Article, 2023

Long-term prognostic value of [15O]H2O PET imaging in patients suspected for cerebral hemodynamic insufficiency

Journal of Stroke and Cerebrovascular Diseases, ISSN 1052-3057, 1532-8511, Volume 33, 1, Page 107466, 10.1016/j.jstrokecerebrovasdis.2023.107466

Contributors

Bach, Mathias Jacobsen [1] [2] Jakubauskaite, Audrone [1] Law, Ian 0000-0001-9644-7496 [2] [3] Henriksen, Otto Mølby [3] Havsteen, Inger Birgitte 0000-0002-8110-8931 [1] Henriksen, Alexander Cuculiza 0000-0003-0186-417X [1] Rosenbaum, Sverre [1] Marner, L M Lisbeth 0000-0001-5843-5742 (Corresponding author) [1] [2]

Affiliations

  1. [1] Bispebjerg Hospital
    2. [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  2. [2] University of Copenhagen
    3. [NORA names: KU University of Copenhagen; University; Denmark; Europe, EU; Nordic; OECD];
  3. [3] Rigshospitalet
    4. [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD]

Abstract

OBJECTIVES: Quantitative regional cerebral perfusion (rCBF) measurements using [15O]H2O PET with arterial cannulation and acetazolamide (ACZ) challenge have been reserved to identify high-risk patients that are candidates for by-pass operation. We aimed to assess the prognostic value of various parameters in quantitative [15O]H2O PET measurements in patients not subsequently undergoing surgery. METHODS: We identified 32 eligible patients who underwent [15O]H2O brain PET imaging for suspicion of hemodynamic insufficiency between 2009 and 2020. Cerebrovascular events were defined as new ischemic lesions on MRI, stroke, transient ischemic attack, vascular dementia. Follow-up period was 91 months (range: 26-146). rCBF before (rCBFbase) and after (rCBFacz) ACZ challenge and the relative increase (CVR), were examined in the anterior (ACA), middle (MCA), and posterior (PCA) cerebral artery territories of the affected hemisphere, and the most recent MRI scans were scored for infarcts and white matter lesions. RESULTS: Receiver operating characteristic (ROC) curve analysis showed higher prognostic accuracy for rCBFacz(AUC:0.82) compared to CVR (AUC:0.72) and rCBFbase (AUC:0.77). ROC AUC, optimal thresholds (and corresponding sensitivity/specificity/accuracy) for rCBFacz after ACZ in individual territories were 0.79 and 37.8 mL 100g-1 min-1 (0.81/0.63/0.72) for the ACA, 0.84 and 32 mL 100g-1 min-1 (0.81/0.75/0.78) for the MCA, and 0.70 and 43.9 ml/(mL 100g-1 min-1 (0.81/0.43/0,62) for the PCA. Kaplan Meier survival curve showed longer event-free survival in patients with rCBFacz below cut-off (p=0.007). In multivariate analysis rCBFacz remained a significant predictor when correcting for age. CONCLUSION: Quantitative rCBF measurements after ACZ challenge with [15O]H2O PET provided high prognostic value for future cerebrovascular events.

Keywords

ACA, AUC, CVR, MCA, MRI, MRI scans, O-PET, PET imaging, accuracy, acetazolamide, affected hemisphere, artery cannulation, artery territory, attacks, by-pass, by-pass operation, cannulation, cerebral artery territory, cerebral hemodynamic insufficiency, cerebral perfusion, cerebrovascular, cerebrovascular events, characteristics, dementia, events, follow-up period, hemisphere, hemodynamic insufficiency, high-risk patients, images, individual territories, infarction, insufficiency, ischemic attack, ischemic lesions, lesions, long-term prognostic value, measurements, middle, months, operation, optimal threshold, parameters, patients, perfusion, period, prognostic accuracy, prognostic value, receiver operating characteristic, receiver operating characteristic AUC, regional cerebral perfusion, scanning, stroke, surgery, suspicion, territory, threshold, transient ischemic attack, values, vascular dementia, white matter lesions

Funders

  • Capital Region of Denmark

Data Provider: Digital Science

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