Hemodynamic Significance of Internal Carotid or Middle Cerebral Artery Stenosis Detected on Magnetic Resonance Angiography.
10.3349/ymj.2015.56.6.1686
- Author:
Hyo Jung SEO
1
;
Jefferson R PAGSISIHAN
;
Jin Chul PAENG
;
Seung Hong CHOI
;
Gi Jeong CHEON
;
June Key CHUNG
;
Dong Soo LEE
;
Keon Wook KANG
Author Information
1. Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea. paengjc@snu.ac.kr
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Magnetic resonance angiography;
stenosis;
acetazolamide-challenged brain perfusion SPECT;
cerebrovascular reserve;
stroke
- MeSH:
*Acetazolamide;
Adult;
Aged;
Aged, 80 and over;
Brain/blood supply/radionuclide imaging;
Carotid Artery, Internal/physiopathology/radionuclide imaging;
Carotid Stenosis/physiopathology/*radionuclide imaging;
*Cerebrovascular Circulation;
Constriction, Pathologic;
Diuretics;
Female;
*Hemodynamics;
Humans;
Hypertension/physiopathology;
Iodine Radioisotopes;
*Magnetic Resonance Angiography;
Male;
Middle Aged;
*Radiopharmaceuticals;
Tomography, Emission-Computed, Single-Photon/*methods
- From:Yonsei Medical Journal
2015;56(6):1686-1693
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: We evaluated hemodynamic significance of stenosis on magnetic resonance angiography (MRA) using acetazolamide perfusion single photon emission computed tomography (SPECT). MATERIALS AND METHODS: Of 171 patients, stenosis in internal carotid artery (ICA) and middle cerebral artery (MCA) (ICA-MCA) on MRA and cerebrovascular reserve (CVR) of MCA territory on SPECT was measured using quantification and a 3-grade system. Stenosis and CVR grades were compared with each other, and their prognostic value for subsequent stroke was evaluated. RESULTS: Of 342 ICA-MCA, 151 (44%) presented stenosis on MRA; grade 1 in 69 (20%) and grade 2 in 82 (24%) cases. Decreased CVR was observed in 9% of grade 0 stenosis, 25% of grade 1, and 35% of grade 2. The average CVR of grade 0 was significantly different from grade 1 (p<0.001) and grade 2 stenosis (p=0.007). In quantitative analysis, average CVR index was -0.56+/-7.91 in grade 0, -1.81+/-6.66 in grade 1 and -1.18+/-5.88 in grade 2 stenosis. Agreement between stenosis and CVR grades was fair in patients with lateralizing and non-lateralizing symptoms (kappa=0.230 and 0.346). Of the factors tested, both MRA and CVR were not significant prognostic factors (p=0.104 and 0.988, respectively), whereas hypertension and renal disease were significant factors (p<0.05, respectively). CONCLUSION: A considerable proportion of ICA-MCA stenosis detected on MRA does not cause CVR impairment despite a fair correlation between them. Thus, hemodynamic state needs to be assessed for evaluating significance of stenosis, particularly in asymptomatic patients.
