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Dynamic CT Perfusion Imaging with Acetazolamide Challenge for the Preprocedural Evaluation of a Patient with Symptomatic Middle Cerebral Artery Occlusive Disease

James D. Eastwooda, Michael J. Alexanderb, Jeffrey R. Petrellaa and James M. Provenzalea

a Department of Radiology, Division of Neuroradiology, Duke University Medical Center, Durham, North Carolina
b Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina



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  		FIG 1. Images in a 53-year-old man with episodes of right-sided numbness.

A, Digital subtraction angiogram in the left anterior oblique projection following injection of the left internal carotid artery shows severe narrowing and irregularity of the left MCA (arrows).

B, Digital subtraction angiogram following angioplasty and stent placement in the left MCA shows a nearly normal caliber and appearance to the proximal left MCA (arrows).

C, Preprocedural CBF map before acetazolamide infusion shows decreased blood flow in the left hemisphere represented as extensive areas displayed as blue (arrow).

D, Preprocedural CBF map obtained 20 minutes after infusion of acetazolamide, with use of the same section location and display parameters as those in C. Despite appropriate response on the right, no increase in CBF is apparent in the left hemisphere. Instead, additional decrease in CBF can be seen in areas such as the basal ganglia (arrowhead) and frontal lobe (arrows). By using ROI analysis, an inappropriate (ie, paradoxical) decrease in mean cortical CBF values of 23% was measured on the left and was interpreted as evidence of severe hemodynamic impairment.

E, Postprocedural CBF map before infusion of acetazolamide shows greatly improved blood flow in the left hemisphere compared with that seen in C and D. Appropriate increases in mean cortical CBF values were measured in both hemispheres after repeat acetazolamide challenge (not shown).





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