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Research ArticleBrain

Correlation of Cerebrovascular Reserve as Measured by Acetazolamide-challenged SPECT with Angiographic Flow Patterns and Intra- or Extracranial Arterial Stenosis

Hasan T. Ozgur, T. Kent Walsh, Anthony Masaryk, Joachim F. Seeger, Walter Williams, Elizabeth Krupinski, Miguel Melgar and Enrique Labadie
American Journal of Neuroradiology May 2001, 22 (5) 928-936;
Hasan T. Ozgur
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T. Kent Walsh
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Anthony Masaryk
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Joachim F. Seeger
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Walter Williams
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Elizabeth Krupinski
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Miguel Melgar
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Enrique Labadie
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    fig 1.

    58-year-old man with neurosyphilis and progressive neurologic symptoms. SPECT scans before right MCA angioplasty show relatively normal baseline perfusion (top row) but significantly decreased perfusion in the right ACA, MCA, and PCA territories after acetazolamide administration (bottom row), consistent with decreased rCVR. (The printed color scale representing brain perfusion is different from the linear 10-level color scale used for interpreting nuclear medicine studies; however, it allows easier comparison with fig 3.)

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    fig 2.

    A, Anteroposterior view of right ICA angiogram shows occlusion of the right ACA and high-grade stenosis of the right MCA (arrow).

    B and C, Anteroposterior views of early (B) and late (C) arterial phases of left CCA angiogram show complete occlusion of the proximal left ACA and reconstitution of both pericallosal arteries (arrows) and the anterior communicating artery from leptomeningeal collaterals (arrowheads).

    D and E, Lateral views of early (D) and late (E) arterial phases of left CCA angiogram show reconstitution of the pericallosal artery (arrows) in the late arterial phase by leptomeningeal collaterals

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    fig 2.

    F and G, Lateral views of early arterial (F) and capillary (G) phases of left vertebral angiogram show high-grade stenosis of the mid-basilar artery (arrow, F) and retrograde filling of the pericallosal artery (arrows, G) via PCA collaterals.

    H, Anteroposterior view of left vertebral angiogram shows an occluded right PCA.

    I, Anteroposterior view of right ICA angiogram after right MCA angioplasty shows almost complete resolution of the right MCA stenosis

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    fig 3.

    SPECT scans after right MCA angioplasty show improved CBF in right ACA and MCA territories on postacetazolamide study (bottom row), consistent with improved rCVR. The rCVR in the right PCA territory appears to be worse as compared with baseline study (top row)

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    TABLE 1:

    Cerebral vascular reserve and angiographic findings in 27 patients

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    TABLE 2:

    Comparison of angiographic cerebral flow patterns in the anterior, middle, and posterior cerebral artery territories with rCVR

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    TABLE 3:

    Comparison of angiographic anterior circulation arterial stenosis or occlusion with rCVR

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American Journal of Neuroradiology
Vol. 22, Issue 5
1 May 2001
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Cite this article
Hasan T. Ozgur, T. Kent Walsh, Anthony Masaryk, Joachim F. Seeger, Walter Williams, Elizabeth Krupinski, Miguel Melgar, Enrique Labadie
Correlation of Cerebrovascular Reserve as Measured by Acetazolamide-challenged SPECT with Angiographic Flow Patterns and Intra- or Extracranial Arterial Stenosis
American Journal of Neuroradiology May 2001, 22 (5) 928-936;

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Correlation of Cerebrovascular Reserve as Measured by Acetazolamide-challenged SPECT with Angiographic Flow Patterns and Intra- or Extracranial Arterial Stenosis
Hasan T. Ozgur, T. Kent Walsh, Anthony Masaryk, Joachim F. Seeger, Walter Williams, Elizabeth Krupinski, Miguel Melgar, Enrique Labadie
American Journal of Neuroradiology May 2001, 22 (5) 928-936;
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  • Reporting Standards for Angioplasty and Stent-Assisted Angioplasty for Intracranial Atherosclerosis
  • Efficacy Assessment of Cerebral Arterial Bypass Surgery Using Statistical Parametric Mapping and Probabilistic Brain Atlas on Basal/Acetazolamide Brain Perfusion SPECT
  • Prominent Laterality of the Posterior Cerebral Artery at Three-Dimensional Time-of-Flight MR Angiography in M1-Segment Middle Cerebral Artery Occlusion
  • Qualitative versus Quantitative Assessment of Cerebrovascular Reactivity to Acetazolamide Using iodine-123-N-Isopropyl-p-Iodoamphetamine SPECT in Patients with Unilateral Major Cerebral Artery Occlusive Disease
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  • Guidelines and Recommendations for Perfusion Imaging in Cerebral Ischemia: A Scientific Statement for Healthcare Professionals by the Writing Group on Perfusion Imaging, From the Council on Cardiovascular Radiology of the American Heart Association
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