Perfusion Computed Tomography Evaluation of Cerebral Hemodynamic Impairment in Patients With Unilateral Chronic Steno-Occlusive Disease: A Comparison With the Acetazolamide Challenge (99m)Tc-Hexamethylpropyleneamine Oxime Single-Photon Emission Computed Tomography

Abstract

Purpose: The purpose of this study was to determine which pefusion computed tomography (PCT) parameter is the most valid predictor of cerebral vascular reserve (CVR) as determined by (99m)Tc-hexamethylpropylencamine oxime single-photon emission computed tomography (SPECT). Methods: Single-photon emission computed tomography with acetazolamide challenge and PCT were used in 23 patients with unilateral steno-occlusive vascular disease. After coregistration of the PCT and SPECT images, we assessed the relationship between the PCT parameters and SPECT findings and the predictive values of the PCT parameters for decreased CVR. Results: All PCT parameters of cerebral blood flow, cerebral blood volume, and mean transit time (MTT) were significantly correlated with SPECT regional cerebral blood flow ratios (P < 0.01). The MTT values more strongly correlated with acetazolamide effect than with cerebral blood volume or cerebral blood flow (P < 0.001). The MTT difference (values in the pathological hemisphere minus the values in the contralateral hemisphere) was a threshold of 1.5 seconds, with a sensitivity of 88% and a specificity of 70% for predicting decreased CVR. Conclusion: Mean transit time is the most predictive parameter for assessing decreased CVR in patients with unilateral steno-occlusive vascular disease.