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28 - Single photon emission computed tomography (SPECT)

from Monitoring the local and distal effects of carotid interventions

Published online by Cambridge University Press:  03 December 2009

By
Kuniaki Ogasawara
Edited by
Jonathan Gillard ,
Martin Graves ,
Thomas Hatsukami  and
Chun Yuan
Kuniaki Ogasawara
Affiliation:
Iwate Medical University, Morioka, Japan
Jonathan Gillard
Affiliation:
University of Cambridge
Martin Graves
Affiliation:
University of Cambridge
Thomas Hatsukami
Affiliation:
University of Washington
Chun Yuan
Affiliation:
University of Washington
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Summary

Introduction

Brain single-photon emission computed tomography (SPECT) has been widely used to assess regional brain perfusion and can also quantify regional cerebral blood flow (CBF) and regional cerebral hemodynamic reserve by measuring cerebrovascular reactivity to acetazolamide. The relationship between the brain perfusion using SPECT and the risk of stroke recurrence in patients with symptomatic carotid disease or the risk for cerebral hyperperfusion or hyperperfusion syndrome after carotid endarterectomy has been investigated.

In this chapter, the utility of SPECT in the evaluation of carotid disease and interventions are discussed.

Cerebrovascular reactivity to acetazolamide and outcome in patients with symptomatic carotid artery occlusion

The hemodynamic effects of an occlusive lesion on the distal circulation have been categorized into three stages (Powers et al., 1987; Derdeyn et al., 1999). Occlusive lesions often have no effect on the distal circulation (stage 0, normal cerebral hemodynamics). When the perfusion pressure distal to the lesion begins to fall, however, reflex vasodilatation maintains normal blood flow (stage 1). This response is known as autoregulation. Autoregulatory vasodilatation can be detected using two basic strategies (Norrving et al., 1982). The first involves quantitative measurements of resting CBF and cerebral blood volume (CBV). CBV increases with autoregulatory vasodilatation and the CBV/CBF ratio, which means the vascular transit time of red blood cells, increases. The second method relies on measurements of CBF at rest and following a vasodilatory stimulus. An absent or diminished response indicates autoregulatory vasodilatation. When autoregulatory vasodilatation is not adequate to maintain normal CBF, CBF begins to fall.

Keywords

acetazolamidecarotid artery occlusioncarotid endarterectomycerebral hyperperfusionsingle-photon emission computed tomographycerebrovascular reactivity
Type
Chapter
Information
Carotid Disease
The Role of Imaging in Diagnosis and Management
 , pp. 387 - 395
Publisher: Cambridge University Press
Print publication year: 2006

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