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A comparative study of perfusion CT and 99m Tc-HMPAO SPECT measurement to assess cerebrovascular reserve capacity in patients with internal carotid artery occlusion.

Eicker SO, Turowski B, Heiroth HJ, Steiger HJ, Hänggi D - Eur. J. Med. Res. (2011)

Bottom Line: Recently perfusion CT (PCT) gained widely acceptance in stroke imaging.A preserved CVR was present in seven patients.Therefore this easy-to-perform technique seems to be an adequate method for the evaluation of cerebral perfusion in patients with ICA occlusion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany. Sven.Eicker@med.uni-duesseldorf.de

ABSTRACT

Background and purpose: Patients with internal carotid artery (ICA) occlusion can demonstrate impaired cerebral vascular reserve (CVR). The detection of CVR using single photon emission CT (SPECT) is nowadays widely accepted as a predictor in the diagnostic pathway in patients considered for cerebral revascularization. Recently perfusion CT (PCT) gained widely acceptance in stroke imaging. The present study was aimed at comparing the results of perfusion CT (PCT) and 99m Tc-HMPAO SPECT with acetazolamide challenge in patients with ICA occlusion.

Methods: 13 patients were included in the prospective evaluation. Both PCT and 99m Tc-HMPAO SPECT were performed before and after the administration of acetazolamide. In detail, regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), adapted time to peak (Tmax) and mean transit times (MTT) were compared with SPECT data. -

Results: 99m Tc-HMPAO SPECT demonstrated an impairment of CVR in six patients. A preserved CVR was present in seven patients. All patients with impaired CVR proven by SPECT had a delayed MTT (mean +2.98 s) and a delayed Tmax (mean + 5.9 s), (both p <0.005 compared with the non occluded side). 66% of patients with impaired CVR in SPECT showed a complete correlation of Tmax measurements in PCT with a high positive predictive value (PPV: 88.8%). -

Conclusion: The prospective study demonstrated a highly significant correlation of perfusion parameters as detected by 99m Tc-HMPAO SPECT and the Tmax as detected by PCT in patients with ICA occlusion. Therefore this easy-to-perform technique seems to be an adequate method for the evaluation of cerebral perfusion in patients with ICA occlusion.

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Brain map devided into 36 segments and the six analysed vascular terretories.
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Figure 1: Brain map devided into 36 segments and the six analysed vascular terretories.


A comparative study of perfusion CT and 99m Tc-HMPAO SPECT measurement to assess cerebrovascular reserve capacity in patients with internal carotid artery occlusion.

Eicker SO, Turowski B, Heiroth HJ, Steiger HJ, Hänggi D - Eur. J. Med. Res. (2011)

Brain map devided into 36 segments and the six analysed vascular terretories.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3351805&req=5

Figure 1: Brain map devided into 36 segments and the six analysed vascular terretories.
Bottom Line: Recently perfusion CT (PCT) gained widely acceptance in stroke imaging.A preserved CVR was present in seven patients.Therefore this easy-to-perform technique seems to be an adequate method for the evaluation of cerebral perfusion in patients with ICA occlusion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany. Sven.Eicker@med.uni-duesseldorf.de

ABSTRACT

Background and purpose: Patients with internal carotid artery (ICA) occlusion can demonstrate impaired cerebral vascular reserve (CVR). The detection of CVR using single photon emission CT (SPECT) is nowadays widely accepted as a predictor in the diagnostic pathway in patients considered for cerebral revascularization. Recently perfusion CT (PCT) gained widely acceptance in stroke imaging. The present study was aimed at comparing the results of perfusion CT (PCT) and 99m Tc-HMPAO SPECT with acetazolamide challenge in patients with ICA occlusion.

Methods: 13 patients were included in the prospective evaluation. Both PCT and 99m Tc-HMPAO SPECT were performed before and after the administration of acetazolamide. In detail, regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), adapted time to peak (Tmax) and mean transit times (MTT) were compared with SPECT data. -

Results: 99m Tc-HMPAO SPECT demonstrated an impairment of CVR in six patients. A preserved CVR was present in seven patients. All patients with impaired CVR proven by SPECT had a delayed MTT (mean +2.98 s) and a delayed Tmax (mean + 5.9 s), (both p <0.005 compared with the non occluded side). 66% of patients with impaired CVR in SPECT showed a complete correlation of Tmax measurements in PCT with a high positive predictive value (PPV: 88.8%). -

Conclusion: The prospective study demonstrated a highly significant correlation of perfusion parameters as detected by 99m Tc-HMPAO SPECT and the Tmax as detected by PCT in patients with ICA occlusion. Therefore this easy-to-perform technique seems to be an adequate method for the evaluation of cerebral perfusion in patients with ICA occlusion.

Show MeSH
Related in: MedlinePlus