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Correlative Assessment of Hemodynamic Parameters Obtained with T2*-weighted Perfusion MR Imaging and SPECT in Symptomatic Carotid Artery Occlusion

Jae Hyoung KimGo,a, Sun Joo Leea, Taemin Shina, Kyeong Hun Kanga, Pil Youb Choia, Jung Hee Kima, Jae Chul Gonga, Nack-Cheon Choia and Byeong Hoon Lima

a From the Gyeongsang Institute for Neuroscience (Ja.H.K., T.S., N-C.C., B.H.L.), the Research Institute of Industrial Technology (T.S., K.H.K.), and the Department of Radiology (Ja.H.K., S.J.L., P.Y.C., Ju.H.K.), Gyeongsang National University Hospital, Chinju; and the Department of Radiology, Inchon Christian Hospital, Inchon (J.C.G.), South Korea.



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  		FIG 1. Scanning protocol for SPECT. At 5 minutes after injection of the first dose of 99mTc-HMPAO, the first scan (acquisition time, 20 minutes) starts for resting CBF imaging. At 8 minutes after the start of the first scan (ie, 12 minutes before the second HMPAO injection), 1 g of acetazolamide is administered. At the end of the first scan, the second dose of 99mTc-HMPAO is injected, and the second scan for postacetazolamide CBF imaging starts 5 minutes later



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  		FIG 2. Case 1: 59-year-old man with reversible ischemic neurologic deficit.

A, Anteroposterior view of right common carotid angiogram shows complete occlusion of the right proximal ICA.

B, T2-weighted image (3500/90/1) obtained at the level of perfusion MR imaging is normal except for subtle ischemic lesions in both occipital periventricular white matters.

C, CBV map shows slightly increased CBV in the right whole MCA distribution compared with contralateral corresponding region.

D, CBV map shows irregular ROIs placed for measurement of CBV ratio between the affected MCA territory and the contralateral region. Calculated CBV ratio was 1.04.

E, Corresponding uMTT map shows increased uMTT in the right whole MCA distribution compared with contralateral region.

F, 99mTc-HMPAO brain SPECT scan obtained at approximately the same level as C and E reveals mild hypoperfusion throughout the right whole anterior and MCA territories.

G, 99mTc-HMPAO brain SPECT scan with acetazolamide challenge reveals remarkable hypoperfusion in the right side as compared with F, suggesting reduced vascular reserve capacity in the right side.



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  		FIG 3. Scatterplot shows the relationship between uMTT ratios and {delta}CBF ratios. There is a significant correlation between uMTT ratios and {delta}CBF ratios (r = 0.69, P < .05)





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X