The efficacy of cerebral arterial bypass surgery was assessed on brain perfusion SPECT using statistical parametric mapping (SPM) and a probabilistic brain atlas.
Methods: Fifteen patients with ischemia in the internal carotid artery (ICA) territory and 21 age-matched healthy volunteers were enrolled. (99m)Tc-HMPAO basal/acetazolamide brain perfusion SPECT was performed 2 wk before and after bypass surgery and also on a healthy control group. Using SPM analysis, group comparisons were made between pre- and postoperative SPECT for each basal/acetazolamide image, and improvements of perfusion and perfusion reserve were assessed. The number of significant voxels on the SPM analysis was defined as the extent of ischemia. With the use of the probabilistic brain atlas, the counts for the cerebral lobes and the ICA territory were automatically calculated for each image and compared.
Results: The group comparisons by SPM between patients and healthy volunteers showed a significant improvement in general perfusion status in the ICA territory. The improvement in perfusion reserve was more extensive than the improvement in perfusion. The extent of ischemia was also significantly decreased after surgery (1,693 +/- 2,604 to 371 +/- 523 voxels in basal images, P = 0.060; 11,879 +/- 6,449 to 5,997 +/- 3,864 voxels in acetazolamide images, P = 0.005). In the analysis using the probabilistic brain atlas, the preoperatively decreased perfusion was normalized after surgery, but a residual decrease in the perfusion reserve was also observed in the ICA territory. The counts in the volume of interest of the ICA territory were significantly improved (38.5 +/- 4.1 to 41.5 +/- 2.7 in basal images, P = 0.024; 34.2 +/- 4.4 to 38.8 +/- 2.9 in acetazolamide images, P = 0.003). One patient showing a decrease in perfusion had a perioperative cerebral infarct.
Conclusion: Using SPM and a probabilistic brain atlas, the perfusion, the perfusion reserve, and changes in both after cerebral arterial bypass surgery were effectively assessed and correlated well with physiologic reasoning.