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首页> 美国卫生研究院文献>Neurologia medico-chirurgica >Does Preoperative Measurement of Cerebral Blood Flow with Acetazolamide Challenge in Addition to Preoperative Measurement of Cerebral Blood Flow at the Resting State Increase the Predictive Accuracy of Development of Cerebral Hyperperfusion after Carotid Endarterectomy? Results from 500 Cases with Brain Perfusion Single-photon Emission Computed Tomography Study
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Does Preoperative Measurement of Cerebral Blood Flow with Acetazolamide Challenge in Addition to Preoperative Measurement of Cerebral Blood Flow at the Resting State Increase the Predictive Accuracy of Development of Cerebral Hyperperfusion after Carotid Endarterectomy? Results from 500 Cases with Brain Perfusion Single-photon Emission Computed Tomography Study

机译：除了在静息状态下进行术前脑血流量测量前术前用乙酰唑胺激发进行脑血流量测量是否会提高颈动脉内膜切除术后脑灌注过度的预测准确性？ 500例脑灌注单光子发射计算机断层扫描研究的结果

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The purpose of the present study was to determine whether preoperative measurement of cerebral blood flow (CBF) with acetazolamide in addition to preoperative measurement of CBF at the resting state increases the predictive accuracy of development of cerebral hyperperfusion after carotid endarterectomy (CEA). CBF at the resting state and cerebrovascular reactivity (CVR) to acetazolamide were quantitatively assessed using N-isopropyl-p-[123I]-iodoamphetamine (IMP)-autoradiography method with single-photon emission computed tomography (SPECT) before CEA in 500 patients with ipsilateral internal carotid artery stenosis (≥ 70%). CBF measurement using 123I-IMP SPECT was also performed immediately and 3 days after CEA. A region of interest (ROI) was automatically placed in the middle cerebral artery territory in the affected cerebral hemisphere using a three-dimensional stereotactic ROI template. Preoperative decreases in CBF at the resting state [95% confidence intervals (CIs), 0.855 to 0.967; P = 0.0023] and preoperative decreases in CVR to acetazolamide (95% CIs, 0.844 to 0.912; P < 0.0001) were significant independent predictors of post-CEA hyperperfusion. The area under the receiver operating characteristic curve for prediction of the development of post-CEA hyperperfusion was significantly greater for CVR to acetazolamide than for CBF at the resting state (difference between areas, 0.173; P < 0.0001). Sensitivity, specificity, and positive- and negative-predictive values for the prediction of the development of post-CEA hyperperfusion were significantly greater for CVR to acetazolamide than for CBF at the resting state (P < 0.05, respectively). The present study demonstrated that preoperative measurement of CBF with acetazolamide in addition to preoperative measurement of CBF at the resting state increases the predictive accuracy of the development of post-CEA hyperperfusion.
机译：本研究的目的是确定除在静息状态下进行术前CBF之外，术前使用乙酰唑胺进行脑血流量（CBF）的术前测量是否能提高颈动脉内膜切除术（CEA）后脑灌注过多的预测准确性。使用N-异丙基-对-[ 123 I]-碘苯丙胺（IMP）-放射自显影法结合单光子发射计算机体层摄影术定量评估静止状态下的CBF和对乙酰唑酰胺的脑血管反应性（CVR）。 SPECT）在500例同侧颈内动脉狭窄（≥70％）的患者中进行CEA。在CEA后立即和3天使用 123 I-IMP SPECT测量CBF。使用三维立体定向ROI模板，将感兴趣区域（ROI）自动放置在受影响的大脑半球的大脑中动脉区域。静息状态下，术前CBF降低[95％置信区间（CIs），0.855至0.967； P = 0.0023]，术前CVR降低至乙酰唑胺（95％CI，0.844至0.912； P <0.0001）是CEA灌注过度的重要独立预测因子。在静息状态下，CVR转化为乙酰唑胺的受试者工作特征曲线下用于预测CEA过度灌注的面积明显大于CBF（面积之间的差异为0.173； P <0.0001）。静息状态下，CVR转化为乙酰唑胺的敏感性，特异性以及阳性和阴性预测值显着高于CVR对乙酰唑胺的发生率（分别为P <0.05）。本研究表明，除在静息状态下进行术前CBF之外，术前用乙酰唑胺进行CBF的术前测量还可以提高CEA灌注后发展的预测准确性。

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