Detection of Misery Perfusion With Split-Dose 123 I-Iodoamphetamine Single-Photon Emission Computed Tomography in Patients With Carotid Occlusive Diseases

• Published in: Stroke (1970) 2002-09, Vol.33 (9), p.2217-2223
• Main Authors: Imaizumi, Masao, Kitagawa, Kazuo, Hashikawa, Kazuo, Oku, Naohiko, Teratani, Tadamasa, Takasawa, Masashi, Yoshikawa, Takuya, Rishu, Piao, Ohtsuki, Toshiho, Hori, Masatsugu, Matsumoto, Masayasu, Nishimura, Tsunehiko
• Format: Article
• Language: English
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000027638.19392.7E

Background and Purpose— Patients with carotid occlusive disease and stage 2 cerebral hemodynamic failure, characterized by an increased oxygen extraction fraction (OEF) as measured by positron emission tomography (PET) and otherwise known as misery perfusion, have a high risk of cerebral ischemia and subsequent stroke. In clinical practice, the detection of patients with misery perfusion through the use of widely available, noninvasive, and cost-effective modalities such as single-photon emission computed tomography (SPECT) is extremely important. Methods— We evaluated the relationships between the regional hemodynamic status of cerebral circulation, measured with split-dose [ 123 I] N -isopropyl-p-iodoamphetamine SPECT ( 123 I-IMP SPECT) and an acetazolamide challenge, and hemodynamic parameters, including OEF measured with PET, in 27 patients with both unilateral and bilateral carotid occlusive diseases. Results— A significant negative correlation was found between the SPECT-measured cerebrovascular reserve after acetazolamide administration and both the PET-measured OEF and cerebral blood volume. Neither the cerebrovascular reserve nor the cerebral blood flow index, when expressed as a SPECT-measured cerebrum-to-cerebellum ratio, was useful for detecting lesions with an elevated OEF. However, a combination of the cerebrovascular reserve and cerebral blood flow index showed high sensitivity, specificity, and positive predictive value for the detection of misery perfusion. Conclusions— Our study suggests that split-dose 123 I-IMP SPECT with an acetazolamide challenge could be useful for screening patients with misery perfusion in carotid occlusive diseases.