BACKGROUND: We evaluated the clinical usefulness of CT perfusion (CTP) with angiography (CTA) as an alternative to digital subtraction angiography (DSA) and acetazolamide (ACZ)-challenged single-photon emission computed tomography (SPECT) in the follow-up evaluation of hemodynamic changes and bypass patency after bypass surgery in chronic cerebral ischemic diseases. METHODS: Thirty-five patients who underwent superficial temporal artery/middle cerebral artery bypass surgery for chronic cerebral ischemic diseases were retrospectively enrolled. We assessed the relationship between CTP parameters [cerebral blood volume, cerebral blood flow (CBF), mean transit time (MTT), affected-to-unaffected hemisphere (ATU) ratio of perfusion parameters and MTT differences between hemispheres] and SPECT parameters (regional CBF and cerebrovascular reserve) and compared the preoperative CTP parameters with the postoperative ones. For the bypass patency, we compared CTA with DSA. RESULTS: MTT showed the best correlation with CVR of SPECT (r = -0.343; p < 0.001). ATU ratio (r = -0.547; p < 0.001) and ATU differences (r = -0.592; p < 0.001) of MTT correlated well with the ATU ratio of rCBF on ACZ-challenged SPECT. Significant improvement of perfusion parameters could be demonstrated in the affected vascular territory with postoperative CTP. The CTA findings were consistent with those of DSA in 96% of the cases. The examination-related complication rate was 0, 2.8 and 8.6% for CT studies, DSA and SPECT, respectively. CONCLUSIONS: CTP performed simultaneously with CTA seems to be a safe and efficient substitute for DSA and ACZ-challenged SPECT in the follow-up evaluation after bypass surgery in patients with chronic cerebral ischemic diseases.
BACKGROUND: We evaluated the clinical usefulness of CT perfusion (CTP) with angiography (CTA) as an alternative to digital subtraction angiography (DSA) and acetazolamide (ACZ)-challenged single-photon emission computed tomography (SPECT) in the follow-up evaluation of hemodynamic changes and bypass patency after bypass surgery in chronic cerebral ischemic diseases. METHODS: Thirty-five patients who underwent superficial temporal artery/middle cerebral artery bypass surgery for chronic cerebral ischemic diseases were retrospectively enrolled. We assessed the relationship between CTP parameters [cerebral blood volume, cerebral blood flow (CBF), mean transit time (MTT), affected-to-unaffected hemisphere (ATU) ratio of perfusion parameters and MTT differences between hemispheres] and SPECT parameters (regional CBF and cerebrovascular reserve) and compared the preoperative CTP parameters with the postoperative ones. For the bypass patency, we compared CTA with DSA. RESULTS:MTT showed the best correlation with CVR of SPECT (r = -0.343; p < 0.001). ATU ratio (r = -0.547; p < 0.001) and ATU differences (r = -0.592; p < 0.001) of MTT correlated well with the ATU ratio of rCBF on ACZ-challenged SPECT. Significant improvement of perfusion parameters could be demonstrated in the affected vascular territory with postoperative CTP. The CTA findings were consistent with those of DSA in 96% of the cases. The examination-related complication rate was 0, 2.8 and 8.6% for CT studies, DSA and SPECT, respectively. CONCLUSIONS:CTP performed simultaneously with CTA seems to be a safe and efficient substitute for DSA and ACZ-challenged SPECT in the follow-up evaluation after bypass surgery in patients with chronic cerebral ischemic diseases.
Authors: Joseph C Serrone; Lincoln Jimenez; Dennis J Hanseman; Christopher P Carroll; Aaron W Grossman; Lily Wang; Achala Vagal; Ondrej Choutka; Norberto Andaluz; Andrew J Ringer; Todd Abruzzo; Mario Zuccarello Journal: J Neurol Surg B Skull Base Date: 2014-05-27