1
|
Wong TH, Shagera QA, Ryoo HG, Ha S, Lee DS. Basal and Acetazolamide Brain Perfusion SPECT in Internal Carotid Artery Stenosis. Nucl Med Mol Imaging 2020; 54:9-27. [PMID: 32206127 PMCID: PMC7062956 DOI: 10.1007/s13139-019-00633-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/19/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022] Open
Abstract
Internal carotid artery (ICA) stenosis including Moyamoya disease needs revascularization when hemodynamic insufficiency is validated. Vascular reserve impairment was the key to find the indication for endarterectomy/bypass surgery in the atherosclerotic ICA stenosis and to determine the indication, treatment effect, and prognosis in Moyamoya diseases. Vascular reserve was quantitatively assessed by 1-day split-dose I-123 IMP basal/acetazolamide SPECT in Japan or by Tc-99m HMPAO SPECT in other countries using qualitative or semi-quantitative method. We summarized the development of 1-day basal/ acetazolamide brain perfusion SPECT for ICA stenosis, both quantitative and qualitative methods, and their methodological issues regarding (1) acquisition protocol; (2) qualitative assessment, either visual or deep learning-based; (3) clinical use for atherosclerotic ICA steno-occlusive diseases and mostly Moyamoya diseases; and (4) their impact on the choice of treatment options. Trials to use CT perfusion or perfusion MRI using contrast materials or arterial spin labeling were briefly discussed in their endeavor to use basal studies alone to replace acetazolamide-challenge SPECT. Theoretical and practical issues imply that basal perfusion evaluation, no matter how much sophisticated, will not disclose vascular reserve. Acetazolamide rarely causes serious adverse reactions but included fatality, and now, we need to monitor patients closely in acetazolamide-challenge studies.
Collapse
Affiliation(s)
- Teck Huat Wong
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744 South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Qaid Ahmed Shagera
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744 South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Hyun Gee Ryoo
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744 South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Seunggyun Ha
- Division of Nuclear Medicine Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744 South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea
| |
Collapse
|
2
|
Xiao ZP, Jin K, Wan JQ, Lin Y, Pan YH, Jin YC, Zhang XH. Measurement of cerebrovascular reserve by multimodal imaging for cerebral arterial occlusion or stenosis patients: protocol of a prospective, randomized, controlled clinical study. Trials 2020; 21:49. [PMID: 31915058 PMCID: PMC6950822 DOI: 10.1186/s13063-019-3967-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/06/2019] [Indexed: 12/01/2022] Open
Abstract
Background Cerebrovascular reactivity (CVR) is the change in cerebral blood flow in response to a vaso-active stimulus, and may assist the treatment strategy of ischemic stroke. However, previous studies reported that a therapeutic strategy for stroke mainly depends on the degree of vascular stenosis with steady-state vascular parameters (e.g., cerebral blood flow and CVR). Hence, measurement of CVR by multimodal imaging techniques may improve the treatment of ischemic stroke. Methods/design This is a prospective, randomized, controlled clinical trial that aimed to examine the capability of multimodal imaging techniques for the evaluation of CVR to improve treatment of patients with ischemic stroke. A total of 66 eligible patients will be recruited from Renji Hospital, Shanghai Jiaotong University School of Medicine. The patients will be categorized based on CVR into two subgroups as follows: CVR > 10% group and CVR < 10% group. The patients will be randomly assigned to medical management, percutaneous transluminal angioplasty and stenting, and intracranial and extra-cranial bypass groups in a 1:1:1 ratio. The primary endpoint is all adverse events and ipsilateral stroke recurrence at 6, 12, and 24 months after management. The secondary outcomes include the CVR, the National Institute of Health stroke scale and the Modified Rankin Scale at 6, 12, and 24 months. Discussion Measurement of cerebrovascular reserve by multimodal image is recommended by most recent studies to guide the treatment of ischemic stroke, and thus its efficacy and evaluation accuracy need to be established in randomized controlled settings. This prospective, parallel, randomized, controlled registry study, together with other ongoing studies, should present more evidence for optimal individualized accurate treatment of ischemic stroke. Trial registration Chinese Clinical Trial Registry, ID: ChiCTR-IOR-16009635; Registered on 16 October 2016. All items are from the World Health Organization Trial Registration Data Set and registration in the Chinese Clinical Trial Registry: ChiCTR-IOR-16009635.
