The FLAIR sequence MRI shows hyperintensity of the white matter in the distribution of the left watershed area. This represents an area of prior stroke in an area between the capillary beds of the major cerebral arteries. It has the lowest cerebral blood flow (CBF) and is most sensitive to ischemia with hyperperfusion.
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These corresponding pre (left)/post (right) diamox-SPECT axial images demonstrate the loss of cerebrovascular reserve in the left cerebral hemisphere in response to diamox. Diamox, a carbonic anhydrase inhibitor, increases carbon dioxide in the blood, which normally causes dilation of the cerebral microcirculation and increased cerebral blood flow. The increased spectral red color in the right hemisphere of the right hand image indicates an appropriate increase in perfusion over baseline. However, in the left hemisphere, the microvasculature is already maximally dilated and cannot autoregulate/autodilate above baseline in response to the increased carbon dioxide.
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