scholarly journals Simultaneous PET-MRI imaging of cerebral blood flow and glucose metabolism in the symptomatic unilateral internal carotid artery/middle cerebral artery steno-occlusive disease

2019 ◽  
Vol 47 (7) ◽  
pp. 1668-1677 ◽  
Author(s):  
Bixiao Cui ◽  
Tianhao Zhang ◽  
Yan Ma ◽  
Zhongwei Chen ◽  
Jie Ma ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Glucose Metabolism ◽  
Cerebrovascular Disease ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Internal Carotid ◽  
Ischaemic Cerebrovascular Disease ◽  
Before And After

Abstract Purpose Cerebral blood flow (CBF) and glucose metabolism are important and significant factors in ischaemic cerebrovascular disease. The objective of this study was to use quantitative hybrid PET/MR to evaluate the effects of surgery treatment on the symptomatic unilateral internal carotid artery/middle cerebral artery steno-occlusive disease. Methods Fifteen patients diagnosed with ischaemic cerebrovascular disease were evaluated using a hybrid TOF PET/MR system (Signa, GE Healthcare). The CBF value measured by arterial spin labelling (ASL) and the standardized uptake value ratio (SUVR) measured by 18F-FDG PET were obtained, except for the infarct area and its contralateral side, before and after bypass surgery. The asymmetry index (AI) was calculated from the CBF and SUVR of the ipsilateral and contralateral cerebral hemispheres, respectively. The ΔCBF and ΔSUVR were calculated as the percent changes of CBF and SUVR between before and after surgery, and paired t tests were used to determine whether a significant change occurred. Spearman’s rank correlation was also used to compare CBF with glucose metabolism in the same region. Results The analysis primarily revealed that after bypass surgery, a statistically significant increase occurred in the CBF on the affected side (P < 0.01). The postprocedural SUVR was not significantly higher than the preprocedural SUVR (P > 0.05). However, the postprocedural AI values for CBF and SUVR were significantly lower after surgery than before surgery (P < 0.01). A significant correlation was found between the AI values for preoperative CBF and SUVR on the ipsilateral hemisphere (P < 0.01). Conclusions The present study demonstrates that a combination of ASL and 18F-FDG PET could be used to simultaneously analyse changes in patients’ cerebral haemodynamic patterns and metabolism between before and after superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery. This therefore represents an essential tool for the evaluation of critical haemodynamic and metabolic status in patients with symptomatic unilateral ischaemic cerebrovascular disease.

scholarly journals Cerebral Infarcts and Cerebrovascular Disease in Neurologically Intact Tanzanian Children with Sickle Cell Anaemia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1089-1089
Author(s):  
Mboka Mwakatika Mwakatika ◽  
Dawn E Saunders ◽  
Julie Makani ◽  
Fenella Jane Kirkham
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Infarction ◽  
Middle Cerebral Artery ◽  
Children And Adolescents ◽  
Confidence Intervals ◽  
Sickle Cell ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Silent Cerebral Infarction

