Interrogating the Functional Correlates of Collateralization in Patients with Intracranial Stenosis Using Multimodal Hemodynamic Imaging

The importance of collateralization for maintaining adequate cerebral perfusion is increasingly recognized. However, measuring collateral flow noninvasively has proved elusive. The aim of this study was to assess correlations among baseline perfusion and arterial transit time artifacts, cerebrovascu...

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Bibliographic Details
Published in:American journal of neuroradiology : AJNR 2016-06, Vol.37 (6), p.1132-1138
Main Authors: Roach, B A, Donahue, M J, Davis, L T, Faraco, C C, Arteaga, D, Chen, S-C, Ladner, T R, Scott, A O, Strother, M K
Format: Article
Language:English
Subjects:
Adult
Adult Brain
Aged
Angiography, Digital Subtraction
Cerebrovascular Circulation
Cerebrovascular Disorders - diagnostic imaging
Collateral Circulation
Constriction, Pathologic - diagnostic imaging
Editor's Choice
Female
Functional
Hemodynamics
Humans
Magnetic Resonance Imaging - methods
Male
Middle Aged
Multimodal Imaging - methods
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Summary:The importance of collateralization for maintaining adequate cerebral perfusion is increasingly recognized. However, measuring collateral flow noninvasively has proved elusive. The aim of this study was to assess correlations among baseline perfusion and arterial transit time artifacts, cerebrovascular reactivity, and the presence of collateral vessels on digital subtraction angiography. The relationship between the presence of collateral vessels on arterial spin-labeling MR imaging and DSA was compared with blood oxygen level-dependent MR imaging measures of hypercapnic cerebrovascular reactivity in patients with symptomatic intracranial stenosis (n = 18). DSA maps were reviewed by a neuroradiologist and assigned the following scores: 1, collaterals to the periphery of the ischemic site; 2, complete irrigation of the ischemic bed via collateral flow; and 3, normal antegrade flow. Arterial spin-labeling maps were scored according to the following: 0, low signal; 1, moderate signal with arterial transit artifacts; 2, high signal with arterial transit artifacts; and 3, normal signal. In regions with normal-to-high signal on arterial spin-labeling, collateral vessel presence on DSA strongly correlated with declines in cerebrovascular reactivity (as measured on blood oxygen level-dependent MR imaging, P < .001), most notably in patients with nonatherosclerotic disease. There was a trend toward increasing cerebrovascular reactivity with increases in the degree of collateralization on DSA (P = .082). Collateral vessels may have fundamentally different vasoreactivity properties from healthy vessels, a finding that is observed most prominently in nonatherosclerotic disease and, to a lesser extent, in atherosclerotic disease.
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.A4758