Acetazolamide challenge test using semiquantitative ¹²³I-IMP SPECT for detection of cerebral misery perfusion

Abstract 

The accuracy of the acetazolamide (ACZ) challenge test using semiquantitative SPECT in detecting Stage II hemodynamic failure, i.e. cerebral misery perfusion, in patients so diagnosed with PET has yet to be determined. This study was carried out in 53 patients who had a unilateral occlusion or severe stenosis of their cerebral artery. Asymmetry index (AI) was used to determine relative CBF distribution on each SPECT image. ΔAI (regional vasodilatory capacity) values were compared with the values of several PET parameters. We also repeated SPECT and PET studies in 15 patients after a mean interval of 2.6 years from entry. The correlation between changes in ΔAI and PET data were examined. The ΔAI value closely correlated with the ipsilateral OEF value (r=−0.64, p<0.001). Sensitivity–specificity curve analysis revealed that the optimal cut-off value for detecting Stage II hemodynamic failure was −13.5% of ΔAI, at which point the diagnostic accuracy was 82%. In follow-up studies, changes in ΔAI correlated significantly with changes in OEF values (r=−0.68, p<0.01). Semiquantitative SPECT examination with ACZ challenge detects Stage II hemodynamic failure with a diagnostic accuracy of 82%. An improvement in reduced vasodilatory capacity as determined by SPECT coincides with a reduction in OEF values.

Keywords:  Acetazolamide, Hemodynamics, Vasodilatory, Single-photon emission tomography, Positron emission tomography, Misery perfusion