Abstract Introduction: Children and adolescents with sickle cell anemia (SCA) without history of neurological manifestations remain at risk of stroke and require cost effective screening as evidence-based stroke prevention interventions are developed. Although there are data on the prevalence of Transcranial Doppler (TCD) abnormality, there are relatively few studies on the prevalence of silent cerebral infarction (SCI) on magnetic resonance imaging (MRI) and vasculopathy on MR angiography (MRA), paricularly in Africa, where the burden of disease is greatest. In this study in Africa, we determined the prevalence of SCI on MRI and cerebral vasculopathy on MRA, and explored associations with age, sex, internal carotid/middle cerebral artery (ICA/MCA) and basilar cerebral blood flow velocities (CBFV) on TCD, and hematological variables. Patients and methods: We prospectively studied children with homozygous SCA (HbSS) without prior clinically overt stroke or TIA or seizures. Clinical information and blood for full blood count was collected for all patients. All were offered TCD using non-imaging equipment (Compumedics) and MRI and MRA of intracranial arteries on a Philips 1.5 Tesla scanner. MRA was graded as 1 Turbulence, 2 Stenosis, 3 Occlusion, 4 Occlusion with collaterals (moyamoya). Imaging was reviewed by 2 neuroradiologists (MJ and DS) and consensus was reached. Results: Within a period of 12 months, 395 children with SCA were recruited. Mean age was 12.7+/-4 (range 5-19 years); 199 (50.4%) were male. Mean hemoglobin was 7.6±1.1 (range 4.1-13.5) g/dl. 381 had TCD, of whom 227 (57%) have had brain MRI and MRA so far. Only 14/395 (3.5%) of patients had abnormal CBFV, 8 (2%) with maximum CBFV <50 cm/sec, 3 with CBFV 150-169 cm/sec, 1 with conditional (170-199 cm/sec) and 2 (0.5%) with abnormal CBFV (>200cm/sec). Prevalence of silent cerebral infarction was 29% (65/227) and was similar in males (30%; 34/114) and females (28%; 31/110) but was lower in children aged <9 years (20%; 10/51) than in those aged 10-14 years (33%; 27/83) or those aged 15-19 years (32%; 28/89); this was not significant (p=0.2). The prevalence of cerebral vasculopathy on MRA, defined as stenosis (Grade 2), occlusion (Grade 3) or occlusion with collaterals (moyamoya; Grade 4), was 9% (20/227). The internal carotid and/or middle cerebral artery was affected in all 20 and the anterior cerebral artery was affected in 7 patients. Vasculopathy was not observed on MRA in the posterior cerebral artery and no patients had moyamoya. An additional 9 (4%) patients had turbulence (Grade 1) in at least one artery on MRA. SCI were more common in those with MRA vasculopathy Grades 2-3 (12/64; 19%) and in those with Grade 1 Turbulence (2/9; 22%) than in those with normal MRA (8/165; 5%) (p<0.05). Patients with Grade 1 Turbulence had higher ICA/MCA CBFv (mean 122+/-36 cm/sec) than those with normal MRA (mean 101+/-25 cm/sec) or Grades 2-3 (mean 109+/-21 cm/sec) vasculopathy. The difference in those with Grade 1 turbulence compared with those with normal MRA was significant (mean difference 20 cm/sec, 95% confidence intervals 1, 39 cm/sec; p=0.037). Basilar velocity was also significantly higher in those with Grade 1 turbulence (87+/-21 cm/sec) than in those with normal MRA (76+/-14 cm/sec) and those with Grade 2-3 vasculopathy (80+/-11 cm/sec)(mean difference 11.5 cm/sec, 95% confidence intervals 0.3, 22.6 cm/sec; p=0.043). Basilar velocity weakly correlated with hemoglobin (r=-0.18) but the relationships between hemoglobin and ICA/MCA CBFV or either presence of SCI or MRA abnormality were not significant. Conclusions: The prevalence of SCI on MRI is high in children with SCA without neurological history living in Africa even when TCD CBFV is normal. Children and adolescents with all grades of vasculopathy on MRA are at higher risk of brain parenchymal injury. The lack of association between SCI and hemoglobin may be related to the relatively severe anemia in our African study. As MRA contrast depends on velocity of blood flowing in vessels, it is not surprising that Grade 1 turbulence on MRA appears to reflect high CBFV on TCD. Importantly, high TCD velocity and Grade 1 turbulence may reflect the potentially reversible early stages in the development of SCA vasculopathy when cerebral blood flow is high before stenosis and occlusion supervene. TCD is operator dependent and there may be a case for MRI and MRA screening if follow-up shows that these measures predict stroke. Disclosures No relevant conflicts of interest to declare.

