Journal article
Structural MRI of carotid artery atherosclerotic lesion burden and characterization of hemispheric cerebral blood flow before and after carotid endarterectomy
NMR in biomedicine, Vol.19(2), pp.198-208
04/2006
DOI: 10.1002/nbm.1017
PMID: 16475206
Abstract
Collateral circulation plays a major role in maintaining cerebral blood flow (CBF) in patients with internal carotid artery (ICA) stenosis. CBF can remain normal despite severe ICA stenosis, making the benefit of carotid endarterectomy (CEA) or stenting difficult to assess. Before and after surgery, we assessed CBF supplied through the ipsilateral (stenotic) or contralateral ICA individually with a novel hemisphere-selective arterial spin-labeling (ASL) perfusion MR technique. We further explored the relationship between CBF and ICA obstruction ratio (OR) acquired with a multislice black-blood imaging sequence. For patients with unilateral ICA stenosis (n = 19), conventional bilateral labeling did not reveal interhemispheric differences. With unilateral labeling, CBF in the middle cerebral artery (MCA) territory on the surgical side from the ipsilateral supply (53.7 ± 3.3 ml/100 g/min) was lower than CBF in the contralateral MCA territory from the contralateral supply (58.5 ± 2.7 ml/100 g/min), although not statistically significant (p = 0.09). The ipsilateral MCA territory received significant (p = 0.02) contralateral supply (7.0 ± 2.7 ml/100 g/min), while ipsilateral supply to the contralateral side was not reciprocated. After surgery (n = 11), ipsilateral supply to the MCA territory increased from 57.3 ± 5.7 to 67.3 ± 5.4 ml/100 g/min (p = 0.03), and contralateral supply to the ipsilateral MCA territory decreased. The best predictor of increased CBF on the side of surgery was normalized presurgical ipsilateral supply (r2 = 0.62, p = 0.004). OR was less predictive of change, although the change in normalized contralateral supply was negatively correlated with ORexcess (=ORipsilateral − ORcontralateral) (r2 = 0.58, p = 0.006). The results demonstrate the effect of carotid artery stenosis on blood supply to the cerebral hemispheres, as well as the relative role of collateral pathways before surgery and redistribution of blood flow through these pathways after surgery. Unilateral ASL may better predict hemodynamic surgical outcome (measured by improved perfusion) than ICA OR
Details
- Title: Subtitle
- Structural MRI of carotid artery atherosclerotic lesion burden and characterization of hemispheric cerebral blood flow before and after carotid endarterectomy
- Creators
- C. E Jones - University of PennsylvaniaP. K Saha - University of PennsylvaniaR. L Wolf - University of PennsylvaniaJ Wang - University of PennsylvaniaY Zhang - National Institutes of HealthA. C Wright - University of PennsylvaniaJ. A Detre - University of PennsylvaniaB Das - University of PennsylvaniaH. K Song - Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA, USAE M Mohler III - University of PennsylvaniaR. M Fairman - University of PennsylvaniaE. L Zager - University of PennsylvaniaO. C Velazquez - University of PennsylvaniaM. A Golden - University of PennsylvaniaF. W Wehrli - University of PennsylvaniaJ. P Carpenter - University of Pennsylvania
- Resource Type
- Journal article
- Publication Details
- NMR in biomedicine, Vol.19(2), pp.198-208
- Publisher
- John Wiley & Sons, Ltd
- DOI
- 10.1002/nbm.1017
- PMID
- 16475206
- ISSN
- 0952-3480
- eISSN
- 1099-1492
- Number of pages
- 11
- Language
- English
- Date published
- 04/2006
- Academic Unit
- Radiology; Electrical and Computer Engineering
- Record Identifier
- 9984197258802771
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