• Title/Summary/Keyword: cerebral perfusion

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Hemodynamic Outcome of Successful Bypass Surgery in Patients with Atherosclerotic Cerebrovascular Disease: A study with Acetazolamide and $^{99m}Tc-ECD$ SPECT (죽상경화성 뇌혈관질환 환자에서 성공적인 EC/IC 우회술 후 혈류역학적 변화: 기저/아세타졸아미드 SPECT를 이용한 연구)

  • Eo, Jae-Seon;Oh, Chang-Wan;Kim, Yu-Kyeong;Park, Eun-Kyung;Lee, Won-Woo;Kim, Sang-Eun
    • Nuclear Medicine and Molecular Imaging
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    • v.40 no.6
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    • pp.293-301
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    • 2006
  • Purpose: The aim of the study was to evaluate the hemodynamic changes after successful bypass surgery in patients with atherosclerotic stenosis in ICA using $^{99m}Tc-ECD$ SPECT. Materials and Methods: Fourteen patients (M:F=8:6, mean age; $60{\pm}9$ years) who underwent STA-MCA anastomosis for unilateral atherosclerotic cerebrovascular disease were enrolled. $^{99m}Tc-ECD$ basal/acetazolamide perfusion SPECT studies were performed before, 10 days and 6 months after bypass surgery. Perfusion reserve was defined as the % changes after acetazolamide over rest image. Regional cerebral blood flow and perfusion reserve were compared preoperative, early-postoperative and late-postoperative scans. Results: The mean resting perfusion and decrease in perfusion reserve in affected ICA territory on preoperative scan was $52.4{\pm}3.5\;and\;-7.9{\pm}4.7%$, respectively. The resting perfusion was significantly improved after surgery on early-postoperative scan (mean $53.7{\pm}2.7$) and late-postoperative scan (mean $53.3{\pm}2.5$) compared with preoperative images (p<0.05, respectively). Resting perfusion did not showed further improvement on late-postoperative scan compared with early-postoperative scan. The perfusion reserve was $-3.7{\pm}2.6%$ on early-postoperative scan, and $-1.6{\pm}2.3%$ on late-postoperative scan, which was significantly improved after surgery. Additionally, further improvement of perfusion reserved as observed on late-postoperative scan (p<0.05). While, in the unaffected ICA territory, no significant changes in the resting perfusion and perfusion reserve was observed. Conclusion: The improvement of resting perfusion and perfusion reserve in early-postoperative scan reflects the immediate restoration of the cerebral blood flow by bypass surgery. In contrasts, further improvement of perfusion reserve showing on late-postoperative scan may indicate a good collateral development after surgery, which may indicate good surgical outcome after surgery.

Safety of Aprotinin Under Hypothermic Circulatory Arrest (초저체온 및 순환정지하에서 Aprotinin의 안전성)

  • 장병철;김정택
    • Journal of Chest Surgery
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    • v.30 no.5
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    • pp.501-505
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    • 1997
  • It was reported that use of aprotinin in elderly patients undergoing hypothermic circulatory arrest was associated with an increased risk of renal dysfunction, and myocardial infarction as a result of intravascular coagulation. We reviewed 20 patients who received high-dose aprotinin under deep hypothermic circulatory arrest with(NP group, n= 11) or without selective cerebral perfusion(SP group, n=9). The activated clotting time was exceeded 750 seconds in all but 1 patient. After opening aortic arch, retrograde low flow perfusion was maintained through femoral artery to prevent air embolization to the visceral arteries. Four patients among 20 died during hospitalization'due to bleeding, coronary artery dissection pulmonary hemorrhage and multiple cerebral infarction. Postoperatively, cerebrovascular accidents occurred in two patients; one with preoperative carotid artery dissection and the other with unknown multiple cerebral infarction. In conclusion, use of aprotinin in young patients undergoing hypothermic circulatory arrest did not increase the risk of renal dysfunction or intravascular coagulation if ACT during circulatory arrest is maintained to exceed 750 seconds with low-flow perfusion.

