Department of Neurosurgery, Kanazawa University, Kanazawa, Japan.
Department of Neurosurgery, Kanazawa University, Kanazawa, Japan.
J Neuroradiol. 2018 Oct;45(6):362-367. doi: 10.1016/j.neurad.2018.02.008. Epub 2018 Mar 7.
Hemodynamic impairments are considered risk factors of cerebral hyperperfusion after carotid artery stenting (CAS); measurement by Single-photon emission computed tomography (SPECT) using a subjective region of interest (ROI) method lacks consistency and reproducibility.
The present study compared objective perfusion analysis (stereotactic extraction estimation [SEE] method) with the ROI method for preoperative SPECT to predict the hyperperfusion phenomenon (HPP) after CAS. Preoperative resting asymmetry index (cerebral blood flow [CBF] ratio from the affected to unaffected hemisphere) and cerebrovascular reactivity (CVR) to acetazolamide were measured by N-isopropyl-p-[I]-iodoamphetamine SPECT using the SEE and ROI method in 84 patients. CBF was also measured the day after CAS. Perfusion data with the highest area under the curve (AUC) by receiver-operating characteristic (ROC) analysis was considered a perfusion risk factor of HPP. Multivariate analyses for clinical characteristics and perfusion risk factors were performed to determine predictors of HPP.
The HPP was observed in 10 patients (11.9%). Female sex, contralateral stenosis, and degree of stenosis were significantly associated with HPP development on univariate analysis, and symptomatic stenosis was not found to be a significant factor. On SPECT analysis, CVR in the MCA area by SEE method had the highest AUC (0.981). Multivariate analysis showed that CVR in the MCA area was a significant predictor of HPP (P=0.041). To predict hyperperfusion, the ROC curve of the CVR showed a cutoff value of -0.60%, sensitivity of 94.6%, and specificity of 100% (P<0.001).
Objective SEE method had better a predictive capability than ROI method to identify risk of hyperperfusion after CAS.
血流动力学损伤被认为是颈动脉支架置入术（CAS）后发生脑过度灌注的危险因素；使用主观感兴趣区（ROI）方法的单光子发射计算机断层扫描（SPECT）测量缺乏一致性和可重复性。
本研究比较了术前 SPECT 的客观灌注分析（立体定向提取估计[SEE]方法）与 ROI 方法，以预测 CAS 后发生过度灌注现象（HPP）的风险。84 例患者使用 SEE 和 ROI 方法通过 N-异丙基-p-[I]-碘安非他命 SPECT 测量术前静息不对称指数（受影响半球与未受影响半球的脑血流[CBF]比值）和乙酰唑胺脑血管反应性（CVR）。CAS 后第 1 天还测量了 CBF。通过接收者操作特征（ROC）分析获得的灌注数据的曲线下面积（AUC）最高，被认为是 HPP 的灌注危险因素。对临床特征和灌注危险因素进行多变量分析，以确定 HPP 的预测因子。
10 例患者（11.9%）出现 HPP。单变量分析显示，女性、对侧狭窄和狭窄程度与 HPP 发生显著相关，而症状性狭窄未被发现是显著因素。在 SPECT 分析中，SEE 方法测量的 MCA 区域的 CVR 具有最高的 AUC（0.981）。多变量分析显示，MCA 区域的 CVR 是 HPP 的显著预测因子（P=0.041）。为了预测过度灌注，CVR 的 ROC 曲线显示截断值为-0.60%，敏感性为 94.6%，特异性为 100%（P<0.001）。
与 ROI 方法相比，客观 SEE 方法具有更好的预测能力，可识别 CAS 后发生过度灌注的风险。
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