title: Combination of blood flow asymmetry in the cerebral and cerebellar hemispheres on brain perfusion SPECT predicts 5-year outcome in patients with symptomatic unilateral major cerebral artery occlusion.
abstract: OBJECTIVE
  Misery perfusion increases the risk of stroke recurrence in patients with symptomatic major cerebral artery occlusion. The ratio of brain perfusion contralateral-to-affected asymmetry in the cerebellar hemisphere to brain perfusion affected-to-contralateral asymmetry in the cerebral hemisphere (CblPR/CbrPR) indicates affected-to-contralateral asymmetry of oxygen extraction fraction (OEF) in the cerebral hemisphere. The purpose of the present study was to determine whether the CblPR/CbrPR on brain perfusion single-photon emission computed tomography (SPECT) predicts 5-year outcomes in patients with symptomatic unilateral occlusion of the middle cerebral artery (MCA) or internal carotid artery (ICA).
  
  
  METHODS
  Brain perfusion was assessed using N-isopropyl-p-[123I]-iodoamphetamine (123I-IMP) SPECT in 70 patients. A region of interest (ROI) was manually placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres, and the CblPR/CbrPR was calculated. All patients were prospectively followed for 5 years. The primary end points were stroke recurrence or death.
  
  
  RESULTS
  A total of 17 patients exhibited the primary end points, 11 of whom experienced subsequent ipsilateral strokes. Multivariate analysis revealed that only high CblPR/CbrPR was significantly associated with the development of the primary end point or subsequent ipsilateral strokes (95% confidential limits [CIs], 1.130-3.145; P  =  0.0114 or 95% CIs, 2.558-5.140; P  =  0.0045, respectively). The CblPR/CbrPR provided 65% (11/17) or 91% (10/11) sensitivity and 88% (47/53) or 88% (52/59) specificity in predicting the primary end point or subsequent ipsilateral strokes, respectively.
  
  
  CONCLUSIONS
  The CblPR/CbrPR on brain perfusion SPECT predicts 5-year outcomes in patients with symptomatic unilateral occlusion of the MCA or ICA.
authors: Jun-ichi
authors: J
authors: Nomura
authors: Kuniaki
authors: K
authors: Ogasawara
authors: Hideo
authors: H
authors: Saito
authors: Kazunori
authors: K
authors: Terasaki
authors: Yoshiyasu
authors: Y
authors: Matsumoto
authors: Yoshihiro
authors: Y
authors: Takahashi
authors: Yasushi
authors: Y
authors: Ogasawara
authors: Hiroaki
authors: H
authors: Saura
authors: Koji
authors: K
authors: Yoshida
authors: Yuiko
authors: Y
authors: Sato
authors: Yoshitaka
authors: Y
authors: Kubo
authors: Akira
authors: A
authors: Ogawa
mesh_terms: D000328:Adult; D000368:Aged; D002531:Cerebellum / Q000098:blood supply* / Q000000981:diagnostic imaging; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D054022:Cerebrum / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012039:Regional Blood Flow; D015899:Tomography, Emission-Computed, Single-Photon
keywords: Brain perfusion SPECT,; Crossed cerebellar hypoperfusion,; Subsequent stroke