Effects of cranioplasty in cerebral blood perfusion using quantification with 99m-Tc HMPAO SPECT-CT
This work was previously presented at (International Congress Poster) Syndrome of the Trephined: evaluating brain perfusion before and after cranioplasty using 99m-Tc HMPAO and SPECT-CT Á. Galiana, S. Ruiz, I. Paredes, E. Gutiérrez, M. Tabuenca, M. Marín, E. Martínez, V. Godigna, D. Vega, J. Estenoz. 32nd Annual Congress of the European Association of Nuclear Medicine. Barcelona, October 2019.
Abstract
Background and Purpose
Syndrome of the trephined or sinking skin flap syndrome is an underdiagnosed condition of craniectomized patients that usually improves after cranioplasty. Among the pathophysiological theories proposed, the changes of cerebral blood perfusion (CBP) caused by cranial defects might have a role in the neurological deficiencies observed. We aim to assess the regional cortex changes in CBP after cranioplasty with Technetium 99m hexamethylpropylene-amine oxime (99mTc-HMPAO) SPECT-CT.
Methods
Twenty-eight craniectomized patients subject to cranioplasty were studied with 99mTc-HMPAO SPECT-CT in three different times, before cranioplasty, a week, and 3 months after. The images were processed with quantification software comparing CBP of 24 cortical areas with a reference area, and with a database of controls. A mixed effects model and T-Student were used.
Results
CBP increased significantly in both hemispheres after cranioplasty, either using ratio (β = .019, p-value = .030 first postsurgical SPECT-CT and β = .021, p-value = .015 in the second study, vs. presurgical) or Z-score (β = .220, p-value = .026 and β = .279, p-value = .005, respectively). Nine areas of the damaged side had a significant lower CBP ratio and Z-score than the undamaged. Posterior cingulate showed an increased CBP ratio (p-value = .034) and Z-score (p-value = .028) in the first postsurgical SPECT-CT. These posterior cingulate changes represent a 4.83% increase in ratio and 91.04% in Z-Score (p-value = .035 and .040, respectively).
Conclusion
CBP changes significantly in specific cortical areas after cranioplasty. Posterior cingulate changes might explain some improvements in attention impairments. SPECT-CT could be a useful tool to assess CBP changes in these patients and might be helpful in their clinical management.
