Differences in regional cerebral blood flow in two types of leuko-araiosis

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1 Journl of the Neurologicl Sciences 164 (1999) Differences in regionl cerebrl blood flow in two types of leuko-riosis * Minoru Oishi, Yoko Mochizuki Deprtment of Neurology, Nihon University Nerim Hikrigok Hospitl, Hikrigok, Nerim-ku, Tokyo, Jpn Received 31 August 1998; received in revised form 11 December 1998; ccepted 21 Jnury 1999 Abstrct Cerebrl blood flow nd cerebrovsculr cetzolmide rectivity were investigted in ptients with periventriculr hyperintensity nd in ptients with leuko-riosis in centrum semiovle. Fifteen ptients with periventriculr hyperintensity, 15 ptients with leuko-riosis in centrum semiovle nd 15 ge-mtched controls without leuko-riosis were studied. The regionl cerebrl blood flow ws mesured using the stble xenon CT method before nd 20 min fter intrvenous injection of 17mg/ kg cetzolmide. The blood flow nd the cerebrovsculr cetzolmide rectivity in the re of leuko-riosis were significntly lower in the periventriculr hyperintensity group nd the leuko-riosis in centrum semiovle group thn the control group. The blood flow in the cerebrl cortex ws significntly lower in the leuko-riosis in centrum semiovle group thn in the periventriculr hyperintensity group nd the control group. The cerebrovsculr cetzolmide rectivity in the cerebrl cortex did not show ny significnt difference mong the three groups. The blood flow in the cerebrl cortex ws decresed in ptients with leuko-riosis in centrum semiovle but the cerebrovsculr cetzolmide rectivity in the cerebrl cortex ws norml in ptients with leuko-riosis Elsevier Science B.V. All rights reserved. Keywords: Leuko-riosis; Periventriculr hyperintensity; Cerebrl blood flow; Acetzolmide 1. Introduction ge-mtched controls without leuko-riosis (C) were studied with their informed consent. The ptients with Leuko-riosis [1] is rdiologicl finding nd its leuko-riosis were dmitted to our hospitl nd hed pthophysiology is not uniform [2]. Leuko-riosis my be computed tomogrphy (CT), hed mgnetic resonnce divided into two types; periventriculr hyperintensity nd imging (MRI), echocrdiogrphy nd blood viscosity leuko-riosis in centrum semiovle [2 5]. The distur- were studied on the ptients. A is defined s hyperintensity bnce in cerebrospinl fluid circultion my be relted to res in hed MRI which re contiguous to the ventricles periventriculr hyperintensity nd hypertension my be (Fig. 1) nd B is defined s hyperintensity res in hed relted to leuko-riosis in centrum semiovle [6]. The two MRI which re locted t distnce from the ventricles types my hve some difference in cerebrl circultion. In (Fig. 2). The ptients who hve both A nd B, the ptients order to find out the difference, we investigted cerebrl who hve signs or symptoms of cerebrl infrction, nd the blood flows nd cerebrovsculr cetzolmide rectivity ptients with hydrocephlus nd leukodystrophy were in the two types of leuko-riosis. excluded from this study. Medictions which influence cerebrl blood flow were discontinued 2 weeks prior to the cerebrl blood flow exmintion. Fifteen cses in ech 2. Ptients nd methods group were selected by the order of dmission dte. Tble 1 shows the subjects chrcteristics in the three groups. Fifteen cses of periventriculr hyperintensity (A), 15 The totl volume of leuko-riosis on MRI ws determined cses of leuko-riosis in centrum semiovle (B) nd 15 ccording to the method of Wldemr et l. [7]. The regionl cerebrl blood flow ws mesured using *Corresponding uthor. Tel.: ; fx: the stble xenon CT method [8 11]. The bsl gngli X/ 99/ $ see front mtter PII: S X(99)00043-X 1999 Elsevier Science B.V. All rights reserved.

2 130 M. Oishi, Y. Mochizuki / Journl of the Neurologicl Sciences 164 (1999) Fig. 1. Axil nd coronl sections of T2-weighted imge nd proton Fig. 2. Axil nd coronl sections of T2-weighted imge nd proton density imge of hed MRI in ptient with periventriculr hyperintensi- density imge of hed MRI in ptient with leuko-riosis in centrum ty (A). Hyperintensity res re contiguous to the ventricles. semiovle (B). Hyperintensity res re locted t distnce from the ventricles. section nd the lterl ventricle section prllel to the orbito-metl line were studied. The subjects inhled room The cerebrl cortex blood flow nd cerebrl white mtter ir followed by mixture of 30% xenon nd 50% oxygen blood flow were clculted s the verge of the blood for 3 min. Seril scnning ws performed once before flows in the eight res. xenon inhltion, three times in the wsh-in process nd The regionl cerebrl blood flow ws mesured before five times in the wshout process of 5 min. The seril nd 20 min fter intrvenous injection of 17mg/ kg cetscnning progrm consisted of totl of 18 scns consist- zolmide. Mini-mentl stte exmintion [12] ws pering of nine seril scns on ech section. The xenon formed nd underlying diseses were exmined. concentrtion in the end-tidl expired gs ws continuously Sttisticl nlysis ws performed using Mnn Whitrecorded by the thermoconductivity method. We used the ney s U-tests for comprison of the cerebrl blood flows xenon delivery nd nlysis system (AZ-7000 model, nd using Fisher s exct probbility tests for comprison of Anzi Sogyo, Tokyo, Jpn) nd the CT equipment underlying diseses mong the three groups. (PreSge, Yokogw Medicl Systems, Tokyo, Jpn). Regionl cerebrl blood flows were mesured in the leukoriosis re, nd in the cerebrl cortex nd cerebrl white mtter where the influence of the leuko-riosis ws 3. Results considered to be little. Round region of interest (ROI) with dimeter of 7 mm ws used nd the ROI ws plced in Fig. 3 shows the ctul records of xenon CT in A, B, the center of ech leuko-riosis re in bilterl nterior nd C before nd fter injection of cetzolmide. Before nd posterior regions. The leuko-riosis re blood flow injection of cetzolmide, the blood flow in the leukows clculted s the verge of the blood flows in the four riosis re is lower thn tht in the cerebrl white mtter. leuko-riosis res. In bilterl frontl lobes, prietl The blood flow in the cerebrl cortex is lower in B thn in lobes, temporl lobes nd occipitl lobes, the ROI ws A nd C. After injection of cetzolmide, the blood flow plced in the re where leuko-riosis ws not djcent. is incresed. The increse rte in blood flows by cetzol-

