Diagnostic value of brain computed tomography perfusion in carotid occlusive diseaserejr.

Vishnyakova M.V., Pronin I.N., Larkov R.N., Vishnyakova M.V.

Purpose. To determine the diagnostic value of computed tomography perfusion (CTP) in cerebral blood flow assessment in patients with chronic brain ischemia. To appreciate advisability of CTP for patient with different variants of internal carotid artery (ICA) occlusive disease.	1 - Moscow Regional Research and Clinical Institute (MONIKI). 2 - N.N. Burdenko National Scietific and Practical Ceter of Neurosurgery. Moscow, Russia.

 

 

 

 

 

 

 

 

 

Materials and methods. During 2015-2016 years in CT and MRI department 103 patients underwent complex examination (ultrasound and computed angiography of brachi-ocephalic arteries and cerebral vessels, CTP) before surgical carotid revascularization. 76 patients were operated and had postoperative examination at the 5-6th day after surgery. According to internal carotid artery affection patients were divided in 3 groups: with unilat-eral ICA stenosis, with bilateral ICA stenosis, with combination of on ICA occlusion and an-other ICA stenosis. Cerebral blood flow (CBF) coefficient was determined as relation of CBF on affected (operated) ICA side to contralateral CBF. Results. In patients group I with unilateral ICA stenosis CBF reduction was measured on affected side in 72% of cases. In 26% of cases CBF was reduced on nonstenotic side, in one patient CBF values were symmetric. For second group with bilateral stenosis CBF reduction on the side of heavier ICA stenosis was observed in 46%. Greater CBF numbers on the less affected side were in 42% of cases, in 12% CBF in second group was symmetric. In third group in 74% decrease of CBF was found on the side of ICA occlusion comparing with stenosis side. In 17% of cases CBF was symmetric, in 9% - CBF was faster on occlusion side. Postoperative examination revealed in first group with initial CBF deficit an increase of CBF value in 81% of cases. In second group in majority of patients with initial CBF deficit on the side of heavier stenosis postoperative CBF also increased. In cases with faster CBF on the heavier stenosis side an equation of CBF in both hemispheres was found after surgery. In third group in patients with better CBF on stenosis side comparing with the side of occlusion in 45% there was farther increase in CBF on the side of operated ICA comparing with occlusion, in 55% - equation of parameters. Clinical symptoms characteristic for hyperperfusion syndrome were detected in 1 case in first group. In all other cases, there were no focal neural symptoms. Conclusion. CTP examination in patients with chronic ischemic brain disease can be used with clear clinical purpose. CTP can be most helpful in patients with unilateral ICA stenosis. Farther assessment of CTP diagnostic values for patients with chronic brain is-chemia according to ICA affection variant should be studied to find appropriate criteria for clinical usefulness of the procedure.

 

Keywords: computed tomography perfusion, chronic ischemic brain disease, internal carotid artery stenosis.

 

Corresponding author:Amiryan A.G., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Vishnyakova M.V., Pronin I.N., Larkov R.N., Vishnyakova M.V. Diagnostic value of brain computed tomography perfusion in carotid occlusive diseaserejr. 2017; 7 (2):31-38. DOI:10.21569/2222-7415-2017-7-2-31-38./em>

Received: 15.04.2017 Accepted:05.05.2017