Collapse
Affiliation(s)
- Zhi-Peng Xiao
- Department of Neurosurgery, Renji Hospital, School of Medicine of Shanghai JiaoTong University, Shanghai, 200127, People's Republic of China
| | - Ke Jin
- Department of Neurosurgery, Renji Hospital, School of Medicine of Shanghai JiaoTong University, Shanghai, 200127, People's Republic of China
| | - Jie-Qing Wan
- Department of Neurosurgery, Renji Hospital, School of Medicine of Shanghai JiaoTong University, Shanghai, 200127, People's Republic of China
| | - Yong Lin
- Department of Neurosurgery, Renji Hospital, School of Medicine of Shanghai JiaoTong University, Shanghai, 200127, People's Republic of China
| | - Yao-Hua Pan
- Department of Neurosurgery, Renji Hospital, School of Medicine of Shanghai JiaoTong University, Shanghai, 200127, People's Republic of China
| | - Yi-Chao Jin
- Department of Neurosurgery, Renji Hospital, School of Medicine of Shanghai JiaoTong University, Shanghai, 200127, People's Republic of China
| | - Xiao-Hua Zhang
- Department of Neurosurgery, Renji Hospital, School of Medicine of Shanghai JiaoTong University, Shanghai, 200127, People's Republic of China.
| |
Collapse
|
3
|
Kang HG, Lee S, Ryu HU, Shin Y. Identification of Cerebral Artery Stenosis Using Bilateral Photoplethysmography. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:3253519. [PMID: 29755714 PMCID: PMC5884199 DOI: 10.1155/2018/3253519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 01/24/2018] [Indexed: 11/21/2022]
Abstract
Cerebral artery stenosis is currently diagnosed by transcranial Doppler (TCD), computed tomographic angiography (CTA), or magnetic resonance angiography (MRA). CTA exposes a patient to radiation, while CTA and MRA are invasive and side effects were related to contrast medium use. This study aims to provide a technique that can simply discriminate between people with normal blood vessels and those with cerebral artery stenosis using photoplethysmography (PPG), which is noninvasive and inexpensive. Moreover, the measurement takes only 120 seconds and is conducted on the fingers. The technique projects the light of a specific wavelength and analyzes the pulse waves which are generated when the blood passes through the blood vessels according to one's heartbeat using the transmitted light. Normalization was performed after dividing the extracted pulse waveform into windows, and maximum positive and negative amplitudes (MPA, MNA) were extracted from the detected pulse waves as features. The extracted features were used to identify normal subjects and those with cerebral artery stenosis using a linear discriminant analysis. The study results showed that the recognition rate using MPA was 92.2%, MNA was 90.6%, and combined MPA + MNA was 90.6%. The technique proposed is expected to detect early stage asymptomatic cerebral artery stenosis and help prevent ischemic stroke.
Collapse
Affiliation(s)
- Hyun Goo Kang
- Department of Neurology, Chosun University School of Medicine and Hospital, No. 375 Seosuk-dong, Dong-gu, Gwangju 501-759, Republic of Korea
| | - Seogki Lee
- Department of Thoracic Surgery, Chosun University School of Medicine and Hospital, No. 375 Seosuk-dong, Dong-gu, Gwangju 501-759, Republic of Korea
| | - Han Uk Ryu
- Department of Neurology, Chunbuk National University School of Medicine and Hospital, San 2-20, Geumam-dong, Deokjin-gu, Jeonbuk 561-180, Republic of Korea
| | - Youngsuk Shin
- School of Information and Communication Engineering, Chosun University, No. 309 Pilmun-daero, Dong-gu, Gwangju 61452, Republic of Korea
| |
Collapse
|
4
|
Zhang D, Xu P, Qiao H, Liu X, Luo L, Huang W, Zhang H, Shi C. Carotid DSA based CFD simulation in assessing the patient with asymptomatic carotid stenosis: a preliminary study. Biomed Eng Online 2018. [PMID: 29530025 PMCID: PMC5848462 DOI: 10.1186/s12938-018-0465-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Cerebrovascular events are frequently associated with hemodynamic disturbance caused by internal carotid artery (ICA) stenosis. It is challenging to determine the ischemia-related carotid stenosis during the intervention only using digital subtracted angiography (DSA). Inspired by the performance of well-established FFRct technique in hemodynamic assessment of significant coronary stenosis, we introduced a pressure-based carotid arterial functional assessment (CAFA) index generated from computational fluid dynamic (CFD) simulation in DSA data, and investigated its feasibility in the assessment of hemodynamic disturbance preliminarily using pressure-wired measurement and arterial spin labeling (ASL) MRI as references. Methods