title: Acetazolamide challenge test using semiquantitative 123 I-IMP SPECT for detection of cerebral misery perfusion.
abstract: The accuracy of the acetazolamide (ACZ) challenge test using semiquantitative SPECT in detecting Stage II hemodynamic failure, i.e. cerebral misery perfusion, in patients so diagnosed with PET has yet to be determined. This study was carried out in 53 patients who had a unilateral occlusion or severe stenosis of their cerebral artery. Asymmetry index (AI) was used to determine relative CBF distribution on each SPECT image. DeltaAI (regional vasodilatory capacity) values were compared with the values of several PET parameters. We also repeated SPECT and PET studies in 15 patients after a mean interval of 2.6 years from entry. The correlation between changes in DeltaAI and PET data were examined. The DeltaAI value closely correlated with the ipsilateral OEF value (r=-0.64, p<0.001). Sensitivity-specificity curve analysis revealed that the optimal cut-off value for detecting Stage II hemodynamic failure was -13.5% of DeltaAI, at which point the diagnostic accuracy was 82%. In follow-up studies, changes in DeltaAI correlated significantly with changes in OEF values (r=-0.68, p<0.01). Semiquantitative SPECT examination with ACZ challenge detects Stage II hemodynamic failure with a diagnostic accuracy of 82%. An improvement in reduced vasodilatory capacity as determined by SPECT coincides with a reduction in OEF values.
authors.affiliation: Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Chiaki
authors.initials: C
authors.lastname: Yokota
authors.forename: Masafumi
authors.initials: M
authors.lastname: Tagaya
authors.forename: Kohei
authors.initials: K
authors.lastname: Hayashida
authors.forename: Takenori
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
mesh_terms: D000086:Acetazolamide; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D001810:Blood Volume; D002257:Carbonic Anhydrase Inhibitors; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D002547:Cerebral Palsy; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007291:Inosine Monophosphate; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D007457:Iodine Radioisotopes; D007291:Inosine Monophosphate; D000086:Acetazolamide