title: Preoperative prediction of cerebral hyperperfusion after carotid endarterectomy using middle cerebral artery signal intensity in 1.5-tesla magnetic resonance angiography followed by cerebrovascular reactivity to acetazolamide using brain perfusion single-photon emission computed tomography.
abstract: OBJECTIVE
  The purpose of the present study was to determine whether the signal intensity of the middle cerebral artery (MCA) on preoperative 1.5-T magnetic resonance angiography (MRA) could identify patients at risk for hyperperfusion following carotid endarterectomy (CEA) as a clinical screening test and whether an additional measurement of preoperative cerebrovascular reactivity (CVR) to acetazolamide on brain perfusion single-photon emission computed tomography (SPECT) could increase the predictive accuracy for the development of hyperperfusion.
  
  
  METHODS
  In 301 patients, the signal intensity of the MCA ipsilateral to CEA on MRA was preoperatively graded according to the ability to visualize the MCA. For patients with reduced MCA signal intensity on the MRA study, CVR to acetazolamide was subsequently assessed using brain perfusion SPECT. Cerebral hyperperfusion was determined intraoperatively using transcranial regional cerebral oxygen saturation monitoring with near-infrared spectroscopy.
  
  
  RESULTS
  Preoperative reduced MCA signal intensity was significantly associated with the development of cerebral hyperperfusion (95% CI, 1.188-3.965; p = 0.0352). While the sensitivity and negative predictive value were 100% both for the preoperative MCA signal intensity alone and in combination with subsequent preoperative CVR to acetazolamide, the specificity and positive predictive value were significantly greater for the latter than for the former (p < 0.05).
  
  
  CONCLUSIONS
  Signal intensity of the MCA on preoperative 1.5-T MRA identifies patients at risk for hyperperfusion following CEA as a clinical screening test. An additional measurement of preoperative CVR to acetazolamide increases the predictive accuracy for the development of hyperperfusion.
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Yoshida
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Chida
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Kohki
authors.initials: K
authors.lastname: Oikawa
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Nomura
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ogasawara
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Shunro
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: b School of Medicine , Cyclotron Research Center, Iwate Medical University , Morioka , Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Terasaki
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
mesh_terms: D000086:Acetazolamide / Q000493:pharmacokinetics; D000368:Aged; D000369:Aged, 80 and over; D002257:Carbonic Anhydrase Inhibitors / Q000493:pharmacokinetics; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology*; D003920:Diabetes Mellitus / Q000601:surgery; D050171:Dyslipidemias / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D006973:Hypertension / Q000601:surgery; D008137:Longitudinal Studies; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011300:Preoperative Care; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide
keywords: Carotid endarterectomy; Cerebral hyperperfusion; Cerebrovascular reactivity; MRA