Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Eur Neurol 2012;67:74–80 DOI: 10.1159/000333778 Which Cortical Area Is Related to the Development of Dysphagia after Stroke? A Single Photon Emission Computed Tomography Study Using Novel Analytic Methods Ryo Momosaki Masahiro Abo Wataru Kakuda Go Uruma Department of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan significantly lower in the dysphagia group. The highest area under the curve was found in Brodmann area 4. In this area, 80% sensitivity and 60% specificity for discriminating dys- phagia were achieved with an optimal cutoff value. Conclu- sions: When analyzed with novel methods, SPECT imaging can be useful for predicting the risk of dysphagia and subse- quent aspiration in poststroke patients. Copyright © 2011 S. Karger AG, Basel Introduction Dysphagia is one of the most frequently seen impair- ments in poststroke patients. The incidence of dysphagia has been reported to be 55% in acute stroke patients [1]. The presence of this impairment is significantly associ- ated with a decreased quality-of-life level [2]. Previously, brainstem lesions were considered to be a principle injury causing dysphagia [3]. However, an association between cerebral cortical lesions and the development of dyspha- gia has recently been suggested. Hamdy et al. [4, 5] and Martin et al. [6] reported that some cortical areas such as the primary somatosensory motor cortex, supplementa- Key Words Single photon emission computed tomography  Dysphagia  Stroke Abstract Purpose: The purpose of this study is to clarify cortical areas related to the development of dysphagia in poststroke pa- tients using novel analytic methods for single photon emis- sion computed tomography (SPECT) imaging. Subjects and Methods: Twenty poststroke patients (age: 66.1 8 5.1 years) with a left hemispheric lesion were studied. According to clinical evaluation, patients were divided into a dysphagia group (n = 10) and a control group (n = 10). In each patient, measurement of regional cerebral blood flow (rCBF) was performed by SPECT imaging with a 99mTc-ethylcysteinate dimer. For the analysis, an easy Z-score imaging system and voxel-based stereotactic extraction estimation were ap- plied, with placing regions of interest segmented into the Brodmann area level. We compared rCBF in each area be- tween the two groups, and receiver operating characteristic analysis to calculate the area under the curve was also per- formed. Results: The rCBF in Brodmann areas 4 and 24 was Received: June 16, 2011 Accepted: September 25, 2011 Published online: December 22, 2011 M. Abo, MD, PhD Department of Rehabilitation Medicine, Jikei University School of Medicine 3-25-8, Nishi-Shimbashi, Minato-Ku Tokyo 105-8461 (Japan) Tel. +81 3 3433 1111, E-Mail abo  @  jikei.ac.jp © 2011 S. Karger AG, Basel 0014–3022/12/0672–0074$38.00/0 Accessible online at: www.karger.com/ene Downloaded by: University of Tokyo 133.11.204.54 - 11/15/2014 9:23:04 AM