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Combination of Preoperative Cerebral Blood Flow and 123I-Iomazenil SPECT Imaging Predicts Postoperative Cognitive Improvement in Patients Undergoing Uncomplicated Endarterectomy for Unilateral Carotid Stenosis.
MedLine Citation:
PMID:  22228333     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
PURPOSE: : The purpose of the present study was to determine whether preoperative cerebral blood flow (CBF) or cortical central benzodiazepine receptor binding potential as measured by brain perfusion or I-iomazenil (IMZ) single-photon emission computed tomography (SPECT) imaging, respectively, can predict cognitive improvement after uncomplicated carotid endarterectomy (CEA).
METHODS: : Neuropsychological testing was performed preoperatively and after 1 month postoperatively in 140 patients who underwent CEA for unilateral internal carotid artery (ICA) stenosis (≥70%). Brain perfusion SPECT using N-isopropyl-p-[I]-iodoamphetamine and IMZ SPECT was also performed before surgery. SPECT data were analyzed using a 3-dimensional stereotaxic region-of-interest template.
RESULTS: : Fourteen patients (10%) showed improved cognitive function postoperatively. Logistic regression analysis demonstrated that, among the variables tested, low relative CBF in the cerebral hemisphere ipsilateral to surgery was significantly associated with postoperative cognitive improvement (95% confidence interval: 0.623-0.868; P = 0.0003). The combination of reduced relative CBF and moderately reduced relative uptake of IMZ identified development of postoperative cognitive improvement with 100.0% sensitivity, 84.9% specificity, a positive predictive value of 42.4%, and a negative predictive value of 100%. Further, in a subgroup of patients with reduced relative CBF and moderately reduced relative uptake of IMZ, the difference between these 2 values was significantly greater in patients with postoperative cognitive improvement than in those without (P < 0.0001).
CONCLUSIONS: : The combination of preoperative CBF and cortical central benzodiazepine receptor binding potential as determined by SPECT can predict cognitive improvement after CEA.
Authors:
Takeshi Yamashita; Kuniaki Ogasawara; Hiroki Kuroda; Taro Suzuki; Kohei Chida; Masakazu Kobayashi; Kenji Yoshida; Yoshitaka Kubo; Akira Ogawa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical nuclear medicine     Volume:  37     ISSN:  1536-0229     ISO Abbreviation:  Clin Nucl Med     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-09     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7611109     Medline TA:  Clin Nucl Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  128-33     Citation Subset:  IM    
Affiliation:
From the Department of Neurosurgery and Cyclotron Research Center, Iwate Medical University, Morioka, Japan.
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