PET OEF reactivity for hemodynamic compromise in occlusive vascular disease

Edwin M. Nemoto, Howard Yonas, Ronda R. Pindzola, Hiroto Kuwabara, Donald Sashin, Yuefang Chang, Tudor Jovin

Research output: Contribution to journalArticle

Abstract

Background and Purpose. Hemodynamic compromise in symptomatic patients with occlusive vascular disease (OVD) identified by cerebrovascular reserve (CVR) and oxygen extraction fraction (OEF) is an independent predictor of high stroke risk. However, up to 60% of patients compromised by CVR have normal OEF indicating a high rate of discordance. CVR is measured with an acetazolamide challenge, and OEF reactivity (OEFR) to acetazolamide, ie, a hemodynamic challenge, may reveal hemodynamic compromise and less discordance with measurements of CVR. Methods. Nine symptomatic patients with OVD were studied by positron emission tomography before and 15 minutes after 15 mg/kg intravenous acetazolamide in the middle cerebral artery territories of each hemisphere. Results. A close correlation between hemispheric CVR and OEFR was observed. Two hemispheres from two different patients showed an increase in OEF to acetazolamide challenge despite a normal baseline OEF. The two hemispheres showing an increase in OEF in response to acetazolamide were also associated with the lowest CVR and severest white matter hyperintensities. Conclusions. These observations suggest that positive OEFR may distinguish hemispheres in hemodynamic compromise despite normal OEF and show less discordance with CVR. However, these preliminary observations require confirmation in a larger study.

Original languageEnglish (US)
Pages (from-to)54-60
Number of pages7
JournalJournal of Neuroimaging
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2007

Keywords

  • Cerebral blood flow
  • Oxygen uptake
  • Stroke
  • Stroke risk

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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