Multiparametric flow analysis using four-dimensional flow magnetic resonance imaging can detect cerebral hemodynamic impairment in patients with internal carotid artery stenosis
- 9 June 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Neuroradiology
- Vol. 62 (11), 1421-1431
- https://doi.org/10.1007/s00234-020-02464-2
Abstract
Purpose MRI-based risk stratification should be established to identify patients with internal carotid artery stenosis (ICS) who require further PET or SPECT evaluation. This study assessed whether multiparametric flow analysis using time-resolved 3D phase-contrast (4D flow) MRI can detect cerebral hemodynamic impairment in patients with ICS. Methods This retrospective study analyzed 26 consecutive patients with unilateral ICS (21 men; mean age, 71 years) who underwent 4D flow MRI and acetazolamide-stress brain perfusion SPECT. Collateral flow via the Willis ring was visually evaluated. Temporal mean flow volume rate (Net), pulsatile flow volume (ΔV), and pulsatility index (PI) at the middle cerebral artery were measured. Cerebral vascular reserve (CVR) was calculated from the SPECT dataset. Patients were assigned to the misery perfusion group if the CVR was < 10% and to the nonmisery perfusion group if the CVR was ≥ 10%. Parameters showing a significant difference in both groups were statistically evaluated. Results Affected side ΔV, ratio of affected to contralateral side Net (rNet), and ratio of affected to contralateral side ΔV were significantly correlated to CVR (p = 0.030, p = 0.010, p = 0.015, respectively). Absence of retrograde flow at the posterior communicating artery was observed in the misery perfusion group (p = 0.020). Combined cut-off values of the affected side ΔV (0.18 ml) and rNet (0.64) showed a sensitivity and specificity of 100% and 77.8%, respectively. Conclusion Multiparametric flow analysis using 4D flow MRI can detect misery perfusion by comprehensively assessing blood flow data, including blood flow volume, pulsation, and collateral flow.Funding Information
- Japan Society for the Promotion of Science (17K18160, 19K17151, 19K08186)
- Hitachi Global Foundation (1309)
- Fukuda Foundation for Medical Technology
- Terumo Foundation for Life Sciences and Arts
This publication has 40 references indexed in Scilit:
- Further Implications of Off-Label Use of Acetazolamide in the Management of Moyamoya Disease in JapanRadiology, 2017
- Implications of Off-Label Use of Acetazolamide in the Management of Moyamoya Disease in JapanRadiology, 2016
- Simple Assessment of Cerebral Hemodynamics Using Single-Slab 3D Time-of-Flight MR Angiography in Patients with Cervical Internal Carotid Artery Steno-Occlusive Diseases: Comparison with Quantitative Perfusion Single-Photon Emission CTAmerican Journal of Neuroradiology, 2008
- Cerebrovascular Reactivity to Acetazolamide and Outcome in Patients With Symptomatic Internal Carotid or Middle Cerebral Artery OcclusionStroke, 2002
- Clinical Investigative Studies: Relationship Between Absolute Mean Cerebral Transit Time and Absolute Mean Flow Velocity on Transcranial Doppler Ultrasound After Ischemic StrokeJournal of Neuroimaging, 2002
- Long-Term Prognosis of Medically Treated Patients With Internal Carotid or Middle Cerebral Artery OcclusionStroke, 2001
- Acetazolamide Test in Detecting Reduced Cerebral Perfusion Reserve and Predicting Long-Term Prognosis in Patients with Internal Carotid Artery OcclusionNeurosurgery, 1993
- Parametric imaging of cerebral vascular reserveEuropean Journal of Nuclear Medicine and Molecular Imaging, 1991
- Cerebral hemodynamics in ischemic cerebrovascular diseaseAnnals of Neurology, 1991
- Quantitative Measurement of Regional Cerebral Blood Flow and Oxygen Metabolism in Man Using 15O and Positron Emission TomographyJournal of Computer Assisted Tomography, 1980