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Author Spotlight: Noninvasive Cerebral Blood Flow Determination in Human Functional Brain Region for Diagnosis of Neurological Disorders
Published on: May 31, 2024
Identification of hemodynamically compromised regions by means of cerebral blood volume mapping utilizing computed
Satoshi Takahashi1, Yoshio Tanizaki2, Kazunori Akaji2
1Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan; Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan.
Insights
Computed tomography perfusion (CTP) imaging can identify compromised brain regions in cerebrovascular disease. Elevated relative cerebral blood volume (relCBV) on CTP scans indicates hemodynamic compromise.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Occlusive cerebrovascular disease poses a significant risk for stroke.
- Identifying hemodynamically compromised brain regions is crucial for timely intervention.
- Computed tomography perfusion (CTP) is an advanced imaging technique.
Purpose of the Study:
- To evaluate the utility of CTP in identifying hemodynamically compromised areas in patients with occlusive cerebrovascular disease.
- To determine if CTP parameters can differentiate between symptomatic and asymptomatic patients.
- To establish cut-off values for CTP parameters for clinical application.
Main Methods:
- Twelve patients with internal carotid artery or middle cerebral artery occlusion/stenosis underwent CTP.
- Automated software analyzed CTP data to assess perfusion parameters.
- Patients were grouped into asymptomatic and symptomatic based on distal perfusion pressure (PPdis).
- Statistical analysis (t-test, ROC curves) compared CTP parameters between groups.
Main Results:
- A statistically significant difference was found in relative cerebral blood volume (relCBV) between symptomatic and asymptomatic groups (p=0.028).
- Symptomatic patients exhibited higher relCBV values compared to asymptomatic patients.
- An optimal relCBV cut-off value of 1.059 was identified for distinguishing between the groups.
- relCBV increased as distal perfusion pressure decreased, indicating compensatory vasodilation.
Conclusions:
- Elevated relCBV on CTP accurately reflects compensatory vasodilation.
- CTP imaging, particularly relCBV, can effectively identify hemodynamically compromised regions in occlusive cerebrovascular disease.
- This imaging approach aids in risk stratification and management decisions for affected patients.
Abstract:
The aim of the study was to evaluate the potential role of computed tomography perfusion (CTP) imaging in identifying hemodynamically compromised regions in patients with occlusive cerebrovascular disease. Twelve patients diagnosed with either occlusion or severe stenosis of the internal carotid artery or the M1 portion of the middle cerebral artery underwent CTP imaging. The data was analyzed by an automated ROI-determining software. Patients were classified into two subgroups: an asymptomatic group consisting of three patients in whom perfusion pressure distal to the site of occlusion/stenosis (PPdis) could be maintained in spite of the arterial occlusion/stenosis, and a symptomatic group consisting of nine patients in whom PPdis could not be maintained enough to avoid watershed infarction. Four CTP-related parameters were independently compared between the two groups. Significant differences were determined using a two-sample t-test. When statistically significant differences were identified, cut-off points were calculated using ROC curves. Analysis revealed statistically significant differences between the asymptomatic and symptomatic subgroups only in the measure of relCBV (p=0.028). Higher relCBV values were observed in the symptomatic subgroup. ROC curve analysis revealed 1.059 to be the optimal relCBV cut-off value for distinguishing between the asymptomatic and symptomatic subgroups. The data revealed that, in patients whose PPdis is maintained, relCBV remains around 1.00. Conversely, in patients whose PPdis decreased, relCBV increased. From these findings, we conclude that elevation of relCBV as observed using CTP imaging accurately reflects the extent of compensatory vasodilatation involvement and can identify hemodynamically compromised regions.
