Cerebrovascular Reserve Measured by Acetazolamide-challenged Tc-99m ECD Brain Perfusion SPECT in Symptomatic Internal Carotid Artery and Middle Cerebral Artery Disease

ABSTRACT

BACKGROUND: Hemodynamic evaluation of the brain may be helpful for the identification of a risk of stroke in patients with middle cerebral artery (MCA) or internal carotid artery (ICA) steno-occlusive disease. The aim of this study was to evaluate the hemodynamic state in patients with steno-occlusive disease of ICA or MCA on the base of MRI/MRA and acetazolamide (ACZ)-challenged Tc-99m ECD brain perfusion SPECT findings. METHODS: An analysis of 68 patients who underwent MRI/MRA and ACZ-challenged Tc-99m ECD brain perfusion SPECT was performed. We divided these patients into two groups - MCA and ICA steno-occlusions. RESULTS: The cerebrovascular reserve (CVR) was impaired in 18 of 32 (56.3%) MCA disease patients (20 stenosis and 12 occlusions), and in 19 of 36 (52.8%) ICA disease patients (20 stenosis and 16 occlusion). The CVR was impaired in 22 of 28 (78.6%) occlusive patient, whereas in 15 of 40 (37.5%) stenotic patient (p< 0.01). The insular lesion was more commonly involved in the occlusion group (54%) than in the stenosis group (15%) (p< 0.01). CONCLUSIONS: There was no difference in CVR between MCA and ICA steno-occlusion groups. Incidence of impaired CVR was higher in occlusion group than stenosis group.