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SPECT Quantification of Cerebral Ischemia Before and After Carotid Endarterectomy

Departments of Diagnostic Imaging and Surgery, Temple University Hospital and School of Medicine, Philadelphia, Pennsylvania

Correspondence: For reprints contact: Alan H. Maurer, MD, Director, Nuclear Medicine, Department of Diagnostic Imaging, Temple University Hospital, Broad and Ontario Streets, Philadelphia, PA 19140.

ABSTRACT

A method to assess changes in cerebral perfusion following carotid endarterectomy was developed using late (2 hr)/early (20 min) single-photon emission computed tomography (SPECT)/[¹²³I]iodoamphetamine count ratios. Using a ratio > 1.0 to indicate redistribution and reversible ischemia, pre- and postoperative studies were compared for 20 patients. Regional polar plots based on 30° angular sectors showed improvement > 2 standard deviations (s.d.s) ipsilateral to surgery in 15/19 (79%) and contralateral to the side of surgery in 8/19 (42%) patients with significant hemodynamic lesions. Using a hemispheric perfusion index (mean of four 30° sectors) ipsilateral perfusion improved in 11/19 (58%) with bilateral improvement in 6/19(32%). Visual interpretation was similar to the regional analysis with 14/19 (74%) improving on the operative side; however, it was less sensitive for contralateral changes, 4/19 (21%). We conclude that quantitation of redistribution can provide an objective index of improved perfusion and is especially important to detect contralateral changes.

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