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At least 1,639 records · Page 91Linked to original sources
PubMed1994

[Pre and post operative evaluation of the perfusion reserve by acetazolamide 99mTc-HMPAO SPECT in patients with chronic occlusive cerebral arteries: a comparative study with PET].

We studied the pre and post-operative perfusion reserve using Diamox 99mTc-HMPAO SPECT in 7 patients with chronic occlusive cerebral arteries and then compared the results with PET. STA-MCA anastomosis was performed on 5 patients, while a carotid endarterectomy was done on 2 patients. The cerebral blood flow, the vascular response to CO2 or Diamox, the oxygen extraction fraction and transit time (CBV/CBF) were measured by PET. In the pre-operative state, the visual evaluations for hypoperfusion area at rest were agreed in 5 out of 7 patients in HMPAO SPECT and PET studies. In the remaining 2 patients, hypoperfusion areas were only detected in the PET study. The pre-operative evaluation of perfusion reserve was agreed in 2 patients. In the remaining 5 patients, 3 patients showed definite positive(++) in PET and positive(+) in HMPAO SPECT, and one patient showed positive (+) in PET and negative (-) in HMPAO SPECT. The post-operative change of hypoperfusion areas was well agreed in HMPAO SPECT and PET studies. However, the change of perfusion reserve was underestimated in HMPAO SPECT compared with PET. In the semiquantitative and quantitative analyses, the count rate ratios (affected/unaffected side) in HMPAO SPECT were apparently higher than those of CBF in PET. The postoperative change of the count rate ratios in HMPAO SPECT were smaller than those of CBF in PET. There was no significant correlation between the change in the ratio of the HMPAO SPECT after the administration of Diamox and the oxygen extraction fraction, and it was thus thought to be impossible to predict the areas with an increased oxygen extraction fraction. Thus, Diamox HMPAO SPECT may underestimate the areas of hypoperfusion or decrease in perfusion reserve when compared with PET. We should consider these limitations in the evaluation of pre and post operative cerebral hemodynamics.

Acetazolamide↗
PubMed1993

[Acetazolamide effect on vascular response in crossed cerebellar diaschisis as measured by 99mTc-HMPAO SPECT].

We studied the effect of acetazolamine (DIAMOXR) on vascular response in areas with crossed cerebellar diaschisis (CCD) using consecutive 99mTc-hexamethyl-propyleneamine oxime (HMPAO) SPECT studies before and after DIAMOX administration with a subtraction method. Regions of interest were drawn over the bilateral cerebellar cortices and interhemispheric asymmetry indices (IAI) were obtained. Eleven of 14 patients with CCD at baseline showed decrease of IAI after DIAMOX administration. Although there is a possibility of underestimation of increase in perfusion in unaffected cerebellar hemisphere, this result suggests a greater increase in perfusion in the affected cerebellar hemisphere as compared with in the contralateral unaffected one and suggests more dilatation of the arterioles in areas with CCD post-DIAMOX than in areas without CCD. However nonsignificant correlation between IAI at baseline and difference of IAI from baseline to post-DIAMOX did not support the hypothesis of more dilatation post-DIAMOX of more constricted arterioles.

Acetazolamide↗
PubMed1996

[Usefulness of change ratio map in 99mTc-HMPAO SPECT with acetazolamide enhancement].

Although a sequential 99mTc-HMPAO SPECT technique with Diamox test (seq-SPECT) is a simple and time-saving procedure to assess brain perfusion reserve, the influence of the first dose of the tracer on the second one is not negligible. Therefore, a subtraction of the rest-SPECT from the 2nd SPECT is widely-used. However, subtracted SPECT images not only need to be corrected for the injected dose and the radiochemical purity due to inherent instability of HMPAO but also are usually degraded in quality. This study was undertaken to resolve these problems utilizing a change ratio (CR) map. The CR map was obtained by dividing 2nd SPECT by rest-SPECT. Prior to subtraction, the 2nd SPECT was normalized with the ratio of the mean whole brain counts between both SPECTs. To validate CR map, 7 patients were studied with both seq-SPECT and 133Xe inhalation CBF measurement (Xe-CBF). The right to left count ratio obtained from the ROIs placed on MCA territory of CR map correlated well with that from Xe-CBF (r = 0.89, p < 0.01). Fifty-three patients with stroke underwent the seq-SPECT which was compared with the cerebral angiography (CAG) and classified into 4 groups according to the CR map. In 25 patients, all of the rest-, the subtracted-SPECT and the CR map did not show any difference between the affected side and the contralateral normal side. Seven patients with normal rest-SPECT showed decreased subtracted-SPECT counts and CR on the affected side. Three of them showed more than 75% stenosis on CAG. Four patients with the decreased counts both at the rest- and the subtracted-SPECT revealed no difference on the CR map suggesting the matched decrease of both blood flow and metabolism in the affected side. In conclusion, the CR map was a simple and useful method to evaluate the brain perfusion reserve with the seq-SPECT.

Acetazolamide↗