Skip to main content
SpringerLink
Log in

Clinical significance of cerebrovascular reserve in acetazolamide challenge —comparison with acetazolamide challenge H2O-PET and Gas-PET—

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

The response of cerebral blood flow (CBF) to acetazolamide (ACZ) challenge is frequently determined in clinical settings to evaluate cerebrovascular reserve (CVR). A reduced CVR can indicate patients with occlusive cerebrovascular disease and compromised hemodynamics who may be at increased risk of cerebral ischemia. However, how precisely ACZ reflects cerebral hemodynamic impairment remains obscure. The present study aims to clarify the pathological significance of CVR in patients with occluded carotid arteries.

Methods

We recruited seventeen patients with occlusive lesions in the internal carotid artery (ICA) or middle cerebral artery (MCA). We assessed these patients in terms of resting cerebral blood flow (CBF) and the CVR response to ACZ challenge using H2O positron emission tomography (PET). In addition, we evaluated hemodynamic parameters including oxygen extraction fraction (OEF) using Gas-PET.

Results

We identified a significant negative correlation between the CVR and OEF or the cerebral blood volume (CBV)/CBF ratio, as a potential index of cerebral perfusion pressure. Although the CVR values were reduced in all regions with elevated OEF (Stage II), these values were highly variable regardless of the CB V/CBF ratios. The cut-off value of CVR alone could not detect Stage II, but when combined with resting CBF, misery perfusion accompanied by increased OEF was detected with high sensitivity (6/7) and specificity (61/62).

Conclusion

CVR could be applied as an index reflecting both autoregulatory capacity and OEF. The present study also supported the notion that SPECT with ACZ challenge can be clinically applied to detect misery perfusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Yonas H, Smith HA, Durham SR, Pentheny SL, Johnson DW. Increased stroke risk predicted by compromised cerebral blood flow reactivity.J Neurosurg 1993; 79:483–4899.

    Article  PubMed  CAS  Google Scholar 

  2. Grubb RL Jr, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, et al. Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion.JAMA 1998; 280:1055–10600.

    Article  PubMed  Google Scholar 

  3. Yamauchi H, Fukuyama H, Nagahama Y, Nabatame H, Ueno M, Nishizawa S, et al. Significance of increased oxygen extraction fraction in five-year prognosis of major cerebral arterial occlusive diseases.J Nucl Med 1999; 40:1992–19988.

    PubMed  CAS  Google Scholar 

  4. Powers WJ, Press GA, Grubb RL Jr, Gado M, Raichle ME. The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation.Ann Intern Med 1987; 106:27–344.

    PubMed  CAS  Google Scholar 

  5. Powers WJ. Cerebral hemodynamics in ischemic cerebrovascular disease.Ann Neurol 1991; 29:231–2400.

    Article  PubMed  CAS  Google Scholar 

  6. Baron JC, Bousser MG, Rey A, Guillard A, Comar D, Castaigne P. Reversal of focal “misery-perfusion syndrome” by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with15O positron emission tomography.Stroke 1981; 12:454–4599.

    PubMed  CAS  Google Scholar 

  7. North America Symptomatic Carotid Endarterectomy Trial Steering Committee. North America Symptomatic Carotid Endarterectomy Trial: methods, patient characteristics and progress.Stroke 1991; 22:711–7200.

    Google Scholar 

  8. Whisnant JP, Basford JR, Bernstein EF. Classification of cerebrovascular disease III.Stroke 1990; 21:637–6766.

    Google Scholar 

  9. Hirano T, Minematsu K, Hasegawa Y, Tanaka Y, Hayashida K, Yamaguchi T. Acetazolamide reactivity on123I-IMP single photon emission computed tomography in patients with major cerebral artery occlusive disease: correlation with positron emission tomography parameters.J Cereb Blood Flow Metab 1994; 14:763–7700.

    PubMed  CAS  Google Scholar 

  10. Imaizumi M, Kitagawa K, Hashikawa K, Oku N, Teratani T, Takasawa M, et al. Detection of Misery Perfusion Using Split-dosel23I-Iodoamphetamine SPECT in Patients with Carotid Occlusive Diseases.Stroke 2002; 33:2217–22233.

