Neurological Surgery 脳神経外科50巻4号

2022年07月発行

特集 STA-MCAバイパス術—日本が世界に誇る技を学ぶ Ⅰバイパス術の適応

脳循環代謝検査

著者： 上野育子¹ 佐々木真理¹

所属機関： ¹岩手医科大学医歯薬総合研究所超高磁場MRI診断・病態研究部門

ページ範囲：P.719 - P.726

Point
・STA-MCAバイパス術の適応決定には定量的脳循環代謝検査による評価が必要である．
・指標として，慢性脳虚血の重症度を反映する酸素摂取率，脳血液量，血管反応性などが用いられる．
・¹⁵O-PETやアセタゾラミドSPECTが標準であり，CT，MRIの意義は十分確立していない．

参考文献

1）日本脳卒中学会脳卒中ガイドライン委員会（編）：脳卒中治療ガイドライン2021．協和企画，東京，2021, pp. 94-95

2）日本脳卒中学会，日本脳神経外科学会，日本神経学会，日本核医学会：アセタゾラミド（ダイアモックス注射用）適正使用指針．2015年4月　https://www.jsts.gr.jp/img/acetazolamide.pdf（2021年12月29日アクセス）

3）Powers WJ：Cerebral hemodynamics in ischemic cerebrovascular disease. Ann Neurol 29：231-240, 1991

O positron emission tomography. Stroke 12：454-459, 1981

5）Maddula M, et al：Cerebral misery perfusion due to carotid occlusive disease. Stroke Vasc Neurol 2：88-93, 2017

mTc-ECD SPET. Eur J Nucl Med Mol Imaging 29：331-341, 2002

I-IMP single photon emission computed tomography in patients with major cerebral artery occlusive disease：correlation with positron emission tomography parameters. J Cereb Blood Flow Metab 14：763-770, 1994

I-iodoamphetamine and single photon emission computed tomography. Neuroimage 33：1126-1135, 2006

9）Sasaki M, et al：Penumbral imaging by using perfusion computed tomography and perfusion-weighted magnetic resonance imaging：current concepts. J Stroke Cerebrovasc Dis 22：1212-1215, 2013

10）Endo H, et al：Quantitative assessment of cerebral hemodynamics using perfusion-weighted MRI in patients with major cerebral artery occlusive disease：comparison with positron emission tomography. Stroke 37：388-392, 2006

11）Ishida S, et al：Robust arterial transit time and cerebral blood flow estimation using combined acquisition of Hadamard-encoded multi-delay and long-labeled long-delay pseudo-continuous arterial spin labeling：a simulation and in vivo study. NMR Biomed 33：e4319, 2020

-relaxometry and application to arterial cerebral blood volume imaging. Magn Reson Med 87：1329-1345, 2022

13）Setta K, et al：Diagnostic accuracy of screening arterial spin-labeling MRI using Hadamard encoding for the detection of reduced CBF in adult patients with ischemic moyamoya disease. AJNR Am J Neuroradiol 42：1403-1409, 2021

14）Fujioka M, et al：A mismatch between the abnormalities in diffusion- and susceptibility-weighted magnetic resonance imaging may represent an acute ischemic penumbra with misery perfusion. J Stroke Cerebrovasc Dis 22：1428-1431, 2013

15）Kudo K, et al：Oxygen extraction fraction measurement using quantitative susceptibility mapping：comparison with positron emission tomography. J Cereb Blood Flow Metab 36：1424-1433, 2016

16）Uwano I, et al：Noninvasive assessment of oxygen extraction fraction in chronic ischemia using quantitative susceptibility mapping at 7 Tesla. Stroke 48：2136-2141, 2017

17）Sebök M, et al：Mapping cerebrovascular reactivity impairment in patients with symptomatic unilateral carotid artery disease. J Am Heart Assoc 10：e020792, 2021

18）Uwano I, et al：Assessment of impaired cerebrovascular reactivity in chronic cerebral ischemia using intravoxel incoherent motion magnetic resonance imaging. J Stroke Cerebrovasc Dis 30：106107, 2021　doi：10.1016/j.jstrokecerebrovasdis.2021.106107

19）Ishigaki D, et al：Brain temperature measured using proton MR spectroscopy detects cerebral hemodynamic impairment in patients with unilateral chronic major cerebral artery steno-occlusive disease：comparison with positron emission tomography. Stroke 40：3012-3016, 2009

20）Nanba T, et al：Apparent brain temperature imaging with multi-voxel proton magnetic resonance spectroscopy compared with cerebral blood flow and metabolism imaging on positron emission tomography in patients with unilateral chronic major cerebral artery steno-occlusive disease. Neuroradiology 59：923-935, 2017

21）Hirooka R, et al：Simple assessment of cerebral hemodynamics using single-slab 3D time-of-flight MR angiography in patients with cervical internal carotid artery steno-occlusive diseases：comparison with quantitative perfusion single-photon emission CT. AJNR Am J Neuroradiol 30：559-563, 2009

22）Uwano I, et al：Detection of impaired cerebrovascular reactivity in patients with chronic cerebral ischemia using whole-brain 7T MRA. J Stroke Cerebrovasc Dis 29：105081, 2020