| Cerebrovascular insufficiency as the criterion for revascularization procedures in selected patients: a correlation study of xenon contrast-enhanced CT and PWI. | |
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MedLine Citation:
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PMID: 18791753 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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In order to identify patients who suffer from hemodynamic cerebral insufficiency and can benefit from cerebral revascularization procedures, xenon-CT scanning has been established to reliably measure the critical cerebrovascular reserve capacity. As a need for alternative quantification methods arises, this study aims to characterize the significance of both time-to-peak (TTP) and mean transit time (MTT) in perfusion-weighted imaging (PWI) in this particular subset of patients. Ten patients in routine preoperative work-up for cerebral revascularization were prospectively enrolled and underwent both XeCT scanning and PWI. Cerebrovascular reserve capacity (CVRC) was calculated for each region of interest (ROI, n = 504) after administration of a vasoactive stimulus. ROIs were anatomically matched with those of PWI after TTP and MTT were calculated. Highly significant negative correlation was found for TTP and CVRC for all ROIs (r = -0.3954, p < 0.0001; symptomatic ROIs: r = -0.4867, p < 0.0001). Correlation was weak for MTT and CVCR (r = -0.1287; p < 0.01). The optimum threshold for TTP to detect impaired cerebrovascular reactivity in our patient group was 4 s (specificity 90.8%, sensitivity 44.4%) for all ROIs (TTP > 4.4 s for symptomatic ROIs, specificity 88.4%, sensitivity 62.7%). An approximative equation to calculate the probability of pathological findings could be derived from the data. The positive predictive value (PPV) was 0.76 (symptomatic 0.78) with a negative predictive value (NPV) of 0.71 (symptomatic 0.78). While PWI currently is not able to replace XeCT in the direct quantification of CVRC, it may serve as a readily available follow-up tool. A TTP threshold of greater than 4 s allows to confirm a cerebrovascular compromise in a selected high-risk subgroup of patients. |
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Authors:
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Gerrit Alexander Schubert; Carolin Weinmann; Marcel Seiz; Lars Gerigk; Christel Weiss; Peter Horn; Claudius Thomé |
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Publication Detail:
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Type: Journal Article Date: 2008-09-13 |
Journal Detail:
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Title: Neurosurgical review Volume: 32 ISSN: 0344-5607 ISO Abbreviation: Neurosurg Rev Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2008-11-12 Completed Date: 2009-04-24 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7908181 Medline TA: Neurosurg Rev Country: Germany |
Other Details:
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Languages: eng Pagination: 29-35; discussion 35-6 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Germany. gerrit.schubert@nch.ma.uni-heidelberg.de |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Brain / pathology, radiography Carotid Stenosis / pathology, radiography, surgery Cerebral Revascularization* Cerebrovascular Circulation / physiology Cerebrovascular Disorders / pathology*, radiography, surgery* Constriction, Pathologic Female Humans Image Processing, Computer-Assisted Magnetic Resonance Imaging Male Middle Aged Middle Cerebral Artery / pathology, radiography Moyamoya Disease / pathology, radiography, surgery ROC Curve Tomography, X-Ray Computed |
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