    Article  PubMed  CAS  Google Scholar 

  11. Gibbs JM, Leenders KL, Wise RJ, Jones T. Evaluation of cerebral perfusion reserve in patients with carotid-artery occlusion.Lancet 1984; 1:182–1866.

    Article  PubMed  CAS  Google Scholar 

  12. Schumann P, Touzani O, Young AR, Morello R, Baron JC, MacKenzie ET. Evaluation of the ratio of cerebral blood flow to cerebral blood volume as an index of local cerebral perfusion pressure.Brain 1998; 121:1369–13799.

    Article  PubMed  Google Scholar 

  13. Grubb RL Jr, Phelps ME, Raichle ME, Ter-Pogossian MM. The effects of arterial blood pressure on the regional cerebral blood volume by X-ray fluorescence.Stroke 1973; 4:390–3999.

    PubMed  Google Scholar 

  14. Grubb RL Jr, Raichle ME, Phelps ME, Ratcheson RA. Effects of increased intracranial pressure on cerebral blood volume, blood flow, and oxygen utilization in monkeys.J Neurosurg 1975; 43:385–3988.

    PubMed  Google Scholar 

  15. Ferrari M, Wilson DA, Hanley DF, Traytman RJ. Effects of graded hypotension on cerebral blood flow, blood volume, and mean transit time in dogs.Am J Physiol 1992; 262:H1908–19144.

    PubMed  CAS  Google Scholar 

  16. Zaharchuk G, Mandeville JB, Bogdanov AA Jr, Weissleder R, Rosen BR, Marota JJ. Cerebrovascular dynamics of autoregulation and hypoperfusion: an MRI study of CBF and changes in total and microvascular cerebral blood volume during hemorrhagic hypotension.Stroke 1999; 30:2197–22055.

    PubMed  CAS  Google Scholar 

  17. Okazawa H, Yamauchi H, Sugimoto K, Toyoda H, Kishibe Y, Takahashi M. Effects of acetazolamide on cerebral blood flow, blood volume, and oxygen metabolism: A positron emission tomography study with healthy volunteers.J Cereb Blood Flow Metab 2001; 21:1472–14799.

    Article  PubMed  CAS  Google Scholar 

  18. Derdeyn CP, Grubb RL Jr, Powers WJ. Cerebral hemodynamic impairment: methods of measurement and association with stroke risk.Neurology 1999; 53:251–2599.

    PubMed  CAS  Google Scholar 

  19. Derdeyn CP, Videen TO, Yundt KD, Fritsh SM, Carpenter DA, Grubb RL, et al. Variability of cerebral blood volume and oxygen extraction: stages of cerebral haemodynamic impairment revisited.Brain 2002; 125:595–6077.

    Article  PubMed  Google Scholar 

  20. Kuroda S, Houkin K, Kamiyama H, Mitsumori K, Iwasaki Y, Abe H. Long-term prognosis of medically treated patients with internal carotid or middle cerebral artery occlusion: can acetazolamide test predict it?Stroke 2001; 9:2110–21166.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, 565-0871, Osaka, Japan

    Masao Imaizumi, Naohiko Oku, Yasuhiro Osaki & Jun Hatazawa

  2. Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Japan

    Kazuo Kitagawa, Kazuo Hashikawa, Masashi Takasawa, Takuya Yosmkawa, Kouji Matsushita, Masayasu Matsumoto & Masatsugu Hori

Authors
  1. Masao Imaizumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuo Kitagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naohiko Oku
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kazuo Hashikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masashi Takasawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takuya Yosmkawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasuhiro Osaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kouji Matsushita
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masayasu Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Masatsugu Hori
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jun Hatazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masao Imaizumi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Imaizumi, M., Kitagawa, K., Oku, N. et al. Clinical significance of cerebrovascular reserve in acetazolamide challenge —comparison with acetazolamide challenge H2O-PET and Gas-PET—. Ann Nucl Med 18, 369–374 (2004). https://doi.org/10.1007/BF02984479

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02984479

Key words

Search

Navigation