Which CT Perfusion Parameter Best Reflects Cerebrovascular Reserve?: Correlation of Acetazolamide-Challenged CT Perfusion with Single-Photon Emission CT in Moyamoya Patients

Rim, Nae-Jung; Kim, H.S.; Shin, Yang Sik; Kim, S.Y.

doi:10.3174/ajnr.a1229

Cited by 53 publications

(30 citation statements)

References 17 publications

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“…93 Another study correlated ACZchallenged PCT with SPECT in patients with Moyamoya disease and showed that baseline PCT parameters, including CBV and MTT, correlated weakly with the CVR obtained with SPECT. 33 The study demonstrated that percentage change of CBF correlated well with quantitative SPECT CVR measurements.…”

Section: Moyamoya Diseasementioning

confidence: 68%

“…The feasibility of CTP in the evaluation of chronic ischemia has been encouraging in various studies. [32][33][34] Furukawa et al 35 studied the usefulness of PCT in the evaluation of chronic cerebral ischemia and compared the technique with Xe-CT. In their study, the relative scores of CBF obtained by PCT correlated well with Xe-CT values, though the absolute values did not show as good a correlation.…”

Section: Pctmentioning

confidence: 99%

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The Acetazolamide Challenge: Techniques and Applications in the Evaluation of Chronic Cerebral Ischemia

Vagal¹,

Leach²,

Fernández-Ulloa³

et al. 2009

AJNR Am J Neuroradiol

167

116

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SUMMARY:The acetazolamide (ACZ) challenge test is a useful clinical tool and a reliable predictor of critically reduced perfusion. In patients with chronic steno-occlusive disease, the ability to maintain normal cerebral blood flow by reducing vascular resistance secondary to autoregulatory vasodilation is compromised. Identification of the presence and degree of autoregulatory vasodilation (reflecting the cerebrovascular reserve) is a significant prognostic factor in patients with chronic cerebrovascular disease. The pharmacologic challenge of a vasodilatory stimulus such as ACZ can also be used to optimize the treatment strategies for these patients. The pathophysiology, methods, and clinical applications of the ACZ challenge test are discussed in this article. Viability of the cerebral parenchyma is dependent on the ability of the brain vasculature to provide adequate levels of cerebral blood flow (CBF). In patients with chronic stenoocclusive disease, the ability to maintain normal CBF by reducing vascular resistance is compromised. Identification of the degree of autoregulatory vasodilation reflects cerebrovascular reserve (CVR), which is a significant prognostic factor in chronic cerebrovascular disease.1-5 Flow reserve can be assessed with the use of paired blood flow measurements, with the initial measurement obtained at baseline and the second, after a vasodilatory stimulus, such as acetazolamide (ACZ). 6 Pathophysiology of Chronic Cerebrovascular DiseaseChronic cerebral hypoperfusion is usually the result of occlusion or stenosis of large arteries in the neck or the circle of Willis. Clinical symptoms and manifestations of brain ischemia in patients with chronic cerebrovascular disease (CVD) develop as a consequence of 2 main mechanisms: embolic events from atherosclerotic plaques resulting in local compromise of blood flow and systemic hemodynamic alterations that further reduce an already compromised cerebral perfusion state. 7The hemodynamic changes due to a decline in cerebral perfusion pressure have been studied by many investigators. 6,[8][9][10][11] Chronic CBF restriction causes a progressive decrease in cerebral perfusion pressure (CPP). Initially, decreases of CPP cause varying degrees of autoregulatory vasodilation of small distal arterioles.12 Powers 10 and Powers et al 11 proposed a 2-stage classification of hemodynamic impairment in patients with CVD. In stage I (autoregulatory vasodilation), autoregulation reduces cerebral vascular resistance. CBF and oxygen extraction fraction (OEF) are not significantly changed. Increases of cerebral blood volume (CBV) and mean transit time (MTT) are 2 parameters that reflect this initial phase of compensatory autoregulatory vasodilation. Further decreases of CPP beyond cerebral autoregulatory vasodilation capacity eventually result in stage II (autoregulatory failure), characterized by decreases of CBF and increases of OEF. When the CBF decreases, neurons increase the fraction of oxygen extracted from the blood to maintain normal neurologic function. ...

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Section: Moyamoya Diseasementioning

confidence: 68%

Section: Pctmentioning

confidence: 99%

The Acetazolamide Challenge: Techniques and Applications in the Evaluation of Chronic Cerebral Ischemia

Vagal¹,

Leach²,

Fernández-Ulloa³

et al. 2009

AJNR Am J Neuroradiol

167

116

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“…16,17 Longer MTT indicated pre-existing hemodynamic impairment and predisposed the patient to HPS. 18,19 The high signal intensity of subcortical white matter on FLAIR imaging represented edematous change and implied impaired dysautoregulation, likely potentiated by the venous stasis. If one reviewed the 3 patients with abnormal MR imaging findings, no incidences of contralateral stenosis or poor collaterals were seen, their mean age was 70 years, and strict postoperation blood pressure control was also performed.…”

Section: Discussionmentioning

confidence: 99%

Stenotic Transverse Sinus Predisposes to Poststenting Hyperperfusion Syndrome as Evidenced by Quantitative Analysis of Peritherapeutic Cerebral Circulation Time

Lin

Chang

Tsai

et al. 2014

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Hyperperfusion syndrome is a devastating complication of carotid stent placement. The shortening of cerebral circulation time after stent placement is seen as a good indicator of the development of hyperperfusion syndrome. The purpose of our study was to evaluate whether patients with ipsilateral transverse sinus stenosis are prone to having shortened cerebral circulation time after stent placement, subsequently leading to the possible development of hyperperfusion syndrome.

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“…11 Quantitative assessment of CVR by using the acetazolamide challenge is an additional measurement of hemodynamic impairment in patients with major cerebral artery occlusive disease. 12 The risk of developing an ischemic event is known to be higher in patients with reduced CVR. 13,14 The CVR, therefore, often aids in decision-making for treatment options and is used to follow the course of the disease.…”

Section: Discussionmentioning

confidence: 99%

Neuroradiologic Correlates of Cognitive Impairment in Adult Moyamoya Disease

Mogensen¹,

Karzmark²,

Zeifert³

et al. 2011

AJNR Am J Neuroradiol

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Which CT Perfusion Parameter Best Reflects Cerebrovascular Reserve?: Correlation of Acetazolamide-Challenged CT Perfusion with Single-Photon Emission CT in Moyamoya Patients

Cited by 53 publications

References 17 publications

The Acetazolamide Challenge: Techniques and Applications in the Evaluation of Chronic Cerebral Ischemia

The Acetazolamide Challenge: Techniques and Applications in the Evaluation of Chronic Cerebral Ischemia

Stenotic Transverse Sinus Predisposes to Poststenting Hyperperfusion Syndrome as Evidenced by Quantitative Analysis of Peritherapeutic Cerebral Circulation Time

Neuroradiologic Correlates of Cognitive Impairment in Adult Moyamoya Disease

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