Yonsei Med J.  2015 Nov;56(6):1686-1693. 10.3349/ymj.2015.56.6.1686.

Hemodynamic Significance of Internal Carotid or Middle Cerebral Artery Stenosis Detected on Magnetic Resonance Angiography

• Seo HJ
• Pagsisihan JR
• Paeng JC
• Choi SH
• Cheon GJ
• Chung JK
• Lee DS
• Kang KW

• KMID: 2345901
• DOI: http://doi.org/10.3349/ymj.2015.56.6.1686

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.

Keyword

Magnetic resonance angiography; stenosis; acetazolamide-challenged brain perfusion SPECT; cerebrovascular reserve; stroke

MeSH Terms

*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
Acetazolamide
Diuretics
Iodine Radioisotopes
Radiopharmaceuticals

Figure

• 

  Fig. 1 Proportions of decreased CVR (grade 1 and 2) according to stenosis grade. Decreased CVR was more frequently presented in higher stenosis grade group. CVR, cerebrovascular reserve.

• 

  Fig. 2 Kaplan-Meier survival curve for subsequent stroke occurrence in overall group.

• 

  Fig. 3 Kaplan-Meier survival curve for subsequent stroke occurrence according to significant risk factors (A and B) or factors with borderline significances (C and D). TIA, transient ischemic attack.

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