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Perfusion MRI before and after acetazolamide administration for assessment of cerebrovascular reserve capacity in patients with symptomatic internal carotid artery (ICA) occlusion: comparison with 99mTc-ECD SPECT

  • Diagnostic Neuroradiology
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Abstract

Introduction

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 information.

Methods

Enrolled in the study were 12 patients (mean age 61.3 years; 11 male, 1 female) with symptomatic unilateral ICA occlusion proven by angiography. Both perfusion MRI and 99m-technetium-ethyl-cysteinate dimer (99mTc-ECD) SPECT were performed before and after injection of acetazolamide (Diamox ,1000 mg i.v.). CVR parameters including regional cerebral blood flow (rCBF) and volume (rCBV), and mean transit times (MTT) were measured by perfusion MRI.

Results

The patients with impaired CVR proven by SPECT (n = 9) had a negative mean rCBF increment (−46.52%), negative rCBV increment (−13.5%) and delayed MTT (mean +2.98 s), respectively, on the occluded side (Student’s t-test all P < 0.05). The patients with sufficient CVR (n = 3) had a mean rCBF increment of 1.2%, a decrement of rCBV of 10.46%, and a mean MTT shortening of 0.27 s following the acetazolamide injection.

Conclusions

Perfusion MRI before and after acetazolamide administration compares favourably with 99mTc-ECD 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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Acknowledgement

We acknowledge Professor Tarek Yousry, MD, for his valuable input and for co-initiating this study. We thank Professor Gerhard Hamann for the thoughtful discussions in the course of the treatment decisions in our patient cohort.

Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neuroradiology, Klinikum Grosshadern, University of Munich, 81377, Munich, Germany

    J. Ma, M. Holtmannspoetter, H. Brueckmann & R. Bruening

  2. Department of Neurosurgery, Klinikum Grosshadern, University of Munich, 81377, Munich, Germany

    J. H. Mehrkens & R. Schmid-Elsaesser

  3. Department of Nuclear Medicine, Klinikum Grosshadern, University of Munich, 81377, Munich, Germany

    R. Linke

  4. Department of Neurosurgery, Heinrich-Heine University, 40225, Duesseldorf, Germany

    H.-J. Steiger

  5. Department of Radiology, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Germany

    R. Bruening

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  1. J. Ma
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Corresponding author

Correspondence to R. Bruening.

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The first and second author contributed equally to this study.

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Ma, J., Mehrkens, J.H., Holtmannspoetter, M. et al. Perfusion MRI before and after acetazolamide administration for assessment of cerebrovascular reserve capacity in patients with symptomatic internal carotid artery (ICA) occlusion: comparison with 99mTc-ECD SPECT. Neuroradiology 49, 317–326 (2007). https://doi.org/10.1007/s00234-006-0193-x

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  • DOI: https://doi.org/10.1007/s00234-006-0193-x

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