Skip to main content

Advertisement

SpringerLink
Log in

Perfusion Characteristics in Chronic Cerebrovascular Insufficiency

An Anatomically and Clinically Oriented XeCT Analysis of Cerebrovascular Atherosclerotic Disease

  • Original Article
  • Published:
Translational Stroke Research Aims and scope Submit manuscript

Abstract

Xenon-enhanced computed tomography (XeCT) allows quantification of hemodynamic insufficiency in the setting of cerebrovascular atherosclerotic disease (CAD). However, data regarding the relationship between hemodynamic indices [cerebral blood flow (CBF) and cerebrovascular reserve capacity (CVRC)] and normal subjects (with aging) and pathology (progression of CAD or development of stroke symptoms) are limited. In this study, we analyzed 103 consecutive patients undergoing XeCT according to age, anatomical location and disease severity. We stratified anatomically defined ROIs according to a classification system that observes the presence of proximal stenosis (class I vs. class II/III) as well as the presence of neurological symptoms (class II vs. III); CBF, CVRC and hemodynamic stress distribution were calculated. Supratentorial CBF decreases significantly with age, but not infratentorially. Cortical CVRC remains stable over time. Our classification of disease severity correlated highly significantly with a decrease in supratentorial CBF and CVRC, though CVRC is less sensitive to age-related changes. Regression analysis delineated a CVRC of 34% to discriminate between ROI classes. Age-dependent perfusion characteristics in normal vascular territories were characterized. In CAD, CVRC remains the most sensitive parameter. A simplified classification of ROIs according to disease severity correlates well with established markers for hemodynamic insufficiency. It may facilitate comparison of different pathologies such as CAD and Moyamoya disease and will be the focus of further studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

XeCT:

Xenon-enhanced computed tomography

CBF:

cerebral blood flow

CAD:

cerebrovascular atherosclerotic disease

MMD:

Moyamoya disease

ROI:

region of interest

CVRC:

cerebrovascular reserve capacity

ICA:

internal carotid artery

MCA:

middle cerebral artery

hdSD:

hemodynamic stress distribution

References

  1. Webster MW, Makaroun MS, Steed DL, Smith HA, Johnson DW, Yonas H, et al. Compromised cerebral blood flow reactivity is a predictor of stroke in patients with symptomatic carotid artery occlusive disease. J Vasc Surg. 1995;21(2):338–44. discussion 344–5.

    Article  PubMed  CAS  Google Scholar 

  2. Lee M, Zaharchuk G, Guzman R, Achrol A, Bell-Stephens T, Steinberg GK. Quantitative hemodynamic studies in moyamoya disease: a review. Neurosurg Focus. 2009;26(4):E5.

    Article  PubMed  Google Scholar 

  3. Wintermark M, Sesay M, Barbier E, Borbely K, Dillon WP, Eastwood JD, et al. Comparative overview of brain perfusion imaging techniques. Stroke. 2005;36(9):e83–99.

    Article  PubMed  Google Scholar 

  4. Yonas H, Darby JM, Marks EC, Durham SR, Maxwell C. CBF measured by xe-ct: approach to analysis and normal values. J Cereb Blood Flow Metab. 1991;11(5):716–25.

    Article  PubMed  CAS  Google Scholar 

  5. Schmiedek P, Piepgras A, Leinsinger G, Kirsch CM, Einhäupl K. Improvement of cerebrovascular reserve capacity by EC–IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg. 1994;81(2):236–44.

    Article  PubMed  CAS  Google Scholar 

  6. Yonas H, Gur D, Good BC, Latchaw RE, Wolfson SKJ, Good WF, et al. Stable xenon CT blood flow mapping for evaluation of patients with extracranial–intracranial bypass surgery. J Neurosurg. 1985;62(3):324–33.

    Article  PubMed  CAS  Google Scholar 

  7. Yonas H, Smith HA, Durham SR, Pentheny SL, Johnson DW. Increased stroke risk predicted by compromised cerebral blood flow reactivity. J Neurosurg. 1993;79(4):483–9.

    Article  PubMed  CAS  Google Scholar 

  8. Buijs PC, Krabbe-Hartkamp MJ, Bakker CJ, de Lange EE, Ramos LM, Breteler MM, et al. Effect of age on cerebral blood flow: measurement with ungated two-dimensional phase-contrast MR angiography in 250 adults. Radiology. 1998;209(3):667–74.