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Regional Brain Perfusion before and after Treatment with Methylphenidate According to the MspI Polymorphism of the Alpha-2A Adrenergic Receptor Gene in Children with Attention-Deficit Hyperactivity Disorder (주의력결핍 과잉행동장애 아동에서 α-2A 아드레날린 수용체 유전자의 MspI 유전자 다형성에 따른 메칠페니데이트 치료 전후 뇌관류 비교)

  • Park, Subin;Bae, Jeong-Hoon;Kim, Jae-Won;Yang, Young-Hui;Oh, Seungmin;Hong, Soon-Beom;Park, Min-Heyon;Kim, Boong-Nyun;Shin, Min-Sup;Yoo, Hee-Jeong;Cho, Soo-Churl
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.24 no.1
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    • pp.21-27
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    • 2013
  • Objectives : Dysregulation of the central noradrenergic system may be involved in the pathophysiology of attention-deficit hyperactivity disorder (ADHD). The aim of this study was to examine the differences in pre- and post-treatment cerebral perfusion according to the MspI polymorphisms of the alpha-2A-adrenergic receptor gene (ADRA2A) in children with ADHD. Methods : Thirty seven drug-naive ADHD children (8.9+1.8 years old, M=32, F=5) were genotyped. Baseline single-photon emission computed tomography (SPECT) and clinical assessments were performed for ADHD children. After treatment with methylphenidate for eight weeks, SPECT and clinical assessment were repeated. Results : No differences in baseline clinical assessments or cerebral perfusion were observed according to the MspI genotype. However, after treatment, ADHD children with the G/G genotype at the MspI polymorphism showed hyperperfusion in the right cerebellar declive (p=.001, uncorrected) and hypoperfusion in the left lentiform nucleus and left cingulate gyrus (p<.001 and p=.001, uncorrected), compared to children without the G/G genotype. Conclusion : Although the results of this study should be interpreted cautiously, they suggest a possible role of the MspI polymorphisms of the ADRA2A gene in methylphenidate-induced changes in cerebral perfusion.

Arterial Spin Labeling Magnetic Resonance Imaging in Healthy Adults: Mathematical Model Fitting to Assess Age-Related Perfusion Pattern

  • Ying Hu;Rongbo Liu;Fabao Gao
    • Korean Journal of Radiology
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    • v.22 no.7
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    • pp.1194-1202
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    • 2021
  • Objective: To investigate the age-dependent changes in regional cerebral blood flow (CBF) in healthy adults by fitting mathematical models to imaging data. Materials and Methods: In this prospective study, 90 healthy adults underwent pseudo-continuous arterial spin labeling imaging of the brain. Regional CBF values were extracted from the arterial spin labeling images of each subject. Multivariable regression with the Akaike information criterion, link test, and F test (Ramsey's regression equation specification error test) was performed for 7 models in every brain region to determine the best mathematical model for fitting the relationship between CBF and age. Results: Of all 87 brain regions, 68 brain regions were best fitted by cubic models, 9 brain regions were best fitted by quadratic models, and 10 brain regions were best fitted by linear models. In most brain regions (global gray matter and the other 65 brain regions), CBF decreased nonlinearly with aging, and the rate of CBF reduction decreased with aging, gradually approaching 0 after approximately 60. CBF in some regions of the frontal, parietal, and occipital lobes increased nonlinearly with aging before age 30, approximately, and decreased nonlinearly with aging for the rest of life. Conclusion: In adults, the age-related perfusion patterns in most brain regions were best fitted by the cubic models, and age-dependent CBF changes were nonlinear.

Serial Magnetic Resonance Images of a Right Middle Cerebral Artery Infarction : Persistent Hyperintensity on Diffusion-Weighted MRI Over 8 Months

  • Son, Seung-Nam;Choi, Dae-Seob;Choi, Nack-Cheon;Lim, Byeong-Hoon
    • Journal of Korean Neurosurgical Society
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    • v.50 no.4
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    • pp.388-391
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    • 2011
  • A lesion that is hyperintense on diffusion-weighted imaging (DWI) and hypointense on the apparent diffusion coefficient (ADC) map is a characteristic magnetic resonance imaging (MRI) finding in acute ischemic infarction. In some cases, however, these findings can persist for a few months after infarct onset. It is thought that these finding reflect the different evolution speeds of the infarcted tissue. We report a patient with a right middle cerebral artery territory infarction with persistent hyperintensity on DWI and hypointensity on the ADC map for over 8 months. To our knowledge, this is the most persistent case of hyperintensity lesion on DWI and the serial MRI images of this patient provide important information on the evolution of infarcted tissue.