Regional cerebral blood flow and oxygen utilization in superficial temporal-middle cerebral artery anastomosis patients

1979 ◽  
Vol 50 (6) ◽  
pp. 733-741 ◽  
Author(s):  
Robert L. Grubb ◽  
Robert A. Ratcheson ◽  
Marcus E. Raichle ◽  
Arthur B. Kliefoth ◽  
Mokhtar H. Gado
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Regional Cerebral Blood Flow ◽  
Superficial Temporal Artery ◽  
Regional Cerebral Blood ◽  
Oxygen Utilization ◽  
Cerebrovascular Lesions ◽  
Before And After

✓ Regional cerebral blood flow (rCBF) and regional cerebral oxygen utilization (rCMRO2) were measured before and after surgery in nine patients undergoing a superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis to bypass cerebrovascular lesions not amenable to extracranial operative procedures. The objective of these studies was to determine whether measurements of this type could provide objective criteria for surgery as well as assess the effect of surgery. The preliminary data, although limited, suggest that measurements of regional cerebral hemodynamics and metabolism in these patients before and after surgery provide valuable data upon which to develop criteria and assess results. For example, 1) a significant depression of rCBF and rCMRO2 in patients in whom a major cerebral infarction has not occurred, or 2) relative preservation of rCMRO2 despite depressed rCBF seem to be favorable indications for establishing a functioning STA-MCA anastomosis. In such patients, STA-MCA anastomosis can be followed by a return of rCBF and rCMRO2 to virtually normal levels. Relatively normal rCBF and rCMRO2 in the presence of an occluded internal carotid artery in asymptomatic patients indicates satisfactory collateral circulation and is probably a contraindication to surgery.

scholarly journals Cerebral Blood Flow and Glucose Metabolism of the Ischemic Rim in Spontaneously Hypertensive Stroke-Prone Rats with Occlusion of the Middle Cerebral Artery

1995 ◽  
Vol 15 (2) ◽  
pp. 235-241 ◽  
Author(s):  
Hideyuki Kita ◽  
Katsuji Shima ◽  
Miwako Tatsumi ◽  
Hiroo Chigasaki
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
White Matter ◽  
Glucose Metabolism ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Anaerobic Glycolysis ◽  
Spontaneously Hypertensive ◽  
Lateral Segment ◽  
Ischemic Core

To determine acute postischemic metabolic changes of the ischemic rim under conditions of poor collateral circulation, we examined cerebral blood flow and glucose metabolism in the area of the brain around the ischemic tissue in 36 male spontaneously hypertensive stroke-prone rats (SHRSP) in the acute stage of focal ischemia. The right middle cerebral artery (MCA) was occluded dorsal to the rhinal fissure. Four hours after occlusion, local cerebral blood flow (LCBF), glucose content (LCGC), and glucose utilization (LCGU) were measured by quantitative autoradiographic techniques. The lumped constant was determined from the corresponding LCGC. LCBF showed a widespread and marked decrease in the cortex surrounding the ischemic core, in the thalamus, and in the medial portion of the striatum in the MCA-occluded hemisphere, while the lateral segment of the striatum showed an increase of 36%, compared with findings on the contralateral side. LCGC showed little regional variation, but there was an increase of 38% in the zone bordering the ischemic area. LCGU at the cortex surrounding the ischemic core and in the external capsule showed an increase of 55%. The cortex surrounding the ischemic core, the thalamus, and the lateral segment of the striatum in the MCA-occluded hemisphere showed significant decreases in LCGU. It has been speculated that a high accumulation of glucose reflects a demand for glucose for anaerobic glycolysis in the border areas and that such a demand is probably greater in cases of impaired oxygen delivery due to the presence of microcirculatory disturbances in the MCA-occluded SHRSP. The enhancement of glucose consumption may reflect anaerobic glycolysis. Because the hypermetabolic band was present in the cortex and the white matter, hypermetabolism of the white matter may be related to the glial cell.

