We investigated acute stroke patterns on diffusion weighted images and with doppler ultrasonography studies of ICA and MCA steno-occlusive diseases in order to predict the cerbrovascular reserve (CVR), as was measured by acetazolamide (ACZ)-challenged Tc-99m ECD brain perfusion SPECT.

A retrospective analysis was performed of 76 patients who underwent MRI/MRA, ACZ-challenged Tc-99m ECD brain perfusion SPECT, and carotid and vertebral artery Doppler sonography. After dividing these patients into four groups- MCA and ICA steno-occlusions, we analyzed the relationship between the CVR and topologic MR patterns and the flow volume, as was measured by Doppler sonography.

The CVRs were preserved in 26 of 76 patients. The CVRs were impaired in those cases of occlusion that were detected on MRA and also by the pattern of the territorial involvement on the diffusion weighted image (p < 0.05, x2 test). Yet in cases of preserved CVRs, the flow volume of the contralateral ICA, the anterior circulation, and the total cerebral flow volume were increased, as was checked by Doppler sonography (p < 0.05, t-test). As calculated by logistic regression analysis, the accuracy for predicting the preserved CVR by using the statistically significant variables was 78%.

We believe that the MRI-SPECT correlation study was helpful for understanding the hemodynamics and topographic patterns of ischemia in patients with ICA and MCA steno-occlusive disease, and that the flow volume measurement, which was done by using duplex US, was useful for predicting the CVR.