Efficacy Assessment of Cerebral Arterial Bypass Surgery Using Statistical Parametric Mapping and Probabilistic Brain Atlas on Basal/Acetazolamide Brain Perfusion SPECT

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FIGURE 1.
Comparison of pre- and postoperative images using SPM. Basal images show scattered areas of improvement, whereas acetazolamide images show more extensive areas of improvement. CVRI images show more confined areas of improvement around the proximal MCA territory.
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FIGURE 2.
Changes in the numbers of significant voxels on SPM. The numbers of significant voxels in comparison with the control group represent the extent of the abnormality. The postoperative numbers of voxels were significantly lower than the preoperative numbers.
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FIGURE 3.
Changes in the ICA territory counts using the probabilistic brain atlas. The basal and acetazolamide counts of all but 2 patients improved after surgery. One patient, showing a significant decrease in counts, was proven to have a perioperative cerebral infarct.

TABLE 1

Clinical Characteristics of Patients

Patient no.	Sex	Age	Lesion of stenosis	Outcome
1	F	52	L ICA total	Sx improved
2	F	40	L ICA total/R ICA moderate	Sx improved
3	M	51	Both ICA multiple	Postop infarct
4	F	74	L MCA total	Sx improved
5	F	59	L ICA total	Sx improved
6	M	69	L ICA total/R ICA moderate	Sx improved
7	M	59	L ICA total	Sx improved
8	M	31	L MCA total	Sx improved
9	M	63	L ICA total/R ICA moderate	Sx improved
10	F	20	L ICA total/R ICA moderate	Sx improved
11	M	46	Both MCA multiple	Sx improved
12	F	25	MMD in L ICA	Preop Sx free
13	F	29	MMD in L ICA	Sx improved
14	M	62	L MCA near total	Sx improved
15	F	51	L ICA total	Sx improved

Sx = symptom; Postop = postoperative; MMD = moyamoya disease; Preop = preoperative.
Outcome was evaluated 4 wk after postoperative SPECT studies.

TABLE 2

Counts of Each Lobe in the Analysis Using the Probabilistic Brain Atlas

Image type	VOI	Control	Preoperative	Postoperative
Basal	Frontal	47.4 ± 1.8	41.0 ± 4.9*	44.5 ± 3.4*^†
	Temporal	41.9 ± 1.7	38.1 ± 3.6*	41.1 ± 3.2^†
	Parietal	46.9 ± 2.6	39.6 ± 8.6*	45.4 ± 4.0^†
	Occipital	45.1 ± 2.3	41.7 ± 4.0*	43.5 ± 3.2
	ICA	43.0 ± 1.7	38.5 ± 4.1*	41.5 ± 2.7^†
Acetazolamide	Frontal	47.1 ± 1.6	35.7 ± 5.8*	40.9 ± 3.8*^†
	Temporal	41.8 ± 1.6	33.6 ± 4.4*	39.0 ± 3.3*^†
	Parietal	47.0 ± 2.4	34.3 ± 8.5*	42.1 ± 4.5*^†
	Occipital	45.0 ± 2.2	39.4 ± 5.4*	41.8 ± 4.5*
	ICA	42.8 ± 1.6	34.2 ± 4.4*	38.8 ± 2.9*^†
CVRI	Frontal	−0.5 ± 2.0	−13.3 ± 7.7*	−8.2 ± 4.9*^†
	Temporal	0.2 ± 2.0	−11.8 ± 6.0*	−5.0 ± 6.3*^†
	Parietal	0.2 ± 2.0	−13.6 ± 5.8*	−7.4 ± 6.1*^†
	Occipital	−0.1 ± 2.2	−5.8 ± 5.3*	−3.9 ± 5.5*
	ICA	−0.3 ± 1.8	−11.2 ± 5.1*	−6.6 ± 3.8*^†