Quantitative assessment of blood flow reserve using 99mTc-HMPAO in carotid stenosis

Garai, Ildikó; Varga, József; Szomják, Edit; Tóth, Csaba; Bank, Jeffrey S.; Ficzere, Andrea; Olvasztó, Sándor; Galuska, László

doi:10.1007/s00259-001-0688-y

Cited by 7 publications

(2 citation statements)

References 13 publications

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“…For ethical reasons, we have not completed basal and acetazolamide-stimulated study pairs for healthy controls. However, applying the same method for calculating the global CBF in absolute units, we found previously (16) that a group of 12 healthy control subjects had a mean 6 SD of 68.5 6 9.7 mL/min/100 g global CBF after acetazolamide stimulation, higher than that in any of the diabetic groups of the present study. This confirms the tendency that CBF is decreased in both diabetic states.…”

Section: Discussionsupporting

confidence: 47%

Changes in Cerebral Blood Flow Detected by SPECT in Type 1 and Type 2 Diabetic Patients

Káplár¹,

Paragh²,

Erdei³

et al. 2009

J Nucl Med

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Although macrovascular complications are typical for type 2 diabetes mellitus (T2DM), cerebral microvascular damage develops both in type 1 diabetes mellitus (T1DM) and T2DM. Color Doppler ultrasound is widely used for the examination of large-and medium-sized arteries, whereas SPECT and MRI are capable of identifying disturbances in the circulation of microvessels. Former studies using semiquantitative methods showed reduced reactivity and reserve capacity of cerebral vessels in both T1DM and T2DM patients. Our aim was to investigate whether there was any difference in the effects of the 2 types of diabetes mellitus on the global or regional cerebral blood flow, influenced by microvascular damage. Methods: In our study, the circulation and reserve capacity of cerebral arteries was examined using 99m Tc-hexamethylpropylene amine oxime SPECT. A total of 17 individuals with T1DM and 43 individuals with T2DM were involved in the study. Results: Both basal and acetazolamide-challenged brain circulation were significantly lower in T2DM patients than in T1DM patients. We did not find a significant difference in the reserve capacity. However, the circulation of the frontal and occipital lobes changed differently in the 2 groups. The ratio of the circulation of the frontal and occipital lobes was significantly reduced both in basal and in acetazolamide-stimulated states in T2DM patients, independently of age (P , 0.0005 and P , 0.017), showing a greater relative decrease in the circulation of the frontal lobe in T2DM patients. Conclusion: There was a significant association between basal brain circulation and age, body mass index, and high-density lipoprotein (HDL), whereas acetazolamide-stimulated circulation showed a significant association with serum triglyceride and HDL.Key Words: diabetes mellitus; cerebral perfusion; SPECT; reserve capacity; frontooccipital ratio Nucl Med 2009; 50:1993 50: -1998 50: DOI: 10.2967 Di abetes mellitus considerably increases the risk of stroke due to the damage of cerebral arteries (1,2). Macrovascular complications are typical for type 2 diabetes mellitus (T2DM); however, the injury of cerebral microvessels can be detected in both type 1 diabetes mellitus (T1DM) and T2DM. Hyperglycemia leads to structural damage of capillaries and endothelial dysfunction, and the permeability of the blood-brain barrier is also altered in diabetics (3). These factors significantly affect the regional and global cerebral blood flow (CBF) and the metabolism of the brain. The damage of the vessels can be demonstrated even before the appearance of clinical symptoms. B-mode ultrasound can be useful in the examination of large and medium arteries, whereas SPECT, MRI, and transcranial Doppler are able to recognize disturbances of the microcirculation. Previous studies using Doppler ultrasound found decreased reactivity and reserve capacity of large and medium arteries in both types of diabetes (4-6). Fülesdi et al. found that the decrease in circulation became pronounced 10 y after the diagnosis of both typ...

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Section: Discussionsupporting

confidence: 47%

Changes in Cerebral Blood Flow Detected by SPECT in Type 1 and Type 2 Diabetic Patients

Káplár¹,

Paragh²,

Erdei³

et al. 2009

J Nucl Med

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“…Many studies using acetazolamide (24) or 99mTc-HMPAO SPECT before and after injection of dipyridamole (28,29) showed a reduced resting CBF and an altered CVR ipsilateral to the carotid stenosis after injection. More recently, multimodal MRI perfusion studies showed that CBF and CVR were decreased ipsilaterally to the stenosis (30).…”

Section: Hemodynamic and Cerebrovascular Reactivity (Cvr) Studiesmentioning

confidence: 99%

A narrative review of the pathophysiology of ischemic stroke in carotid plaques: a distinction versus a compromise between hemodynamic and embolic mechanism

Mechtouff¹,

Rascle²,

Crespy³

et al. 2021

Ann Transl Med

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Atherosclerotic carotid artery stenosis causes about 10-20% of all ischemic strokes through two main mechanisms: hemodynamic impairment in case of significant stenosis and thromboembolism from an atherosclerotic plaque regardless of the degree of stenosis. The latter is the most frequent mechanism and appear to result from embolization from a vulnerable atherosclerotic plaque or acute occlusion of the carotid artery and propagation of thrombus distally. Downstream infarcts may occur in a territory of major cerebral artery or at the most distal areas between two territories of major cerebral arteries, the so-called watershed (WS), or border zone area. Although WS infarcts, especially deep WS infarct, were historically thought to be due to hemodynamic compromise, the role of microembolism has also been documented, both mechanisms may act synergistically to promote WS infarcts. Routine and more advanced imaging techniques may provide information on the underlying mechanism involved in ipsilateral ischemic stroke. A better understanding of ischemic stroke pathogenesis in carotid stenosis may limit the use of routine non-selective shunt, whose benefit-risk balance is debated, to patients with hemodynamic impairment.After reviewing existing evidence underpinning the contribution of the two mechanisms in downstream ischemic stroke and the various imaging techniques available to investigate them, we will focus on the pathogenesis of WS infarcts that remains debated.

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Quantification in Brain SPECT: Noninvasive Cerebral Blood Flow Measurements Using 99mTc-Labeled Tracers

Matsuda

2020

PET and SPECT in Neurology

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Quantitative assessment of blood flow reserve using 99mTc-HMPAO in carotid stenosis

Cited by 7 publications

References 13 publications

Changes in Cerebral Blood Flow Detected by SPECT in Type 1 and Type 2 Diabetic Patients

Changes in Cerebral Blood Flow Detected by SPECT in Type 1 and Type 2 Diabetic Patients

A narrative review of the pathophysiology of ischemic stroke in carotid plaques: a distinction versus a compromise between hemodynamic and embolic mechanism

Quantification in Brain SPECT: Noninvasive Cerebral Blood Flow Measurements Using 99mTc-Labeled Tracers

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