BACKGROUND AND PURPOSE: Patients with carotid occlusive disease and stage 2 cerebral hemodynamic failure, characterized by an increased oxygen extraction fraction (OEF) as measured by positron emission tomography (PET) and otherwise known as misery perfusion, have a high risk of cerebral ischemia and subsequent stroke. In clinical practice, the detection of patients with misery perfusion through the use of widely available, noninvasive, and cost-effective modalities such as single-photon emission computed tomography (SPECT) is extremely important. METHODS: We evaluated the relationships between the regional hemodynamic status of cerebral circulation, measured with split-dose [123I] N-isopropyl-p-iodoamphetamine SPECT (123I-IMP SPECT) and an acetazolamide challenge, and hemodynamic parameters, including OEF measured with PET, in 27 patients with both unilateral and bilateral carotid occlusive diseases. RESULTS: A significant negative correlation was found between the SPECT-measured cerebrovascular reserve after acetazolamide administration and both the PET-measured OEF and cerebral blood volume. Neither the cerebrovascular reserve nor the cerebral blood flow index, when expressed as a SPECT-measured cerebrum-to-cerebellum ratio, was useful for detecting lesions with an elevated OEF. However, a combination of the cerebrovascular reserve and cerebral blood flow index showed high sensitivity, specificity, and positive predictive value for the detection of misery perfusion. CONCLUSIONS: Our study suggests that split-dose 123I-IMP SPECT with an acetazolamide challenge could be useful for screening patients with misery perfusion in carotid occlusive diseases.
BACKGROUND AND PURPOSE:Patients with carotid occlusive disease and stage 2 cerebral hemodynamic failure, characterized by an increased oxygen extraction fraction (OEF) as measured by positron emission tomography (PET) and otherwise known as misery perfusion, have a high risk of cerebral ischemia and subsequent stroke. In clinical practice, the detection of patients with misery perfusion through the use of widely available, noninvasive, and cost-effective modalities such as single-photon emission computed tomography (SPECT) is extremely important. METHODS: We evaluated the relationships between the regional hemodynamic status of cerebral circulation, measured with split-dose [123I] N-isopropyl-p-iodoamphetamine SPECT (123I-IMP SPECT) and an acetazolamide challenge, and hemodynamic parameters, including OEF measured with PET, in 27 patients with both unilateral and bilateral carotid occlusive diseases. RESULTS: A significant negative correlation was found between the SPECT-measured cerebrovascular reserve after acetazolamide administration and both the PET-measured OEF and cerebral blood volume. Neither the cerebrovascular reserve nor the cerebral blood flow index, when expressed as a SPECT-measured cerebrum-to-cerebellum ratio, was useful for detecting lesions with an elevated OEF. However, a combination of the cerebrovascular reserve and cerebral blood flow index showed high sensitivity, specificity, and positive predictive value for the detection of misery perfusion. CONCLUSIONS: Our study suggests that split-dose 123I-IMP SPECT with an acetazolamide challenge could be useful for screening patients with misery perfusion in carotid occlusive diseases.
Authors: Grant T Gullberg; Bryan W Reutter; Arkadiusz Sitek; Jonathan S Maltz; Thomas F Budinger Journal: Phys Med Biol Date: 2010-09-22 Impact factor: 3.609
Authors: Michiel J de Boorder; Jeroen van der Grond; Alice J van Dongen; Catharina J M Klijn; L Jaap Kappelle; Peter P Van Rijk; Jeroen Hendrikse Journal: J Neurol Date: 2006-10-24 Impact factor: 4.849
Authors: M Kamouchi; K Kishikawa; Y Okada; T Inoue; K Toyoda; S Ibayashi; M Iida Journal: AJNR Am J Neuroradiol Date: 2006 Jun-Jul Impact factor: 3.825
Authors: Thomas T Jiang; Tom O Videen; Robert L Grubb; William J Powers; Colin P Derdeyn Journal: J Cereb Blood Flow Metab Date: 2010-04-07 Impact factor: 6.200
Authors: Suzanne Persoon; L Jaap Kappelle; Bart N M van Berckel; Ronald Boellaard; Cyrille H Ferrier; Adriaan A Lammertsma; Catharina J M Klijn Journal: EJNMMI Res Date: 2012-06-09 Impact factor: 3.138