Correlation of Cerebrovascular Reserve as Measured by Acetazolamide-challenged SPECT with Angiographic Flow Patterns and Intra- or Extracranial Arterial Stenosis
Hasan T. Ozgur
,a,
T. Kent Walsha,
Anthony Masaryka,
Joachim F. Seegera,
Walter Williamsa,
Elizabeth Krupinskia,
Miguel Melgara and
Enrique Labadiea
a From the Departments of Radiology (H.T.O., A.M., J.F.S., E.K.), Nuclear Medicine (T.K.W., W.W.), Neurosurgery (M.M.), and Neurology (E.L.); University of Arizona Health Sciences Center and Veterans Administration Medical Center, Tucson.
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FIG 1. 58-year-old man with neurosyphilis and progressive neurologic symptoms. SPECT scans before right MCA angioplasty show relatively normal baseline perfusion (top row) but significantly decreased perfusion in the right ACA, MCA, and PCA territories after acetazolamide administration (bottom row), consistent with decreased rCVR. (The printed color scale representing brain perfusion is different from the linear 10-level color scale used for interpreting nuclear medicine studies; however, it allows easier comparison with fig 3.)
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FIG 2. A, Anteroposterior view of right ICA angiogram shows occlusion of the right ACA and high-grade stenosis of the right MCA (arrow).
B and C, Anteroposterior views of early (B) and late (C) arterial phases of left CCA angiogram show complete occlusion of the proximal left ACA and reconstitution of both pericallosal arteries (arrows) and the anterior communicating artery from leptomeningeal collaterals (arrowheads).
D and E, Lateral views of early (D) and late (E) arterial phases of left CCA angiogram show reconstitution of the pericallosal artery (arrows) in the late arterial phase by leptomeningeal collaterals
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FIG 2. F and G, Lateral views of early arterial (F) and capillary (G) phases of left vertebral angiogram show high-grade stenosis of the mid-basilar artery (arrow, F) and retrograde filling of the pericallosal artery (arrows, G) via PCA collaterals.
H, Anteroposterior view of left vertebral angiogram shows an occluded right PCA.
I, Anteroposterior view of right ICA angiogram after right MCA angioplasty shows almost complete resolution of the right MCA stenosis
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FIG 3. SPECT scans after right MCA angioplasty show improved CBF in right ACA and MCA territories on postacetazolamide study (bottom row), consistent with improved rCVR. The rCVR in the right PCA territory appears to be worse as compared with baseline study (top row)
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