title: Identification of hemodynamically compromised regions by means of cerebral blood volume mapping utilizing computed tomography perfusion imaging.
abstract: The aim of the study was to evaluate the potential role of computed tomography perfusion (CTP) imaging in identifying hemodynamically compromised regions in patients with occlusive cerebrovascular disease. Twelve patients diagnosed with either occlusion or severe stenosis of the internal carotid artery or the M1 portion of the middle cerebral artery underwent CTP imaging. The data was analyzed by an automated ROI-determining software. Patients were classified into two subgroups: an asymptomatic group consisting of three patients in whom perfusion pressure distal to the site of occlusion/stenosis (PPdis) could be maintained in spite of the arterial occlusion/stenosis, and a symptomatic group consisting of nine patients in whom PPdiscould not be maintained enough to avoid watershed infarction. Four CTP-related parameters were independently compared between the two groups. Significant differences were determined using a two-sample t-test. When statistically significant differences were identified, cut-off points were calculated using ROC curves. Analysis revealed statistically significant differences between the asymptomatic and symptomatic subgroups only in the measure of relCBV (p=0.028). Higher relCBV values were observed in the symptomatic subgroup. ROC curve analysis revealed 1.059 to be the optimal relCBV cut-off value for distinguishing between the asymptomatic and symptomatic subgroups. The data revealed that, in patients whose PPdisis maintained, relCBV remains around 1.00. Conversely, in patients whose PPdisdecreased, relCBV increased. From these findings, we conclude that elevation of relCBV as observed using CTP imaging accurately reflects the extent of compensatory vasodilatation involvement and can identify hemodynamically compromised regions.
authors.affiliation: Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan; Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan. Electronic address: satoshi710@mac.com.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Tanizaki
authors.affiliation: Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Akaji
authors.affiliation: Department of Neurology, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kimura
authors.affiliation: Department of Neurology, Nippon Medical School, Tokyo, Japan; Department of Stroke Medicine, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Katano
authors.affiliation: Department of Neurology, Nippon Medical School, Tokyo, Japan; Department of Stroke Medicine, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Mochizuki
authors.affiliation: Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan.
authors.forename: Satoka
authors.initials: S
authors.lastname: Shidoh
authors.affiliation: Department of Image Diagnosis, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Nakazawa
authors.affiliation: Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Neurology, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan.
authors.forename: Ban
authors.initials: B
authors.lastname: Mihara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000502:physiology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000071937:Cerebral Blood Volume / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D010865:Pilot Projects; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Bypasss surgery; CT perfusion; Cerebral blood volume; Cerebrovascular reserve capacity