title: Preoperative 123I-iomazenil SPECT imaging predicts cerebral hyperperfusion following endarterectomy for unilateral cervical internal carotid artery stenosis.
abstract: OBJECTIVE
  Cerebral hyperperfusion following carotid endarterectomy (CEA) occurs in patients with preoperative impairments in cerebral hemodynamics. The aim of the present study was to determine whether late images/early images on preoperative brain (123)I-iomazenil (IMZ) single-photon emission computed tomography (SPECT), which correlate with oxygen extraction fraction images on positron emission tomography, could identify patients at risk for cerebral hyperperfusion following endarterectomy for unilateral cervical internal carotid artery (ICA) stenosis.
  
  
  METHODS
  In 80 patients, preoperative brain SPECT scans were initiated immediately after (early images) and 180 min after (late images) administration of (123)I-IMZ. A region of interest (ROI) was automatically placed in the middle cerebral artery territory in both the cerebral hemispheres using a three-dimensional stereotaxic ROI template. Transcranial regional cerebral oxygen saturation (rSO(2)) was monitored using near-infrared spectroscope throughout carotid endarterectomy, and a patient was defined as having cerebral hyperperfusion when a ratio of rSO(2) at the end of the surgery to rSO(2) before ICA clamping was ≥ 1.1.
  
  
  RESULTS
  Cerebral hyperperfusion was observed on intraoperative rSO(2) monitoring in eight patients (10%). Preoperative increase in affected side-to-contralateral side asymmetry on late/early (123)I-IMZ value was the only significant independent predictor of cerebral hyperperfusion (95% confidence interval [CI], 1.606 to 8.710; P = 0.0010). The preoperative late/early (123)I-IMZ asymmetry corresponded to an 88% sensitivity and 89% specificity, with 47% positive- and 98% negative-predictive values for the development of cerebral hyperperfusion.
  
  
  CONCLUSIONS
  Preoperative late/early (123)I-IMZ images can identify patients at risk for cerebral hyperperfusion following endarterectomy for unilateral cervical ICA stenosis.
authors.affiliation: Department of Neurosurgery, Iwate Medical University Morioka, Japan ; Cyclotron Research Center, Iwate Medical University Morioka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ogasawara
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Taro
authors.initials: T
authors.lastname: Suzuki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kuroda
authors.forename: Kohei
authors.initials: K
authors.lastname: Chida
authors.forename: Shunrou
authors.initials: S
authors.lastname: Fujiwara
authors.forename: Kenta
authors.initials: K
authors.lastname: Aso
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshida
authors.forename: Kazunori
authors.initials: K
authors.lastname: Terasaki
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
keywords: 123I-iomazenil; brain SPECT; carotid endarterectomy; hyperperfusion