3 M. Oishi, Y. Mochizuki / Journl of the Neurologicl Sciences 164 (1999) Tble 1 Subjects chrcteristics in three groups (A) Periventriculr (B) Leuko-riosis in (C) Age-mtched hyperintensity group centrum semiovle group control group Number of subjects Age (yers) Mle:femle 8:7 7:8 7:8 Hypertension 6/ 15 12/ 15* 4/ 15 Dibetes mellitus 7/ 15 8/ 15 3/ 15 Hyperlipidemi 5/ 15 6/ 15 3/ 15 Mini-mentl stte exmintion score Totl volume of leuko-riosis on MRI (cm ) Men6stndrd devition. * P,0.05 versus B, P,0.01 versus C. mide is lower in the leuko-riosis re thn in the cerebrl Leuko-riosis my be divided into two types; A nd B white mtter. [2 5]. The mechnism of the two types is considered to be Tble 2 shows the men nd stndrd devition of the different [4,5]. There ws no report on the difference in blood flows in the cerebrl cortex, cerebrl white mtter cerebrl blood flow between the two types. The blood flow nd leuko-riosis re. The blood flow in the leuko- in the cerebrl cortex ws significntly lower in B thn in riosis re ws significntly lower thn tht in the A nd C. Becuse the totl volume of leuko-riosis on cerebrl white mtter. The blood flow in the cerebrl MRI did not show ny significnt difference between the cortex ws significntly lower in B thn in A nd C. The two groups, the difference in blood flow in the cerebrl increse rte in blood flows by cetzolmide ws sig- cortex between the two groups is considered to be not due nificntly lower in the leuko-riosis re thn in the to the mount of leuko-riosis but due to the loction of cerebrl white mtter. leuko-riosis. The rte of ssocition of hypertension ws significntly Xenon CT with the wsh-in/ wshout protocol hs been higher in B thn in A nd C (Tble 1). There ws no reported to show considerble relibility in mesuring significnt correltion between hypertension nd cerebrl blood flow in the cerebrl white mtter [9] nd hs been blood flow in the three groups. There ws no significnt used in ptients with pthologicl conditions [10,23,24]. difference in totl volume of leuko-riosis on MRI (Tble Using the sme instrument nd the sme method of xenon 1). CT s ours, Hku et l. [25] reported significnt correltion (r50.68, P,0.001) between regionl cerebrl blood flow vlues (10 30 ml/ 100 g/ min) of the white 4. Discussion mtter re obtined by xenon CT nd those of 133 Xe single-photon emission CT, which hs been ccepted s Leuko-riosis hs mny cuses [2] but the common stndrd method for the mesurement of regionl cerebrl cuses re considered to be rteriolosclerosis [13 15] nd blood flow. norml ging [16 18]. Cerebrl blood flow hs been Acetzolmide is considered to dilte the cerebrl reported to be decresed in leuko-riosis [19 22]. rterioles by inhibiting the crbonic nhydrse in the red Tble 2 Blood flow (ml/ 100g/ min) before the intrvenous injection of cetzolmide nd increse rte (%) in blood flow by the intrvenous injection of cetzolmide (men6stndrd devition) (A) Periventriculr hyper- (B) Leuko-riosis (C) Age-mtched intensity group in centrum control group semiovle group Before the intrvenous injection of cetzolmide Cerebrl cortex blood flow * Cerebrl white mtter blood flow Leuko-riosis re blood flow ** ** After the intrvenous injection of cetzolmide Increse rte in cerebrl cortex blood flow Increse rte in cerebrl white mtter blood flow Increse rte in leuko-riosis re blood flow ** ** * P,0.01 compred with the other two groups. ** P,0.01 compred with the cerebrl white mtter.

4 132 M. Oishi, Y. Mochizuki / Journl of the Neurologicl Sciences 164 (1999) Fig. 3. Actul records of xenon computed tomogrphy before nd fter intrvenous injection of cetzolmide. (A) Periventriculr hyperintensity, (B) leuko-riosis in centrum semiovle, (C) ge-mtched control without leuko-riosis. blood cells nd incresing CO2 in the rterioles [26,27]. show ny significnt difference mong the three groups. Acetzolmide hs been used for exmining cerebrovscu- This suggests tht cerebrovsculr diltory reserve cpcity lr diltory reserve cpcity [28]. is preserved in the cerebrl cortex nd tht decresed In the present study, cerebrovsculr cetzolmide cerebrl cortex blood flow my be due to overlying cortex rectivity ws decresed in the leuko-riosis re. This dischisis in cses of B. suggests tht cerebrovsculr diltory reserve cpcity is The present study showed tht the blood flow in the decresed in the leuko-riosis re. The cerebrovsculr cerebrl cortex ws lower nd the rte of hypertension ws cetzolmide rectivity in the cerebrl cortex did not higher in B thn in A. This suggests tht hypertension nd

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