Detection of impaired cerebrovascular reactivity in patients with chronic cerebral ischemia using whole-brain 7T MRA
Detection of impaired cerebrovascular reactivity in patients with chronic cerebral ischemia using whole-brain 7T MRA
复制标题
全脑7T MRA检测慢性脑缺血患者脑血管反应性受损
DOI：
10.1016/j.jstrokecerebrovasdis.2020.105081
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发表时间：
2020
影响因子：
2.5
通讯作者：
Sasaki Makoto
中科院分区：
文献类型：
--
作者：
Uwano Ikuko;Kameda Hiroyuki;Harada Taisuke;Kobayashi Masakazu;Yanagihara Wataru;Setta Kengo;Ogasawara Kuniaki;Yoshioka Kunihiro;Yamashita Fumio;Mori Futoshi;Matsuda Tsuyoshi;Sasaki Makoto
背景单光子发射计算机断层扫描（SPECT）脑血管对乙酰唑胺（ACZ）的反应性（CVR）可用于评估慢性脑缺血的严重程度，但这是一种有创的方法。我们研究是否全脑磁共振血管造影（MRA）在7 T可以非侵入性地检测受损的CVR慢性脑缺血患者的表现出软脑膜侧支循环（LMCs）。MethodsFifty 7例有症状的单侧颈椎狭窄进行全脑时间的飞行MRA在7 T和脑灌注SPECT前/后ACZ的挑战。根据6点分级系统对MRA图像进行视觉评估，以评估LMCs向大脑中动脉（MCA）的发展和MCA的顺行血流。根据SPECT数据计算患侧的CVR。结果应用大脑前动脉（ACA）和/或大脑后动脉（PCA）的LMCs时，≥ 2级的LMCs的CVR明显低于0-1级（P<0. 0 5）。这些差异比MCA顺行血流分级更明显。ACA/PCA的LMC分级可检出CVR降低（< 18.4%），敏感性/特异性为0.79/0.82。结论7 T全脑MRA LMC显像可无创性检出单侧宫颈狭窄患者CVR降低，敏感性/特异性高。
BackgroundCerebrovascular reactivity (CVR) to acetazolamide (ACZ) on single-photon emission computed tomography (SPECT) can be used to assess the severity of chronic cerebral ischemia; however, this is an invasive method. We examined whether whole-brain magnetic resonance angiography (MRA) at 7T could non-invasively detect impaired CVR in patients with chronic cerebral ischemia by demonstrating the leptomeningeal collaterals (LMCs).MethodsFifty-seven patients with symptomatic unilateral cervical stenosis underwent whole-brain time-of-flight MRA at 7T and cerebral perfusion SPECT before/after the ACZ challenge. MRA images were visually assessed based on 6-point grading systems to evaluate the development of LMCs toward the middle cerebral artery (MCA) and antegrade flow of MCA. CVR of the affected side was calculated from the SPECT data. Subsequently, we compared the LMC grades on MRA with CVR on SPECT.ResultsCVR was significantly lower in grades ≥ 2 of LMCs than in grades 0–1 (P< 0.05) when applying LMCs from the anterior cerebral artery (ACA) and/or posterior cerebral artery (PCA). These differences were more evident than those in the grading of the antegrade MCA flow. The LMC grades from ACA/PCA readily detected reduced CVR (< 18.4%) with a sensitivity/specificity of 0.79/0.82.ConclusionThe development of LMCs on whole-brain MRA at 7T can non-invasively detect reduced CVR with a high sensitivity/specificity in patients with unilateral cervical stenosis.