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Quantitative Evaluation of Mean Transit Times Obtained with Dynamic Susceptibility Contrast-Enhanced MR Imaging and with ¹³³Xe SPECT in Occlusive Cerebrovascular Disease

¹ Department of Radiology, Ehime University School of Medicine, Shitsukawa, Shigenobu-cho, Onsen-gun, Ehime, 791-0295 Japan.
² Department of Medical Engineering, Division of Allied Health Sciences, Osaka University Medical School, 1-7 Yamadaoka, Suita, Osaka, 565-0871 Japan.
³ Department of Neurological Surgery, Ehime University School of Medicine, Ehime, 791-0295 Japan.

OBJECTIVE. We report on quantitative mean transit time images obtained using dynamic susceptibility contrast-enhanced MR imaging after an IV bolus injection of a contrast agent. Our study compared cerebral hemodynamics measured using dynamic susceptibility contrast-enhanced MR imaging with the cerebral perfusion reserve obtained using dynamic ¹³³Xe single-photon emission computed tomography (SPECT).

SUBJECTS AND METHODS. Seventeen patients with chronic cerebral artery occlusion or stenosis diagnosed by digital subtraction angiography were examined. Dynamic susceptibility contrast-enhanced MR imaging data were acquired using a multishot echoplanar sequence. Our procedure for quantification of mean transit time was based on the indicator dilution theory and deconvolution analysis.

RESULTS. The increased mean transit time values obtained with dynamic susceptibility contrast-enhanced MR imaging correlated well (r=-0.789, p < 0.0001) with decreased cerebral perfusion reserve determined by performing dynamic ¹³³Xe SPECT before and after administration of acetazolamide. The mean transit time values in the regions with severely decreased perfusion reserve were significantly higher than those in the regions with normal or moderately decreased perfusion reserve (p < 0.0001 and p = 0.0004, respectively).

CONCLUSION. Mean transit time images generated from dynamic susceptibility contrast-enhanced MR imaging data could be used to evaluate the extent of cerebral perfusion reserve impairment in patients with occlusive cerebrovascular disease.

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