Identifying regions of compromised hemodynamics in symptomatic carotid occlusion by cerebrovascular reactivity and oxygen extraction fraction.
OBJECTIVE
Oxygen extraction fraction (OEF) and cerebrovascular reserve (CVR) are both proven predictors of stroke risk in symptomatic patients with carotid occlusion. Accordingly, hemispheric comparisons of CVR and OEF are significantly correlated. However, there was also substantial disagreement: hemispheres identified as compromised by CVR were normal by OEF. Our aim was to determine whether regional comparisons could resolve the CVR-OEF discordance. We also studied the relationship between white matter (WM) infarction and hemodynamic compromise.


METHODS
Quantitative CVR and OEF were measured in 12 symptomatic patients with internal carotid artery occlusion. CVR and OEF comparisons were made in the anterior watershed (AWS), middle cerebral artery (MCA) and WM territories using various thresholds for hemodynamic compromise. Associations with WM infarction were also recorded.


RESULTS
Comparison of CVR and OEF for the AWS and MCA showed high sensitivity (100%) with specificities of 83 and 40%, respectively. There was also agreement (k=Cohen's Kappa) for the AWS (k=0.83) and MCA (k=0.39) territories. CVR-OEF discordance was reduced with regional analysis. Hemodynamic compromise was more often found in patients with WM infarction.


CONCLUSIONS
Regional comparison of CVR and OEF reduced the discordance compared with hemispheric analysis, especially for the AWS territory. Despite the persistence of some regions with compromised CVR and normal OEF, CVR is able to identify all regions with elevated OEF making it a useful screening technology. Future studies are needed to understand whether those remaining regions with compromised CVR are also at increased stroke risk despite normal OEF.
Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA. pindzolarr@upmc.edu
Ronda R
RR
Pindzola
Donald
D
Sashin
Edwin M
EM
Nemoto
Hiroto
H
Kuwabara
John W
JW
Wilson
Howard
H
Yonas
D000368:Aged; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002341:Carotid Artery Thrombosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D009413:Nerve Fibers, Myelinated / Q000378:metabolism; D010101:Oxygen Consumption / Q000502:physiology*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014980:Xenon Radioisotopes
D014980:Xenon Radioisotopes