan duration of 10 minutes each for 50 minutes after tracer administration. A region of interest was placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres in all standardized images using a 3-dimensional stereotaxic region-of-interest template and affected-to-contralateral asymmetry ratio in the MCA territory (ARMCA) and contralateral-to-affected asymmetry ratio in the cerebellar hemisphere (ARcbl) were calculated. RESULTS The ARMCA or ARcbl on Tc-ECD SPECT with a scan time of 20 to 30 minutes after tracer administration (ARMCA20-30 or ARcbl20-30) was correlated with ARMCA on PET cerebral blood flow (r = 0.654) or ARMCA on PET cerebral metabolic rate of oxygen (r = 0.576), respectively, more strongly than with other scan times. The area under the receiver operating characteristic curve for detecting abnormally elevated ARMCA on PET oxygen extraction fraction was significantly greater for ARcbl20-30/ARMCA20-30 (0.947) than for ARMCA20-30 alone (0.780) (difference between areas, 0.167; P = 0.0001) on Tc-ECD SPECT. CONCLUSIONS Combination of asymmetries in the cerebellar and cerebral hemispheres on Tc-ECD SPECT in a scan time of 20 to 30 minutes after tracer administration optimally detects misery perfusion in unilateral internal carotid artery or MCA occlusive disease.
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Combined measurement of cerebral and cerebellar blood flow on preoperative brain perfusion SPECT imaging predicts development of new cerebral ischemic events after endarterectomy for symptomatic unilateral cervical carotid stenosis. Clin Nucl Med 2014; 38:957-61. [PMID: 24152651 DOI: 10.1097/rlu.0000000000000279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to determine whether the ratio of blood flow contralateral-to-affected asymmetry in the cerebellar hemisphere to blood flow affected-to-contralateral asymmetry in the middle cerebral artery (MCA) territory (AR(cbl)/AR(MCA)) on preoperative brain perfusion SPECT could identify patients at risk for new cerebral ischemic events after carotid endarterectomy (CEA) for symptomatic unilateral cervical carotid stenosis. For the purposes of this study, new cerebral ischemic events included neurological deficits and cerebral ischemic lesions on diffusion-weighted MRI. METHODS Brain blood flow was assessed using 123I-IMP SPECT in 101 patients. A region of interest was automatically placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres using a 3-dimensional stereotaxic region-of-interest template, and the AR(cbl)/AR(MCA) was calculated. Diffusion-weighted MRI was performed within 3 days before and 24 hours after surgery. Patients were neurologically tested before induction of general anesthesia and after recovery from general anesthesia. RESULTS New cerebral ischemic events after CEA were observed in 12 patients (12%). Multivariate analysis revealed that only high AR(cbl)/AR(MCA) was significantly associated with the development of new postoperative cerebral ischemic events (95% confidence interval, 1.945-8.452; P = 0.0070). The AR(cbl)/AR(MCA) provided 75% sensitivity, 84% specificity, and 39% positive and 96% negative predictive values in predicting development of new postoperative cerebral ischemic events. CONCLUSIONS The AR(cbl)/AR(MCA) on preoperative brain perfusion SPECT could identify patients at risk for new cerebral ischemic events after CEA for unilateral cervical carotid stenosis.
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Nomura JI, Ogasawara K, Saito H, Terasaki K, Matsumoto Y, Takahashi Y, Ogasawara Y, Saura H, Yoshida K, Sato Y, Kubo Y, Ogawa A. Combination of blood flow asymmetry in the cerebral and cerebellar hemispheres on brain perfusion SPECT predicts 5-year outcome in patients with symptomatic unilateral major cerebral artery occlusion. Neurol Res 2014; 36:262-9. [PMID: 24512020 DOI: 10.1179/1743132813y.0000000300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Misery perfusion increases the risk of stroke recurrence in patients with symptomatic major cerebral artery occlusion. The ratio of brain perfusion contralateral-to-affected asymmetry in the cerebellar hemisphere to brain perfusion affected-to-contralateral asymmetry in the cerebral hemisphere (CblPR/CbrPR) indicates affected-to-contralateral asymmetry of oxygen extraction fraction (OEF) in the cerebral hemisphere. The purpose of the present study was to determine whether the CblPR/CbrPR on brain perfusion single-photon emission computed tomography (SPECT) predicts 5-year outcomes in patients with symptomatic unilateral occlusion of the middle cerebral artery (MCA) or internal carotid artery (ICA). METHODS Brain perfusion was assessed using N-isopropyl-p-[123I]-iodoamphetamine (123I-IMP) SPECT in 70 patients. A region of interest (ROI) was manually placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres, and the CblPR/CbrPR was calculated. All patients were prospectively followed for 5 years. The primary end points were stroke recurrence or death. RESULTS A total of 17 patients exhibited the primary end points, 11 of whom experienced subsequent ipsilateral strokes. Multivariate analysis revealed that only high CblPR/CbrPR was significantly associated with the development of the primary end point or subsequent ipsilateral strokes (95% confidential limits [CIs], 1.130-3.145; P = 0.0114 or 95% CIs, 2.558-5.140; P = 0.0045, respectively). The CblPR/CbrPR provided 65% (11/17) or 91% (10/11) sensitivity and 88% (47/53) or 88% (52/59) specificity in predicting the primary end point or subsequent ipsilateral strokes, respectively. CONCLUSIONS The CblPR/CbrPR on brain perfusion SPECT predicts 5-year outcomes in patients with symptomatic unilateral occlusion of the MCA or ICA.
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