    PubMed  CAS  Google Scholar 

  9. Chaer RA, Shen J, Rao A, Cho JS, Abu Hamad G, Makaroun MS. Cerebral reserve is decreased in elderly patients with carotid stenosis. J Vasc Surg 2010, Jul 9.

  10. Kohno K, Oka Y, Kohno S, Ohta S, Kumon Y, Sakaki S. Cerebral blood flow measurement as an indicator for an indirect revascularization procedure for adult patients with moyamoya disease. Neurosurgery. 1998;42(4):752–7. discussion 757–8.

    Article  PubMed  CAS  Google Scholar 

  11. Angeloni U, Bozzao L, Fantozzi L, Bastianello S, Kushner M, Fieschi C. Internal borderzone infarction following acute middle cerebral artery occlusion. Neurology. 1990;40(8):1196–8.

    PubMed  CAS  Google Scholar 

  12. Del Sette M, Eliasziw M, Streifler JY, Hachinski VC, Fox AJ, Barnett HJ. Internal borderzone infarction: a marker for severe stenosis in patients with symptomatic internal carotid artery disease. For the North American Symptomatic Carotid Endarterectomy (NASCET) group. Stroke. 2000;31(3):631–6.

    Article  PubMed  Google Scholar 

  13. Gur D, Good WF, Wolfson SKJ, Yonas H, Shabason L. In vivo mapping of local cerebral blood flow by xenon-enhanced computed tomography. Science. 1982;215(4537):1267–8.

    Article  PubMed  CAS  Google Scholar 

  14. Johnson DW, Stringer WA, Marks MP, Yonas H, Good WF, Gur D. Stable xenon CT cerebral blood flow imaging: rationale for and role in clinical decision making. AJNR Am J Neuroradiol. 1991;12(2):201–13.

    PubMed  CAS  Google Scholar 

  15. Kashiwagi S, Yamashita T, Katoh S, Kitahara T, Nakashima K, Yasuhara S, et al. Regression of moyamoya vessels and hemodynamic changes after successful revascularization in childhood moyamoya disease. Acta Neurol Scand Suppl. 1996;166:85–8.

    Article  PubMed  CAS  Google Scholar 

  16. Derdeyn CP, Videen TO, Fritsch SM, Carpenter DA, Grubb RLJ, Powers WJ. Compensatory mechanisms for chronic cerebral hypoperfusion in patients with carotid occlusion. Stroke. 1999;30(5):1019–24.

    Article  PubMed  CAS  Google Scholar 

  17. Leenders KL, Perani D, Lammertsma AA, Heather JD, Buckingham P, Healy MJ, et al. Cerebral blood flow, blood volume and oxygen utilization. Normal values and effect of age. Brain. 1990;113(Pt 1):27–47.

    Article  PubMed  Google Scholar 

  18. Yonas H, Pindzola RR, Meltzer CC, Sasser H. Qualitative versus quantitative assessment of cerebrovascular reserves. Neurosurgery. 1998;42(5):1005–10. discussion 1011–2.

    Article  PubMed  CAS  Google Scholar 

  19. Schubert GA, Seiz M, Hegewald AA, Manville J, Thomé C. Acute hypoperfusion immediately after subarachnoid hemorrhage: a xenon contrast-enhanced CT study. J Neurotrauma. 2009;26(12):2225–31.

    Article  PubMed  Google Scholar 

  20. Przybylski GJ, Yonas H, Smith HA. Reduced stroke risk in patients with compromised cerebral blood flow reactivity treated with superficial temporal artery to distal middle cerebral artery bypass surgery. J Stroke Cerebrovasc Dis. 1998;7(5):302–9.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria

    Gerrit Alexander Schubert, Marcel Seiz & Claudius Thomé

  2. Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Marcus Czabanka

Authors
  1. Gerrit Alexander Schubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcel Seiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcus Czabanka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Claudius Thomé
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerrit Alexander Schubert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schubert, G.A., Seiz, M., Czabanka, M. et al. Perfusion Characteristics in Chronic Cerebrovascular Insufficiency. Transl. Stroke Res. 3, 122–129 (2012). https://doi.org/10.1007/s12975-011-0107-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12975-011-0107-z

Keywords

Search

Navigation