Brain Perfusion Imaging Under Acetazolamide Challenge for Detection of Impaired Cerebrovascular Reserve Capacity: Positive Findings with <sup>15</sup>O-Water PET in Patients with Negative <sup>99m</sup>Tc-HMPAO SPECT Findings.

Acker, Güliz; Lange, Catharina; Schatka, Imke; Pfeifer, Andreas; Czabanka, Marcus A; Vajkoczy, Peter; Buchert, Ralph · J Nucl Med · 2018

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Abstract

Cerebrovascular reserve capacity (CVRC) is an important parameter for treatment decisions in chronic cerebrovascular diseases. It can be assessed by measuring the acetazolamide-induced change in regional cerebral blood flow using SPECT with <sup>99m</sup>Tc-labeled hexamethylpropyleneamine oxime (<sup>99m</sup>Tc-HMPAO) or PET with <sup>15</sup>O-water. <b>Methods:</b> Our database was searched for patients with moyamoya vasculopathy or atherosclerotic cerebrovascular disease who had undergone <sup>15</sup>O-water PET after normal <sup>99m</sup>Tc-HMPAO SPECT results with respect to CVRC. <sup>15</sup>O-water PET was analyzed visually and quantitatively. Quantitative analysis was based on parametric CVRC maps generated by voxelwise image subtraction. <b>Results:</b> The search identified 18 patients (43 ± 15 y, 12 moyamoya vasculopathy). PET revealed impaired CVRC in 8 patients (44%). Quantitative analysis confirmed the positive visual findings in <sup>15</sup>O-water PET and the negative findings in <sup>99m</sup>Tc-HMPAO SPECT. <b>Conclusion:</b><sup>15</sup>O-water PET enables detection of impaired CVRC in a considerable fraction of symptomatic patients with stenoocclusion and negative <sup>99m</sup>Tc-HMPAO SPECT.

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