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Paradoxical reduction of cerebral blood flow after acetazolamide loading: a hemodynamic and metabolic study with 15O PET

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Abstract

Paradoxical reduction of cerebral blood flow (CBF) after administration of the vasodilator acetazolamide is the most severe stage of cerebrovascular reactivity failure and is often associated with an increased oxygen extraction fraction (OEF). In this study, we aimed to reveal the mechanism underlying this phenomenon by focusing on the ratio of CBF to cerebral blood volume (CBV) as a marker of regional cerebral perfusion pressure (CPP). In 37 patients with unilateral internal carotid or middle cerebral arterial (MCA) steno-occlusive disease and 8 normal controls, the baseline CBF (CBFb), CBV, OEF, cerebral oxygen metabolic rate (CMRO2), and CBF after acetazolamide loading in the anterior and posterior MCA territories were measured by 15O positron emission tomography. Paradoxical CBF reduction was found in 28 of 74 regions (18 of 37 patients) in the ipsilateral hemisphere. High CBFb (>47.6 mL/100 mL/min, n = 7) was associated with normal CBFb/CBV, increased CBV, decreased OEF, and normal CMRO2. Low CBFb (<31.8 mL/100 mL/min, n = 9) was associated with decreased CBFb/CBV, increased CBV, increased OEF, and decreased CMRO2. These findings demonstrated that paradoxical CBF reduction is not always associated with reduction of CPP, but partly includes high-CBFb regions with normal CPP, which has not been described in previous studies.

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Authors and Affiliations

  1. Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Japan

    Tadashi Watabe

  2. Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Suita, Japan

    Eku Shimosegawa, Hiroki Kato, Kayako Isohashi, Mana Ishibashi & Jun Hatazawa

  3. Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan

    Kazuo Kitagawa

  4. Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan

    Toshiyuki Fujinaka & Toshiki Yoshimine

  5. Department of Nuclear Medicine, Osaka University Hospital, Suita, Japan

    Tadashi Watabe, Eku Shimosegawa, Hiroki Kato, Kayako Isohashi, Mana Ishibashi & Jun Hatazawa

  6. Department of Radiology, Osaka University Hospital, Suita, Japan

    Mitsuaki Tatsumi

  7. Stroke Center, Osaka University Hospital, Suita, Japan

    Eku Shimosegawa, Kazuo Kitagawa, Toshiyuki Fujinaka, Toshiki Yoshimine & Jun Hatazawa

Authors
  1. Tadashi Watabe
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  2. Eku Shimosegawa
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Correspondence to Tadashi Watabe.

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Watabe, T., Shimosegawa, E., Kato, H. et al. Paradoxical reduction of cerebral blood flow after acetazolamide loading: a hemodynamic and metabolic study with 15O PET. Neurosci. Bull. 30, 845–856 (2014). https://doi.org/10.1007/s12264-013-1459-z

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  • DOI: https://doi.org/10.1007/s12264-013-1459-z

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