Department of Neurosurgery, University of South Florida, 13000 Bruce B. Downs-ML 112, Tampa, FL 33612, USA.
Neurosurg Rev. 2010 Apr;33(2):225-32; discussion 232-3. doi: 10.1007/s10143-010-0237-x. Epub 2010 Feb 6.
The usefulness of dynamic perfusion computerized tomography for early diagnosis of stroke is well established. However, limited data exists to assess the value of PCT in the evaluation of patients with chronic cerebral ischemia. The purpose of the study was to assess the utility of perfusion computerized tomography with acetazolamide challenge (PCTA) in the evaluation of cerebral perfusion and cerebrovascular reserve (CVR) in adult Moyamoya patients. From 2005-2008, 41 patients with Moyamoya were scrutinized by PCTA. Of these, 22 patients (12 females, ten males, mean age 41 years) with ischemic symptoms from Moyamoya disease were found to have no response or decreased cerebrovascular flow post-acetazolamide indicating compromised CVR. Eight had bilateral symptoms. Based on matching symptoms and decreased CVR on PCTA, those 22 patients underwent 30 superficial temporal artery-to-middle cerebral artery (STA-MCA) by-pass (eight with bilateral abnormal PCTA had bilateral STA-MCA by-pass). After a mean follow-up of 14 months (range, 3-36 months), no new strokes or symptoms were reported. Graft patency, as documented by postoperative computerized tomography angiography at a mean 12 weeks after surgery was 100%. Eight patients had postoperative PCTA documenting improved CVR after STA-MCA by-pass. At latest follow-up, none of the 19 patients with PCTA findings suggestive of normal CVR had any ischemic symptoms. CVR testing by means of PCTA may have a key role in patient selection for revascularization surgery and postoperative follow-up. These promising results warrant further testing of the technique.
动态灌注计算机断层扫描在早期诊断中风方面的有效性已得到充分证实。然而，评估过碳酸氯噻嗪在慢性脑缺血患者评估中的价值的相关数据有限。本研究旨在评估过碳酸氯噻嗪脑灌注计算机断层扫描（PCTA）在评估成人烟雾病患者脑灌注和脑血管储备（CVR）方面的作用。2005 年至 2008 年，41 例烟雾病患者接受了 PCTA 检查。其中，22 例（12 例女性，10 例男性，平均年龄 41 岁）有缺血症状的烟雾病患者在服用过碳酸氯噻嗪后发现脑血流无反应或减少，表明 CVR 受损。其中 8 例有双侧症状。根据 PCTA 上的症状和 CVR 降低情况，这 22 例患者接受了 30 例颞浅动脉-大脑中动脉（STA-MCA）搭桥术（8 例双侧 PCTA 异常患者行双侧 STA-MCA 搭桥术）。平均随访 14 个月（3-36 个月）后，无新发中风或症状。术后计算机断层血管造影显示，术后平均 12 周时吻合通畅率为 100%。8 例患者术后 PCTA 显示 CVR 改善。在最新的随访中，19 例 PCTA 检查结果提示 CVR 正常的患者均无缺血症状。PCTA 检查可以在选择血管重建手术和术后随访患者方面发挥关键作用。这些有希望的结果需要进一步的技术测试。
