Korean J Radiol.  2007 Dec;8(6):458-465. 10.3348/kjr.2007.8.6.458.

Assessment of Cerebrovascular Reserve before and after STA-MCA Bypass Surgery by SPECT and SPM Analysis

• O JH
• Jang KS
• Yoo IR
• Kim SH
• Chung SK
• Sohn HS
• Rha HK
• Park HK
• Chung YA
• Jeong J

• KMID: 1089432
• DOI: http://doi.org/10.3348/kjr.2007.8.6.458

Abstract

OBJECTIVE: The purpose of this study was to objectively assess the efficacy of superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery using Technetium (Tc)-99m-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) in patients who underwent STA-MCA bypass surgery. MATERIALS AND METHODS: Brain perfusion SPECT images obtained at baseline and after the administration of acetazolamide were reconstructed using statistical parametric mapping in 23 patients, both before and after STA-MCA bypass surgery. The clinical outcomes of the surgery were also recorded and compared with the hemodynamic changes. A voxel with an uncorrected p-value of less than 0.001 was considered to be statistically significant. RESULTS: SPECT images of the territory supplied by the bypass graft showed an increase in both cerebrovascular flow and reserve at baseline, and the increase was significantly higher following the administration of acetazolamide. All patients showed improvement of clinical symptoms and increased blood flow to the left temporal, parietal, and frontal cortices as well as the thalamus. CONCLUSION: Brain SPECT effectively and objectively demonstrated the improved outcomes of STA-MCA bypass surgery, and thus may be used in postoperative analyses.

Keyword

Cerebral revascularization; STA-MCA bypass; SPECT, Tc-99m-ECD

MeSH Terms

Acetazolamide/diagnostic use
Adult
Aged
Brain/*radionuclide imaging
Brain Mapping/methods
Carotid Stenosis/surgery
*Cerebral Revascularization
*Cerebrovascular Circulation
Cysteine/analogs & derivatives/diagnostic use
Female
Follow-Up Studies
Humans
Image Processing, Computer-Assisted
Intracranial Arteriosclerosis/surgery
Male
Middle Aged
Middle Cerebral Artery/*surgery
Models, Statistical
Organotechnetium Compounds/diagnostic use
Predictive Value of Tests
Radiopharmaceuticals/diagnostic use
Temporal Arteries/*surgery
Tomography, Emission-Computed, Single-Photon/*methods
Treatment Outcome

Figure

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  Fig. 1 Regions with decreased blood flow demonstrated on SPECT images after acetazolamide stimulation before surgery.

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  Fig. 2 Regions with increased blood flow after acetazolamide stimulation after the surgery.

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  Fig. 3 Regions with increased baseline blood flow after surgery.

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  Fig. 4 Regions with increased blood flow on acetazolamide SPECT images after surgery.

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