The cerebral multi-delay multi-parametric ASL-MRI and carotid DSA including trans-stenotic pressure-wired measurement were implemented on a 65-year-old man with asymptomatic unilateral (left) ICA stenosis. A CFD simulation using simplified boundary condition was performed in DSA data to calculate the CAFA index. The cerebral blood flow (CBF) and arterial transit time (ATT) of ICA territories were acquired. Results CFD simulation showed good correlation (r = 0.839, P = 0.001) with slight systematic overestimation (mean difference − 0.007, standard deviation 0.017) compared with pressure-wired measurement. No significant difference was observed between them (P = 0.09). Though the narrowing degree of in the involved ICA was about 70%, the simulated and measured CAFA (0.942/0.937) revealed a functionally nonsignificant stenosis which was also verified by a compensatory final CBF (fronto-temporal/fronto-parietal region: 51.58/45.62 ml/100 g/min) and slightly prolonged ATT (1.23/1.4 s) in the involved territories, together with a normal left–right percentage difference (2.1–8.85%). Conclusions The DSA based CFD simulation showed good consistence with invasive approach and could be used as a cost-saving and efficient way to study the relationship between hemodynamic disorder caused by ICA stenosis and subsequent perfusion variations in brain. Further research should focus on the role of noninvasive pressure-based CAFA in screening asymptomatic ischemia-causing carotid stenosis.
Collapse
Affiliation(s)
- Dong Zhang
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Pengcheng Xu
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Science, Southern Medical University, Guangzhou, 510515, China
| | - Hongyu Qiao
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Xin Liu
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Science, Southern Medical University, Guangzhou, 510515, China
| | - Liangping Luo
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Wenhua Huang
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Science, Southern Medical University, Guangzhou, 510515, China
| | - Heye Zhang
- Institute of Advanced Computing and Digital Engineering, Shenzhen Institutes of Advanced Technology, 1068 Xueyuan Ave, Xili University Town, Nanshan, Shenzhen, 518055, Guangdong Province, China.
| | - Changzheng Shi
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangzhou, 510630, Guangdong Province, China.
| |
Collapse
|
5
|
The Pathophysiology of Watershed Infarction: A Three-Dimensional Time-of-Flight Magnetic Resonance Angiography Study. J Stroke Cerebrovasc Dis 2017; 26:1966-1973. [PMID: 28694111 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.016] [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: 04/05/2017] [Accepted: 06/08/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Most of the time, watershed infarcts (WIs) involve steno-occlusive carotid disease. The pathophysiological mechanism could be predicted by their pattern: internal WIs (IWIs) are thought to be due to hemodynamic impairment in contrast to cortical WIs (CWIs), which are more likely to be caused by microembolic phenomena. We used a 3D time-of-flight (TOF) magnetic resonance angiography (MRA) study to assess this hypothesis. METHODS In 45 consecutive patients with a recent WI and ipsilateral cervical carotid stenosis, clinical and radiological data were obtained retrospectively. 3D TOF MRA were analyzed both qualitatively and quantitatively (internal carotid and anterior, middle and posterior cerebral arteries). Then, 2 groups were determined depending on their radiological patterns: WIs with (IWI+) or without (IWI-) an internal watershed. RESULTS Thirty-two of the 45 patients (71%) had IWIs that were or were not associated with CWIs (IWI+), while 13 patients (29%) had only CWIs (IWI-). There was no significant relationship between the radiological pattern and the demographic data, the cardiovascular risk factors, or the degree of stenosis. However, IWI+ patients more frequently had motor weakness (P = .03) than CWI patients. An ipsilateral reduced middle cerebral artery intensity on 3D TOF MRA in both qualitative and quantitative analyses was significantly associated with IWI+. Instead within IWI-, no significantly reduced signal intensity was found. CONCLUSION These findings originally support the view that IWIs are mainly caused by a hemodynamic impairment related to carotid stenosis, whereas CWIs are mostly due to a microembolic mechanism. 3D TOF MRA, which gives pertinent information on pathophysiology on IWIs, can help in decision making.
Collapse
|