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AJNR - American Journal of Neuroradiology

Published ahead of print on July 10, 2008
doi: 10.3174/ajnr.A1229

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Which CT Perfusion Parameter Best Reflects Cerebrovascular Reserve?: Correlation of Acetazolamide-Challenged CT Perfusion with Single-Photon Emission CT in Moyamoya Patients

N.-J. Rim^a, H.S. Kim^a, Y.S. Shin^b and S.Y. Kim^a

^a Department of Diagnostic Radiology, Ajou University School of Medicine, Gyeonggi-do, Korea
^b Department of Neurosurgery, Ajou University School of Medicine, Gyeonggi-do, Korea

View larger version (46K): [in this window] [in a new window]   Fig 1. ROIs drawn in a reference CT image (A), MTT map (B), and vessel-removed MTT map (C). The ROIs were placed on cortical regions in the MCA territory, EBZ, ACA territory, and BG.

View larger version (21K): [in this window] [in a new window]   Fig 2. Clustered box-and-whisker graphs show the differences in the mean values of baseline and drug-challenged CT perfusion parameters between the normal and impaired cerebrovascular reserve groups in each vascular territory. For analysis of baseline CTP parameters (A to C), the mean values of CBV (A) and MTT (C) in the impaired CVR group were significantly higher than those in normal CVR group in EBZ and BG, and the mean values of CBF (B) were significantly lower than those in normal CVR group only in EBZ. For analysis of the percentage changes of baseline CTP parameters (D to F), pcCBV (D) was significantly different between the normal and impaired CVR groups only in EBZ, and pcCBF (E) and pcMTT (F) were significantly different in all of the vascular territories.

View larger version (20K): [in this window] [in a new window]   Fig 3. Scatter plots show the correlation between the CT perfusion parameters and the quantitative cerebrovascular reserve by using SPECT on the 152 ROIs in all of the vascular territories.

View larger version (12K): [in this window] [in a new window]   Fig 4. ROC curve analysis for each CT perfusion parameter's ability to correctly identify the impaired cerebrovascular reserve. With optimal threshold value (–16%) of pcCBF, the sensitivity, specificity, PPV, and NPV for defining the impaired cerebrovascular reserve are 94.4%, 93.2%, 97.1%, and 87.2%, respectively (the area under the ROC curves = 0.98; A). For defining impaired CVR with pcMTT, statistical analysis gave a threshold value of 10%, with a sensitivity, specificity, PPV, and NPV of 85.2%, 65.9%, 86.0%, and 64.4%, respectively (the area under the ROC curves = 0.79; B).