Hemodynamic Significance of Internal Carotid or Middle Cerebral Artery Stenosis Detected on Magnetic Resonance Angiography
- Authors
- Seo, Hyo Jung; Pagsisihan, Jefferson R.; Paeng, Jin Chul; Choi, Seung Hong; Cheon, Gi Jeong; Chung, June-Key; Lee, Dong Soo; Kang, Keon Wook
- Issue Date
- 1-Nov-2015
- Publisher
- YONSEI UNIV COLL MEDICINE
- Keywords
- Magnetic resonance angiography; stenosis; acetazolamide-challenged brain perfusion SPECT; cerebrovascular reserve; stroke
- Citation
- YONSEI MEDICAL JOURNAL, v.56, no.6, pp 1686 - 1693
- Pages
- 8
- Indexed
- SCI
SCIE
SCOPUS
KCI
- Journal Title
- YONSEI MEDICAL JOURNAL
- Volume
- 56
- Number
- 6
- Start Page
- 1686
- End Page
- 1693
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/34552
- DOI
- 10.3349/ymj.2015.56.6.1686
- ISSN
- 0513-5796
1976-2437
- 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 MBA; 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 MBA 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 MBA 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.
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