Can the detection of misery perfusion in chronic cerebrovascular disease be based on reductions in baseline CBF and
Hidehiko Okazawa1, Tatsuro Tsuchida, Masato Kobayashi
1Biomedical Imaging Research Center, University of Fukui, 23-3 Shimoaizuki, Matcuoka-cho, Fukui, 910-1193, Japan. okazawa@fmsrsa.fukui-med.ac.jp
Insights
Reductions in baseline cerebral blood flow (CBF) and cerebral vasoreactivity (CVR) using acetazolamide challenge can detect misery perfusion in chronic cerebrovascular disease (CVD) with high specificity. Baseline CBF reduction is more accurate than CVR alone.
Area of Science:
- Neuroimaging and cerebrovascular research.
- Medical diagnostics and patient stratification.
Background:
- Chronic cerebrovascular disease (CVD) can lead to reduced cerebral blood flow (CBF) and impaired cerebral vasoreactivity (CVR).
- Misery perfusion, a state of critical hypoperfusion, is a marker of advanced CVD and carries a high risk of stroke.
Purpose of the Study:
- To determine if decreased baseline regional cerebral blood flow (rCBF) and cerebral vasoreactivity (CVR), assessed via acetazolamide (ACZ) challenge, can identify misery perfusion in patients with chronic CVD.
- To evaluate the diagnostic accuracy of these parameters in detecting misery perfusion.
Main Methods:
- 115 patients with unilateral CVD (>70% stenosis) underwent (15)O-gas and water PET to measure oxygen extraction fraction (OEF) and other hemodynamic parameters.
- Misery perfusion was defined as OEF elevation > mean+2SD compared to healthy controls.
- CBF, CVR (percent change in CBF post-ACZ), and OEF were analyzed in middle cerebral artery territories.
Main Results:
- Using criteria of decreased CVR and baseline CBF, misery perfusion was detected with 42% sensitivity and 95% specificity in all patients.
- In patients with occlusive lesions, sensitivity increased while specificity slightly decreased.
- Baseline CBF threshold alone showed similar diagnostic accuracy to combined criteria and outperformed OEF asymmetry index.
Conclusions:
- Decreased CVR and baseline CBF, assessed with ACZ challenge, can detect misery perfusion in CVD with high specificity.
- Reduced baseline rCBF is a more accurate indicator of misery perfusion than reduced CVR alone.
Purpose:
The aim of this study was to clarify whether decreases in baseline regional cerebral blood flow (rCBF) and in residual cerebral vasoreactivity (CVR), assessed by the acetazolamide (ACZ) challenge, can detect misery perfusion in patients with chronic cerebrovascular disease (CVD).
Methods:
Oxygen extraction fraction (OEF) and other haemodynamic parameters were measured in 115 patients (64+/-9 years old) with unilateral cerebrovascular steno-occlusive disease (>70% stenosis) using (15)O-gas and water PET. A significant elevation of OEF, by greater than the mean+2SD compared with healthy controls, was defined as misery perfusion. CBF, CVR determined by percent change in CBF after ACZ administration, OEF and other haemodynamic parameters in the territories of the bilateral middle cerebral arteries were analysed. Diagnostic accuracy for the detection of misery perfusion using the criteria determined by baseline CBF and CVR was evaluated in all patients and in only those patients with occlusive lesions.
Results:
Ten of 24 patients with misery perfusion showed a significant reduction in CVR. Using criteria determined by significant decreases in CVR and baseline CBF, misery perfusion was detected with a sensitivity of 42% and a specificity of 95% in all patients. In patients with occlusive lesions (n=50), sensitivity was higher but specificity was slightly lower. The diagnostic accuracy of the threshold determined by baseline CBF alone was similar in all patients and in only those patients with occlusive lesions, and was higher than that achieved using the asymmetry index of OEF.
Conclusion:
Reductions in CVR and baseline CBF in the ACZ challenge for CVD would detect misery perfusion with high specificity. Reduction in baseline rCBF is more accurate than reduction in CVR alone for the detection of misery perfusion.