Regional cerebral blood flow studies following superficial temporal-middle cerebral artery anastomosis

1975 ◽  
Vol 43 (6) ◽  
pp. 706-716 ◽  
Author(s):  
M. Peter Heilbrun ◽  
O. Howard Reichman ◽  
Robert E. Anderson ◽  
Theodore S. Roberts
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Regional Cerebral Blood Flow ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Regional Cerebral Blood ◽  
Content Type ◽  
Significant Difference

✓ Regional cerebral blood flow (rCBF) studies were performed during the postoperative period on 16 patients with internal carotid occlusions and inaccessible stenoses, and middle cerebral artery occlusion and stenoses, who underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomoses. The intra-arterial xenon method with selective application of the xenon bolus through the internal carotid and the newly established superficial temporal channel has allowed comparison of the flow provided by the pathological input with flow through the new input. The results show that initial rCBF (rCBF1) was globally reduced in all patients to a mean of 28.4 ± 11.9 ml/100 gm/min at a mean pCO2 of 29.6 ± 9.55 mm Hg. Patients with transient ischemic attacks (TIA) and minor strokes with minimal residua (RIND) had a mean rCBF1 of 30.4 ± 11.6 ml/100 gm/min at a mean pCO2 of 30 ± 10 mm Hg, while patients with completed strokes had a mean rCBF1 of 25.0 ± 12.4 ml/100 gm/min at a mean pCO2 of 29.1 ± 8.8 mm Hg. There was no significant difference between these two groups. This finding suggests that in this small group of patients with TIA's and RIND's, the cause of the stroke is probably related more to decreased perfusion than embolus, and may explain why these patients' symptoms improve after STA-MCA anastomosis. The results of this study suggest that in addition to an inaccessible lesion, global or focal decreased rCBF is a necessary criterion in the definition of indications for intracranial revascularization procedures.

133Xe-DSPECT: Normalwerte von zerebraler Ruhedurchblutung und Reservekapazität

1987 ◽  
Vol 26 (05) ◽  
pp. 192-197 ◽  
Author(s):  
T. Kreisig ◽  
P. Schmiedek ◽  
G. Leinsinger ◽  
K. Einhäupl ◽  
E. Moser
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebrovascular Disease ◽  
Correlation Coefficient ◽  
Regional Cerebral Blood Flow ◽  
Regression Line ◽  
Reserve Capacity ◽  
Regional Cerebral Blood ◽  
Quantitative Measurements ◽  
Before And After

Using the 133Xe-DSPECT technique, quantitative measurements of regional cerebral blood flow (rCBF) were performed before and after provocation with acetazolamide (Diamox) i. v. in 32 patients without evidence of brain disease (normals). In 6 cases, additional studies were carried out to establish the time of maximal rCBF increase which was found to be approximately 15 min p. i. 1 g of Diamox increases the rCBF from 58 ±8 at rest to 73±5 ml/100 g/min. A Diamox dose of 2 g (9 cases) causes no further rCBF increase. After plotting the rCBF before provocation (rCBFR) and the Diamox-induced rCBF increase (reserve capacity, Δ rCBF) the regression line was Δ rCBF = −0,6 x rCBFR +50 (correlation coefficient: r = −0,77). In normals with relatively low rCBF values at rest, Diamox increases the reserve capacity much more than in normals with high rCBF values before provocation. It can be expected that this concept of measuring rCBF at rest and the reserve capacity will increase the sensitivity of distinguishing patients with reversible cerebrovascular disease (even bilateral) from normals.

Effect of Ketanserin on Global Cerebral Blood Flow and Middle Cerebral Artery Flow Velocity

1995 ◽  
Vol 80 (1) ◽  
pp. 64-70 ◽  
Author(s):  
Andreas Weyland ◽  
Heidrun Stephan ◽  
Frank Grune ◽  
Wolfgang Weyland ◽  
Hans Sonntag
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Global Cerebral Blood Flow ◽  
Artery Flow
Sign in / Sign up

Export Citation Format

Share Document