Authors: J Ma J H Mehrkens M Holtmannspoetter R Linke R SchmidElsaesser HJ Steiger H Brueckmann R Bruening
Publish Date: 2007/01/03
Volume: 49, Issue: 4, Pages: 317-326
Abstract
Impaired cerebral vascular reserve CVR in patients with symptomatic internal carotid artery ICA occlusion is regarded as a possible indication for performing extra/intracranial EC/IC bypass surgery As perfusion MR imaging MRI can demonstrate cerebral haemodynamics at capillary level our hypothesis was that perfusion MRI could be used in these patients for the evaluation of CVR following acetazolamide challenge in a similar way to single photon emission CT SPECT and might provide additional informationEnrolled in the study were 12 patients mean age 613 years 11 male 1 female with symptomatic unilateral ICA occlusion proven by angiography Both perfusion MRI and 99mtechnetiumethylcysteinate dimer 99mTcECD SPECT were performed before and after injection of acetazolamide Diamox 1000 mg iv CVR parameters including regional cerebral blood flow rCBF and volume rCBV and mean transit times MTT were measured by perfusion MRIThe patients with impaired CVR proven by SPECT n = 9 had a negative mean rCBF increment −4652 negative rCBV increment −135 and delayed MTT mean +298 s respectively on the occluded side Student’s ttest all P 005 The patients with sufficient CVR n = 3 had a mean rCBF increment of 12 a decrement of rCBV of 1046 and a mean MTT shortening of 027 s following the acetazolamide injectionPerfusion MRI before and after acetazolamide administration compares favourably with 99mTcECD SPECT for the detection of impaired CVR The impact that perfusion MRI studies before and after acetazolamide administration might have on the treatment decision in patients with ICA occlusion has yet to be determined by a prospective study
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