Article Figures & Data
Figures
- Fig 1.
Angiogram and ACZ-challenged SPECT scans of patient 8, who had right internal carotid artery occlusion.
Left, Baseline and ACZ-challenged SPECT scans. Asymmetry index in right MCA territory of baseline scan is 0.78 (A/B) and of ACZ-challenged scan is 0.55 (A′/B′); therefore, regional reactivity index is 0.71 (0.55/0.78).
Right, Angiogram of right vertebral artery. Right MCA territory is perfused via the leptomeningeal artery from the right posterior cerebral artery (PCA). When the left PCA territory is in capillary phase, the right MCA territory is still in arteriole phase. Although the rACCT of left MCA territory is 3.9 s, that of right MCA territory is 8.8 s; therefore, the rACCT ratio is 2.3 (8.8/3.9).
- Fig 2.
rACCT ratio of poor reserve group is larger than that of normal reserve group.
A, rACCT ratio and qualitative estimation on ACZ-challenged SPECT scan.
B, Correlation of rACCT ratio with regional reactivity index, calculated from ACZ asymmetry index/baseline asymmetry index.
C, Correlation of rACCT with asymmetry index of baseline study.
Tables
- TABLE 1:
Patient characteristics, angiographic findings, and results of acetazolamide-challenged single photon emission CT
Patient Characteristics Angiographic Findings ACZ-Challenged SPECT Occlusive Maximum rACCT (s) rACCT (s) rACCT Ratio Patient No. Sex Age (yr) Diagnosis Artery Grade (%) Occlusive Side [Flow Pattern] Normal Side Qualitative Estimation Baseline AI ACZ AI rRI 1 M 61 TIA R MCA 80 5.9 [lept(A)] 2.9 2.03 Poor 1.03 0.90 0.87 2 F 65 TIA R MCA 99 5.4 [lept(P)] 2.6 2.08 Poor 1.01 0.89 0.88 3 M 55 ATI R ICA Occlusion 3.4 [lept(P)] 2.5 1.36 Normal 1.00 0.96 0.96 4 M 68 ATI R ICA Occlusion 2.6 [Willis] 2.6 1.00 Normal 1.05 1.08 1.03 5 M 74 ATI R ICA 99 7.9 [physiol] 4.2 1.88 Poor 0.86 0.65 0.76 6 M 75 TIA R MCA Occlusion 4.9 [lept(A)] 4.7 1.04 Normal 1.03 1.01 0.98 7 M 72 TIA R ICA Occlusion 3.5 [lept(P)] 3.0 1.17 Normal 0.95 0.95 1.00 8 M 63 ATI R ICA Occlusion 8.8 [lept(P)] 3.9 2.26 Poor 0.78 0.55 0.71 9 M 70 TIA R ICA 70 3.7 [physiol] 3.1 1.19 Normal 0.96 0.98 1.02 10 M 73 Lacuna L MCA 70 3.9 [physiol] 3.4 1.15 Normal 0.93 0.95 1.02 11 M 71 ATI R ICA 99 5.7 [lept(P)] 2.4 2.38 Poor 0.69 0.52 0.75 12 F 70 ATI L ICA 70 6.8 [physiol] 3.4 2.00 Poor 0.97 0.87 0.90 13 M 71 ATI L MCA Occlusion 7.3 [lept(P)] 3.2 2.28 Poor 1.00 0.89 0.89 14 M 62 ATI R MCA 70 2.5 [physiol] 2.4 1.04 Normal 0.95 1.00 1.05 15 M 65 Lacuna L ICA 75 5.1 [physiol] 3.5 1.46 Poor 0.88 0.83 0.94 16 M 64 TIA R ICA 80 3.2 [Willis] 2.7 1.19 Normal 1.02 1.00 0.98 17 M 47 TIA L MCA Occlusion 4.7 [lept(A)] 2.1 2.24 Poor 0.91 0.79 0.87 18 M 60 TIA R ICA 99 6.3 [physiol] 3.7 1.70 Poor 0.86 0.77 0.9 19 M 53 TIA R ICA Occlusion 5.8 [lept(A)] 3.0 1.93 Poor 0.89 0.80 0.90 20 M 83 TIA L ICA 80 5.9 [lept(A)] 3.1 1.90 Poor 0.97 0.80 0.82 21 F 71 TIA R ICA 100 5.7 [lept(P)] 3.5 1.63 Poor 1.03 0.76 0.74 22 M 52 TIA R MCA 100 7.0 [lept(P)] 2.7 2.59 Poor 0.96 0.67 0.70 23 M 79 TIA R ICA 70 5.3 [lept(P)] 3.7 1.43 Normal 1.04 0.97 0.93 24 M 69 TIA R ICA 90 6.8 [lept(P)] 3.5 1.94 Poor 0.99 0.88 0.89 25 F 67 TIA R ICA 100 4.7 [lept(P)] 2.6 1.81 Poor 1.02 0.87 0.85 26 M 77 ATI R ICA 100 6.7 [EC-IC] 3.2 2.09 Poor 0.94 0.75 0.80 27 M 69 TIA L ICA 100 6.7 [Willis] 4.3 1.56 Poor 0.93 0.80 0.86 28 M 68 Lacuna R ICA 70 3.3 [physiol] 2.7 1.22 Normal 1.04 1.03 0.99 Note.—ACZ indicates acetazolamide; SPECT, single photon emission CT; rACCT, regional arteriocapillary circulation time; AI, asymmetry index; rRI, regional reactivity index; M, male; F, female; TIA, transient ischemic attack; ATI, atherothrombotic infarction; Lacuna, lacuna infarction; R, right; L, left; MCA, middle cerebral artery; ICA, internal carotid artery; lept(A), leptomeningeal collateral via anterior cerebral artery; lept(P), leptomeningeal collateral via posterior cerebral artery; Willis, circle of Willis collateral; physiol, physiological flow pattern; EC-IC, external to internal carotid collateral.
Flow Pattern n rACCT (s) mean ± SD (min-max) Non-occlusive artery 28 3.2 ± 0.6 (2.1–4.7) Physiological (70–89% stenosis) 9 4.3 ± 1.4 (2.5–6.8) Physiological (90–99% stenosis) 5 5.3 ± 2.0 (2.9–7.9) Circle of Willis collateral 8 3.3 ± 0.7 (2.5–6.7) EC-IC collateral 2 4.9 ± 2.5 (3.1–6.7) Leptomeningeal collateral 26 5.4 ± 1.3 (3.4–8.8) Note.—rACCT indicates regional arteriocapillary circulation time; min, minimum; max, maximum; EC-IC, external to internal carotid. The number of each flow pattern perfusing bilateral middle cerebral artery territories is presented. Some cases have two or three flow patterns filling the middle cerebral artery territory on the occlusive side.
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