Abstract
Introduction: Single-photon emission computed tomography (SPECT) with acetazolamide challenge is useful in the prediction and assessment of post-carotid endarterectomy (CEA) or carotid stenting (CAS) cerebral hyperperfusion (CHP). However, serious adverse reactions to acetazolamide have been reported to date.
Purpose: The purpose of this study was to predict the CHP using computed tomography perfusion imaging (CTP).
Methods: SPECT with acetazolamide challenge and CTP, as a preoperative study, were used in 116 patients undergoing CEA or CAS from August 2015 to August 2018. Twenty-one patients were determined to be at risk of CHP by SPECT with acetazolamide challenge. After co-registration of the CTP and SPECT images, we assessed the relationship between the CTP parameters and SPECT findings in 21 patients regarded as having a high risk of CHP. CTP maps were assessed for cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time-to-peak (TTP), time-to-start (TTS), and time-to-drain (TTD).
Results: Increased CBV and delayed TTD and TTP were observed in all the 21 patients. Six of the 21 patients had a CHP. In these six patients, delayed MTT and delayed TTS were observed. The delay in MTT and TTS was strongly correlated with postoperative CHP (p ＜ 0.05).
Conclusion: Preoperative CTP may be useful for the prediction of cerebral hyperperfusion.
