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Accuracy of brain perfusion single-photon emission computed tomography for detecting misery perfusion in adult patients with symptomatic ischemic moyamoya disease

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Abstract

Objective

The purpose of the present study was to determine how accurately relative cerebral blood flow (RCBF) and relative cerebrovascular reactivity (RCVR) to acetazolamide assessed using brain perfusion single-photon emission computed tomography (SPECT) detected misery perfusion identified on positron emission tomography (PET) in adult patients with ischemic moyamoya disease (MMD).

Methods

Oxygen extraction fraction (OEF), RCBF, and RCVR were assessed using 15O gas PET and N-isopropyl-p-[123I]-iodoamphetamine SPECT without and with acetazolamide challenge, respectively, in 45 patients. Regions of interest (ROIs) were automatically placed in the five middle cerebral artery (MCA) territories in the symptomatic cerebral hemisphere and in the ipsilateral cerebellar hemisphere using a three-dimensional stereotaxic ROI template. For RCBF and RCVR to acetazolamide, the ratio of the MCA ROI to cerebellar ROI was calculated. Of the five MCA ROIs in the symptomatic cerebral hemisphere in each patient, the ROI with the highest and lowest OEF value (two ROIs per patient) was selected for analyses.

Results

A significant square or linear correlation was observed between the OEF and RCBF (correlation coefficient, 0.780) or RCVR (correlation coefficient, − 0.345), respectively. The area under the receiver operating characteristic curve for detecting misery perfusion (OEF > 51.3%) was significantly greater for the RCBF than for the RCVR (difference between areas, 0.221; p < 0.0001). Sensitivity, specificity, and positive- and negative-predictive values for the RCBF for detecting misery perfusion were 100, 91, 67, and 100%, respectively. The specificity and positive-predictive value did not differ between the combination of the RCBF and RCVR and the CBF ratio alone.

Conclusions

RCBF assessed using brain perfusion SPECT detects misery perfusion with high sensitivity, a high negative-predictive value, and a low positive-predictive value in adult patients with ischemic MMD. The accuracy of RCVR to acetazolamide assessed using brain perfusion SPECT is lower than that of RCBF.

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

CBF:

Cerebral blood flow

CI:

Confidence interval

CVR:

Cerebrovascular reactivity

ICA:

Internal carotid artery

123I-IMP:

N-Isopropyl-p-[123I]-iodoamphetamine

MCA:

Middle cerebral artery

MMD:

Moyamoya disease

OEF:

Oxygen extraction fraction

PET:

Positron emission tomography

RCBF:

Relative cerebral blood flow

RCBFACZ :

Relative cerebral blood flow with acetazolamide challenge

RCBFrest :

Relative cerebral blood flow without acetazolamide challenge

RCVR:

Relative cerebrovascular reactivity to acetazolamide

ROC:

Receiver operating characteristic

ROIs:

Regions of interest

SD:

Standard deviation

SPECT:

Single-photon emission computed tomography

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Funding

This work was partly supported by Grants-in-Aid for Strategic Medical Science Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan (S1491001); and for Scientific Research from the Japan Society for the Promotion of Science (JP18K09002).

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Authors and Affiliations

  1. Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan

    Kengo Setta, Daigo Kojima, Yasuyoshi Shimada, Jun Yoshida, Sotaro Oshida, Kentaro Fujimoto, Shouta Tsutsui, Takayuki Chiba, Shunrou Fujiwara & Kuniaki Ogasawara

  2. Cyclotron Research Center, Iwate Medical University, Morioka, Japan

    Kengo Setta, Daigo Kojima, Yasuyoshi Shimada, Jun Yoshida, Kazunori Terasaki & Kuniaki Ogasawara

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  1. Kengo Setta
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  2. Daigo Kojima
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Correspondence to Kuniaki Ogasawara.

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Conflict of interest

The author (Kuniaki Ogasawara) declared the following potential conflict of interest with respect to the research, authorship, and/or publication of this article: Consigned research funds from Nihon Medi-Physics Co., Ltd.

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Setta, K., Kojima, D., Shimada, Y. et al. Accuracy of brain perfusion single-photon emission computed tomography for detecting misery perfusion in adult patients with symptomatic ischemic moyamoya disease. Ann Nucl Med 32, 611–619 (2018). https://doi.org/10.1007/s12149-018-1283-7

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  • DOI: https://doi.org/10.1007/s12149-018-1283-7

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