• Ayako Ikemura, Ichiro Yuki, Katharina Otani, Toshihiro Ishibashi, Chihebeddine Dahmani, Masaki Ebara, Yukiko Abe, Ikki Kajiwara, Mitsuyoshi Watanabe, and Yuichi Murayama.
• Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan. Electronic address: ayako.udgw613@gmail.com.
• World Neurosurg. 2020 Jan 1; 133: e522-e528.

ObjectiveWe aimed to compare flat detector computed tomography cerebral blood volume (FD-CBV) imaging to single-photon emission computed tomography (SPECT) as an adjunctive technique during balloon test occlusion (BTO) in patients with intracranial aneurysms or tumors.MethodsTwelve patients who underwent SPECT (99mTc-ethyl cysteinate dimer) and FD-CBV imaging during BTO were enrolled. Color-coded cerebral blood flow (CBF) images and color-coded FD-CBV images were generated and visually inspected whether there were asymmetries between the ipsilateral and contralateral cerebral hemispheres. Region of interest measurements were performed on the color-coded images at the same locations for both modalities. The mean interhemispheric region of interest ratios were calculated, and the ratio between these were estimated using linear regression models.ResultsTen patients had no symptoms during BTO. Two patients developed subtle but inconclusive neurologic changes approximately 10 minutes after balloon inflation; their images showed asymmetric color-coded images with decreased CBF and FD-CBV in the ipsilateral hemisphere. The mean interhemispheric ratio of CBF was significantly smaller in patients with subtle changes than in those without (0.84 vs. 0.98; P < 0.001). Similarly, the mean interhemispheric ratio of FD-CBV was significantly smaller in patients with subtle changes than in those without (0.88 vs. 1.06; P = 0.01). No patient showed increased CBF or FD-CBV in the ipsilateral hemisphere.ConclusionsThe patients with decreased CBF on SPECT also showed decreased FD-CBV in the ipsilateral hemisphere. FD-CBV imaging may be useful as an adjunctive technique for BTO before potential therapeutic carotid artery occlusion.Copyright © 2019 Elsevier Inc. All rights reserved.

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