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Mutoh T, Totsune T, Takenaka S, Tatewaki Y, Nakagawa M, Suarez JI, Taki Y, Ishikawa T. Reduced CBF recovery detected by longitudinal 3D-SSP SPECT analyses predicts outcome of postoperative patients after subarachnoid haemorrhage. Clin Exp Pharmacol Physiol 2017; 45:127-132. [PMID: 28981977 DOI: 10.1111/1440-1681.12867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 11/27/2022]
Abstract
The aim of this study was to evaluate the impact of cerebral blood flow (CBF) recovery obtained from brain single-photon emission computed tomography (SPECT) images on postoperative outcome after aneurysmal subarachnoid haemorrhage (SAH). Twenty-nine patients who had undergone surgical clipping for ruptured anterior communicating artery aneurysms were analyzed prospectively. Routine measurements of CBF were performed using technetium-99 m hexamethyl propyleneamine oxine SPECT on days 4 and 14 after SAH. Regional voxel data analyzed by three dimensional stereotactic surface projection (3D-SSP) were compared between patients and age-matched normal database (NDB). In 3D-SSP analysis of all patients, cortical hypoperfusion around the surgical site in bilateral frontal lobes was evident on day 4 (P < .05 vs NDB), which was improved significantly on day 14. However, the recovery was less complete in patients with poor clinical grades (P < .05) and presenting symptoms attributable to delayed cerebral ischaemia (DCI) (P < .05) than those without. Multivariate analysis showed that patients with mild to moderate CBF recovery (relative Z-score differences of <4) (P = .014; odds ratio, 2.5; 95% confidence interval, 1.93-3.31) was independently associated with poor functional outcome at 3 months. We conclude that reduced CBF recovery detected by serial 3D-SSP SPECT image analyses can be a potential predictor of poor prognosis in postoperative patients after SAH.
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Affiliation(s)
- Tatsushi Mutoh
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan.,Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Tomoko Totsune
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Shunsuke Takenaka
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan
| | - Yasuko Tatewaki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Manabu Nakagawa
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yasuyuki Taki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Tatsuya Ishikawa
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan
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Han JH, Park YS, Lee WH, Koong SS, Min KS, Lee MS, Kim YG, Kim DH, Yi KS, Cha SH. Cerebral-perfusion-based single-photon emission computed tomography (SPECT) staging using NeuroGam® in patients with moyamoya disease. Childs Nerv Syst 2016; 32:1471-7. [PMID: 26661381 DOI: 10.1007/s00381-015-2974-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral angiography (CA) is the gold standard for moyamoya disease (MMD) staging and diagnosis, but CA findings are not well correlated with clinical symptoms. The purpose of this study was to establish novel cerebral-perfusion-based staging for MMD that is well correlated with clinical symptoms. MATERIALS AND METHODS From 2010 to 2015, regional cerebrovascular reserve (rCVR) was examined by single-photon emission computed tomography (SPECT) using NeuroGam® (Segamicorp, Houston, TX, USA) in 30 patients (17 women, 13 men; 60 hemispheres; mean 42.0 years old [range 5-60 years old]) with MMD, which was diagnosed by CA and magnetic resonance angiography (MRA). Brain CT or brain magnetic resonance imaging (MRI) was used to evaluate neurological conditions such as transient ischemic attack (TIA), cerebral hemorrhage, and cerebral infarction. A novel staging system for MMD was developed by combining findings from CA, MRI, and SPECT with NeuroGam®. RESULTS Our novel staging system was strongly associated with clinical symptoms. Twenty-two hemispheres out of 60 were categorized as stage I, 24 hemispheres were categorized as stage II, and 14 hemispheres were categorized as stage III. Hemispheres with higher scores exhibited a higher incidence of clinical symptoms. These findings indicate that cerebral-perfusion-based staging is predictive of MMD clinical symptoms. CONCLUSION Perfusion-based SPECT staging correlates well with clinical symptoms and may be a reliable alternative to the Suzuki staging by CA.