The Effect of LI4-LI11 Electrical Acupuncture at Unaffected Limb on Cerebral Blood Flow in Ischemic Stroke Patients using SPECT (SPECT를 이용한 뇌경색환자의 건측 합곡-곡지 전침치료가 뇌관류에 미치는 영향)

  • Moon, Sang-kwan;Kim, Young-suk;Park, Sung-uk;Jung, Woo-sang;Ko, Chang-nam;Cho, Ki-ho;Bae, Hyung-sup;Lee, Jae-dong;Kim, Deok-yoon
    • Journal of Acupuncture Research
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    • v.21 no.1
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    • pp.111-118
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    • 2004
  • Background and purpose: Opposing-needling technique involves selecting acupoints at unaffected limb. The aim of this study was to evaluate the effect of LI4-LI11 electrical acupuncture at unaffected limb on the cerebral blood flow in ischemic stroke patients using SPECT Methods: We selected 9 ischemic stroke patients. Baseline brain SPECT was done with triple head gamma camera(MultiSPECT3, Siemens, USA) after intravenous administration of 925 MBq of Tc-99m ECD). Fifteen-minute electro-acupuncture at Hapgok(LI 4) and Gokji(LI 11) were applied on unaffected upper limb of subjects. The same dose of Tc-99m ECD was injected during the electro-acupuncture, and the second SPECT images were obtained. Using the computer software(ICON 7.1, Siemens, USA), 3 SPECT slices(upper, middle, lower) surrounding the brain lesion were selected and each slice was divided by 10-16 brain regions. Asymmetry indexes were analyzed in each brain region. We regarded$\geq$10% changes of asymmetry index between before and after electro-acupuncture as significance. Results: Seven Patients(77.8%) had significantly increased perfusion and 2(22.2%) didn't show increased perfusion in post-acupuncture scans compared to pre-acupuncture scans(baseline). The regions of CBF improvement were mostly frontal lobes and anterior temporal lobes. Conclusions: This study demonstrated that LI4-LI11 electro-acupuncture at unaffected limb increased regional cerebral blood perfusion to the corresponding brain areas in ischemic stroke patients.

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Systemic Administration of the Potassium Channel Activator in the Polystyrene Latex Bead-Induced Cerebral Vasospasm (Polystyrene Latex Bead에 의한 뇌혈관연축 모델에서 K+ 통로활성제의 전신투여)

  • Jang, Sung Jo;Kang, Sung Don;Yun, Ki Jung
    • Journal of Korean Neurosurgical Society
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    • v.29 no.6
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    • pp.719-724
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    • 2000
  • Objectives : It has been reported that the presence of a pharmacologically inactive foreign substance, polystyrene latex bead, in subarachnoid space activates a non-specific immunological response and elicits arterial narrowing. Recently the activation of potassium($K^+$) channels may be of benefit in relieving cerebral vasospasm. The present study examined the effects of systemic administration of a ATP-sensitive $K^+$ channel activator, cromakalim, on the polystyrene latex bead-induced cerebral vasospasm. Methods : The spasm models similar to that caused by subarachnoid blood injection were created by injection of bead into rabbit cisterna magna. Intravenous injections of cromakalim were administered twice daily(bid) 30 minutes after induction of vasospasm. Animals were killed by perfusion-fixation 2 days after vasospasm. Basilar arteries were removed and sectioned, and the luminal cross-sectional areas were measured. Results : Injection of bead elicited an arterial constriction, reducing arterial diameter to 33.3% of resting tone. Cromakalim inhibited bead-induced constriction at a dose of 0.3mg/kg(Mann-Whitney test, p<0.01). Conclusion : These results support the concept that the cellular events triggered by inactivation of ATP-sensitive $K^+$ channels are responsible for the pathogenesis of vasospasm. The findings also indicate that cromakalim represents a potential therapeutic agents for the treatment of cerebral vasospasm.

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