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Can the detection of misery perfusion in chronic cerebrovascular disease be based on reductions in baseline CBF and vasoreactivity?

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Abstract:

Purpose:

The aim of this study was to clarify whether decreases in baseline regional cerebral blood flow (rCBF) and in residual cerebral vasoreactivity (CVR), assessed by the acetazolamide (ACZ) challenge, can detect misery perfusion in patients with chronic cerebrovascular disease (CVD).

Methods:

Oxygen extraction fraction (OEF) and other haemodynamic parameters were measured in 115 patients (64±9 years old) with unilateral cerebrovascular steno-occlusive disease (>70% stenosis) using 15O-gas and water PET. A significant elevation of OEF, by greater than the mean+2SD compared with healthy controls, was defined as misery perfusion. CBF, CVR determined by percent change in CBF after ACZ administration, OEF and other haemodynamic parameters in the territories of the bilateral middle cerebral arteries were analysed. Diagnostic accuracy for the detection of misery perfusion using the criteria determined by baseline CBF and CVR was evaluated in all patients and in only those patients with occlusive lesions.

Results:

Ten of 24 patients with misery perfusion showed a significant reduction in CVR. Using criteria determined by significant decreases in CVR and baseline CBF, misery perfusion was detected with a sensitivity of 42% and a specificity of 95% in all patients. In patients with occlusive lesions (n=50), sensitivity was higher but specificity was slightly lower. The diagnostic accuracy of the threshold determined by baseline CBF alone was similar in all patients and in only those patients with occlusive lesions, and was higher than that achieved using the asymmetry index of OEF.

Conclusion:

Reductions in CVR and baseline CBF in the ACZ challenge for CVD would detect misery perfusion with high specificity. Reduction in baseline rCBF is more accurate than reduction in CVR alone for the detection of misery perfusion.

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Acknowledgements

The authors thank Mr. Kasamatsu and other staff in the Biomedical Imaging Research Center and doctors in the Department of Neurosurgery, University of Fukui for technical and clinical support. We also thank Dr. Yamauchi and other staff in the Research Institute, Shiga Medical Center. This study was partly funded by a Grant-in-Aid for Scientific Research from Japan Society for the Promotion of Science (17209040, 18591334), 21st Century COE Program (Medical Science).

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Authors and Affiliations

  1. Biomedical Imaging Research Center, University of Fukui, 23-3 Shimoaizuki, Matcuoka-cho, Fukui, 910-1193, Japan

    Hidehiko Okazawa, Masato Kobayashi, Marco Pagani & Yoshiharu Yonekura

  2. Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan

    Tatsuro Tsuchida

  3. Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan

    Yoshikazu Arai & Makoto Isozaki

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  1. Hidehiko Okazawa
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  2. Tatsuro Tsuchida
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  3. Masato Kobayashi
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  4. Yoshikazu Arai
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  5. Marco Pagani
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  6. Makoto Isozaki
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  7. Yoshiharu Yonekura
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Correspondence to Hidehiko Okazawa.

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Okazawa, H., Tsuchida, T., Kobayashi, M. et al. Can the detection of misery perfusion in chronic cerebrovascular disease be based on reductions in baseline CBF and vasoreactivity?. Eur J Nucl Med Mol Imaging 34, 121–129 (2007). https://doi.org/10.1007/s00259-006-0192-5

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  • DOI: https://doi.org/10.1007/s00259-006-0192-5

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