Cerebral blood flow territory instability in patients with atherosclerotic intracranial stenosis.
J Magn Reson Imaging
; 50(5): 1441-1451, 2019 11.
Article
en En
| MEDLINE
| ID: mdl-30938468
ABSTRACT
BACKGROUND:
Stroke risk stratification in patients with symptomatic intracranial atherosclerotic arterial disease (ICAD) remains an important clinical objective owing to the high 14-19% recurrent stroke rate in these patients on standard-of-care medical management. There thus remains a need for hemodynamic markers that may allow for the selection of personalized therapies for high-risk symptomatic patients.PURPOSE:
To determine if shifting of cerebral blood flow (CBF) territories in response to changes in cerebral perfusion pressure (CPP) may provide a marker for stroke risk in ICAD patients. STUDY TYPE Prospective. POPULATION Twenty ICAD patients who experienced a stroke within 45 days of study enrollment and 10 healthy controls. SEQUENCE 3.0T MRI including anatomical imaging (T1 -weighted, T2 -weighted/FLAIR), 3D MR angiography, and normocapnic and hypercapnic vessel-encoded CBF-weighted arterial spin labeling. ASSESSMENT Patients were scanned within 45 days of overt stroke and monitored (duration = 13.2 ± 4.4 months) for the endpoint of non-cardioembolic stroke or transient ischemic attack. Flow territory shifting (shifting index) was calculated from the first scan by determining whether a voxel shifted from its primary arterial source from normocapnia to hypercapnia. STATISTICAL TESTS A Mann-Whitney U-test (significance:
P < 0.05) was performed to determine whether patients meeting the endpoint had greater shifting indices relative to controls or patients not meeting the endpoint.RESULTS:
Shifting indices (mean ± standard error) were significantly higher in patients meeting endpoint criteria relative to controls (P = 0.0057; adjusted P = 0.036) and patients not meeting endpoint criteria (P = 0.0047; adjusted P = 0.036). DATACONCLUSION:
Flow territory shifting may provide a marker of recurrent stroke risk in symptomatic ICAD patients on standard-of-care medical management therapies. LEVEL OF EVIDENCE 1 Technical Efficacy Stage 2 J. Magn. Reson. Imaging 2019;501441-1451.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Marcadores de Spin
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Arteriosclerosis Intracraneal
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Circulación Cerebrovascular
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Constricción Patológica
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Aterosclerosis
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Magn Reson Imaging
Asunto de la revista:
DIAGNOSTICO POR IMAGEM
Año:
2019
Tipo del documento:
Article
País de afiliación:
Estados Unidos