혈관조영영상의 소견과 뇌혈관반응성의 상관 관계 비교

Abstract

Background : As an imaging modality of cerebral vasoreactivity CVR), the role of acetazolamide(ACZ) single photon emission computed tomography(SPECT) has been well-established. However the reports regarding the angiographic determinants for CVR in patients with cerebrovascular disease are limited. Thus we compared transfemoral cerebral angiography(TFCA) and ACZ SPECT in patients to correlate between the angiographic findings and the CVR. Methods : We studied CVR to ACZ using a 99m Tc-hexamet hylpropyleneamine oxime(HMPAO) SPECT in 31 hemispheres of 27 patients with carotid or middle cerebral artery occlusion. All patients underwent 4-vessel TFCA. The possible determinants for CVR on TFCA - the site of occlusion, the site and number of collateral channels, the degree of capillary staining(CS) - were investigated. Results : There were the common or internal carotid artery(CCA/ICA) occlusions in 18 hemispheres and the middle cerebral artery(MCA) occlusions in 13. The collaterals were investigated for ophthalmic artery, anterior communicating artery, posterior communicating artery, leptomeningeal arteries, basal collateral channels, and transdural artery. There were no correlation between CVR and the site of occlusion CCA/ICA vs. MCA). Both of the site and number of collateral channels were not predictive of CVR. But CS proved to have correlation with CBF reactivity(p=0.020, OR=0.17). All three hemispheres with good CS had normal CVR. In the delayed CS group(n=13), the conditions of CVR were variable. Only one hemisphere in the poor CS group(n=15) had normal CVR whereas the others had moderate or severe compromise. Conclusions : CVR cannot be predicted relying on the site of occlusion or collateral channels. But CS can suggest the status of CVR. Our results show that TFCA cannot replace ACZ SPECT for the CVR assessment in patients with major cervicocerebral artery occlusion. Korean Journal of Stroke 2001;3(2): 137~146