title: Combined measurement of cerebral and cerebellar blood flow on preoperative brain perfusion SPECT imaging predicts development of new cerebral ischemic events after endarterectomy for symptomatic unilateral cervical carotid stenosis.
abstract: OBJECTIVE
  The aim of this study was to determine whether the ratio of blood flow contralateral-to-affected asymmetry in the cerebellar hemisphere to blood flow affected-to-contralateral asymmetry in the middle cerebral artery (MCA) territory (AR(cbl)/AR(MCA)) on preoperative brain perfusion SPECT could identify patients at risk for new cerebral ischemic events after carotid endarterectomy (CEA) for symptomatic unilateral cervical carotid stenosis. For the purposes of this study, new cerebral ischemic events included neurological deficits and cerebral ischemic lesions on diffusion-weighted MRI.
  
  
  METHODS
  Brain blood flow was assessed using 123I-IMP SPECT in 101 patients. A region of interest was automatically placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres using a 3-dimensional stereotaxic region-of-interest template, and the AR(cbl)/AR(MCA) was calculated. Diffusion-weighted MRI was performed within 3 days before and 24 hours after surgery. Patients were neurologically tested before induction of general anesthesia and after recovery from general anesthesia.
  
  
  RESULTS
  New cerebral ischemic events after CEA were observed in 12 patients (12%). Multivariate analysis revealed that only high AR(cbl)/AR(MCA) was significantly associated with the development of new postoperative cerebral ischemic events (95% confidence interval, 1.945-8.452; P = 0.0070). The AR(cbl)/AR(MCA) provided 75% sensitivity, 84% specificity, and 39% positive and 96% negative predictive values in predicting development of new postoperative cerebral ischemic events.
  
  
  CONCLUSIONS
  The AR(cbl)/AR(MCA) on preoperative brain perfusion SPECT could identify patients at risk for new cerebral ischemic events after CEA for unilateral cervical carotid stenosis.
authors.affiliation: From the Department of Neurosurgery and Cyclotron Research Center, Iwate Medical University, Morioka, Japan.
authors.forename: Kohki
authors.initials: K
authors.lastname: Oikawa
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Hideo
authors.initials: H
authors.lastname: Saito
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshida
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Saura
authors.forename: Yuiko
authors.initials: Y
authors.lastname: Sato
authors.forename: Kazunori
authors.initials: K
authors.lastname: Terasaki
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Wada
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kubo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000601:surgery*; D002531:Cerebellum / Q000098:blood supply*; D002560:Cerebrovascular Circulation; D002574:Cervical Vertebrae / Q000098:blood supply; D004691:Endarterectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging; D057234:Preoperative Period; D015899:Tomography, Emission-Computed, Single-Photon