CEREBRAL PERFUSION AND CIRCULATION DISTURBANCES. PART III (NON-CONTAST METHODS, RATIONALE AND SAFETY): A REVIEW

Abstract

The third part of the review article provides new insights into tissue / cell brain perfusion in chronic cerebral vascular insuffciency, commonly accompanied by polyvascular disease, i.e. stenotic and occlusive lesions of the carotid and coronary arteries. The evaluation of regional cerebral blood flow and cerebrovascular reactivity in the preoperative period of revascularization procedures remains an issue of concern for radiologists. Partly the choice of revascularization strategy, staged or simultaneous revascularization of the carotid and coronary arteries, depends on these parameters. Contrast-enhanced perfusion magnetic resonance imaging (MRI) and computed tomography perfusion (CTP) are commonly associated with a rather high risk of adverse reactions, compared to the widespread single-photon emission computed tomography (SPECT) and arterial spin labelling (ASL) MR perfusion technique, rapidly growing in the last decade. Clinical studies and the introduction of radionuclide diagnostics (SPECT) and non-contrast MR methods (ASL) into routine clinical practice will minimize these risks, while providing clinicians with accurate information on the capacity and cerebral blood flow reserve, which play signifcant role in determining the treatment strategy, similar to the capacity and myocardial blood flow reserve.