Does Preoperative Measurement of Cerebral Blood Flow with Acetazolamide Challenge in Addition to Preoperative Measurement of Cerebral Blood Flow at the Resting State Increase the Predictive Accuracy of Development of Cerebral Hyperperfusion after Carotid Endarterectomy? Results from 500 Cases with Brain Perfusion Single-photon Emission Computed Tomography Study
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- OSHIDA Sotaro
- Department of Neurosurgery, Iwate Medical University
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- OGASAWARA Kuniaki
- Department of Neurosurgery, Iwate Medical University
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- SAURA Hiroaki
- Department of Neurosurgery, Iwate Medical University
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- YOSHIDA Koji
- Department of Neurosurgery, Iwate Medical University
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- FUJIWARA Shunro
- Department of Neurosurgery, Iwate Medical University
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- KOJIMA Daigo
- Department of Neurosurgery, Iwate Medical University
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- KOBAYASHI Masakazu
- Department of Neurosurgery, Iwate Medical University
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- YOSHIDA Kenji
- Department of Neurosurgery, Iwate Medical University
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- KUBO Yoshitaka
- Department of Neurosurgery, Iwate Medical University
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- OGAWA Akira
- Department of Neurosurgery, Iwate Medical University
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抄録
The purpose of the present study was to determine whether preoperative measurement of cerebral blood flow (CBF) with acetazolamide in addition to preoperative measurement of CBF at the resting state increases the predictive accuracy of development of cerebral hyperperfusion after carotid endarterectomy (CEA). CBF at the resting state and cerebrovascular reactivity (CVR) to acetazolamide were quantitatively assessed using N-isopropyl-p-[123I]-iodoamphetamine (IMP)-autoradiography method with single-photon emission computed tomography (SPECT) before CEA in 500 patients with ipsilateral internal carotid artery stenosis (≥ 70%). CBF measurement using 123I-IMP SPECT was also performed immediately and 3 days after CEA. A region of interest (ROI) was automatically placed in the middle cerebral artery territory in the affected cerebral hemisphere using a three-dimensional stereotactic ROI template. Preoperative decreases in CBF at the resting state [95% confidence intervals (CIs), 0.855 to 0.967; P = 0.0023] and preoperative decreases in CVR to acetazolamide (95% CIs, 0.844 to 0.912; P < 0.0001) were significant independent predictors of post-CEA hyperperfusion. The area under the receiver operating characteristic curve for prediction of the development of post-CEA hyperperfusion was significantly greater for CVR to acetazolamide than for CBF at the resting state (difference between areas, 0.173; P < 0.0001). Sensitivity, specificity, and positive- and negative-predictive values for the prediction of the development of post-CEA hyperperfusion were significantly greater for CVR to acetazolamide than for CBF at the resting state (P < 0.05, respectively). The present study demonstrated that preoperative measurement of CBF with acetazolamide in addition to preoperative measurement of CBF at the resting state increases the predictive accuracy of the development of post-CEA hyperperfusion.
収録刊行物
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- Neurologia medico-chirurgica
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Neurologia medico-chirurgica 55 (2), 141-148, 2015
一般社団法人 日本脳神経外科学会