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Affiliation(s)
- Jai-Hyuck Han
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea
| | - Young Seok Park
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea.
| | - Won Hyoung Lee
- Department of Nuclear Medicine, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
| | - Sung-Soo Koong
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea.,Department of Nuclear Medicine, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea.,Department of Radiology, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
| | - Kyung-Soo Min
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea
| | - Mou-Seop Lee
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea
| | - Young-Gyu Kim
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea
| | - Dong-Ho Kim
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea
| | - Kyung-Sil Yi
- Department of Radiology, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
| | - Sang-Hoon Cha
- Department of Radiology, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
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IWANAGA T, HARADA M, KUBO H, FUNAKOSHI Y, KUNIKANE Y, MATSUDA T. Operator-bias-free Comparison of Quantitative Perfusion Maps Acquired with Pulsed-continuous Arterial Spin Labeling and Single-photon-emission Computed Tomography. Magn Reson Med Sci 2014; 13:239-49. [DOI: 10.2463/mrms.2013-0117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Takashi IWANAGA
- Department of Medical Imaging, Institute of Health Biosciences, The University of Tokushima Graduate School
| | - Masafumi HARADA
- Department of Radiology, Institute of Health Biosciences, The University of Tokushima Graduate School
| | - Hitoshi KUBO
- Department of Radiology, Institute of Health Biosciences, The University of Tokushima Graduate School
| | - Yasuhiro FUNAKOSHI
- Department of Medical Imaging, Institute of Health Biosciences, The University of Tokushima Graduate School
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Marushima A, Tsurushima H, Suzuki K, Nakai Y, Nemoto H, Matsumura A. Time-Course Analysis of Brain Perfusion Single Photon Emission Computed Tomography Using a Three-Dimensional Stereotactic Region-of-Interest Template in Patients with Moyamoya Disease. World Neurosurg 2011; 76:304-10. [DOI: 10.1016/j.wneu.2011.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 01/14/2011] [Accepted: 02/02/2011] [Indexed: 10/16/2022]
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Hamano SI, Higurashi N, Koichihara R, Oritsu T, Kikuchi K, Yoshinari S, Tanaka M, Minamitani M. Interictal cerebral blood flow abnormality in cryptogenic West syndrome. Epilepsia 2010; 51:1259-65. [PMID: 20132286 DOI: 10.1111/j.1528-1167.2009.02495.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To elucidate the abnormality of interictal regional cerebral blood flow (rCBF) of West syndrome at the onset. METHODS Quantitative measurement of rCBF with an autoradiography method using N-isopropyl-((123)I) p-iodoamphetamine single photon emission computed tomography (SPECT) was performed on 14 infants with cryptogenic West syndrome. Regions of interest (ROIs) for rCBF were placed automatically using an automated ROI analysis software (three-dimensional stereotactic ROI template), and were grouped into 12 segments: callosomarginal, precentral, central, parietal, angular, temporal, posterior cerebral, pericallosal, lenticular nucleus, thalamus, hippocampus, and cerebellum. We compared rCBF between the patients and seven age-matched infants with cryptogenic focal epilepsy as a control group. The patients were divided into two groups according to the duration from onset to SPECT, to compare rCBF. RESULTS Quantitative analysis revealed cerebral hypoperfusion in cryptogenic West syndrome with normal SPECT images under visual inspection. In bilateral central, posterior cerebral, pericallosal, lenticular nucleus, and hippocampus, and in the left parietal, temporal, and cerebellum, and in the right angular and thalamus segments there were statistical differences (p < 0.05). Compared with the duration from onset to SPECT, there were no significant differences of rCBF in all segments. DISCUSSION Broad cerebral hypoperfusion with posterior predominance involving the hippocampus and lenticular nucleus implies that even cryptogenic West syndrome has a widespread cerebral dysfunction at least transiently, which would correspond to clinical manifestations of hypsarrhythmia and epileptic spasms. Hippocampal hypoperfusion suggests the dysfunction of hippocampal circuitry in the brain adrenal axis, and may contribute to subsequent cognitive impairment of cryptogenic West syndrome.
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Affiliation(s)
- Shin-ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
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