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HMPAO SPECT to Assess Neurologic Deficits during Balloon Test Occlusion

Departments of Diagnostic Radiology, ENT and Neurosurgery, Yonsei University, Medical College, Seoul, Korea

Correspondence: For correspondence or reprints contact: T.S. Chung, Department of Diagnostic Radiology, Yonsei University, Medical College, 134 Shinchondong, Seodaemoon-Gu, Seoul, Korea, 120-752.

ABSTRACT

The purpose of this study was to determine if one could objectively and preoperatively predict the safety of permanent occlusion of an internal carotid artery with ^99mTc-HMPAO brain SPECT. Methods: Twenty-four patients underwent balloon test occlusion of the internal carotid arteries because of neck and skull base tumors. We assessed the uptake of both middle cerebral artery territories before and during balloon test occlusion with ^99mTc-HMPAO brain SPECT using the semiquantitative analysis. The results were compared with other factors, including neurologic examination, arterial stump pressure and electroencephalogram. Results: Nineteen patients experienced no neurological deterioration or any problem during balloon test occlusion. The comparative uptake of their middle cerebral artery territories was 95%–101% of the pre-balloon test occlusion state. The remaining five patients showed severe neurologic symptoms, such as transient hemiplegia and unconsciousness. The comparative uptake of their middle cerebral artery territories was 77%–85% of the pre-balloon test occlusion state and was well matched with other factors. Conclusion: Technetium-99m-HMPAO brain SPECT before and during balloon test occlusion seems to be a simple and objective method for predicting permanent neurologic deficits when the comparative uptake of middle cerebral artery territories during balloon test occlusion is less than 85% of that before balloon test occlusion.

Key Words: cerebral angiography • SPECT • balloon test occlusion • technetium-99m-HMPAO

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