Intra-arterial high signals on arterial spin labeling perfusion images predict the occluded internal carotid artery segment
Abstract
Purpose
Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment.
Methods
Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4).
Results
Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1–C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3–C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1–C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion.
Conclusion
High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site.
Keywords
Magnetic resonance imaging Arterial spin labeling Internal carotid artery occlusion Occluded segmentNotes
Acknowledgements
We thank the members of the Stroke Care Unit of Tokushima University Hospital for their contributions to this study.
Compliance with ethical standards
Funding
No funding was received for this study.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
Informed consent
Informed consent was obtained from all participants for whom identifying information is included in this article.
References
- 1.Paciaroni M, Balucani C, Agnelli G, Caso V, Silvestrelli G, Grotta JC, Demchuk AM, Sohn SI, Orlandi G, Leys D, Pezzini A, Alexandrov AV, Silvestrini M, Fofi L, Barlinn K, Inzitari D, Ferrarese C, Tassi R, Tsivgoulis G, Consoli D, Baldi A, Bovi P, Luda E, Galletti G, Invernizzi P, DeLodovici ML, Corea F, Del Sette M, Monaco S, Marcheselli S, Alberti A, Venti M, Acciarresi M, D’Amore C, Macellari F, Lanari A, Previdi P, Gonzales NR, Pandurengan RK, Vahidy FS, Sline M, Bal SS, Chiti A, Gialdini G, Dumont F, Cordonnier C, Debette S, Padovani A, Cerqua R, Bodechtel U, Kepplinger J, Nesi M, Nencini P, Beretta S, Trentini C, Martini G, Piperidou C, Heliopoulos I, D’Anna S, Cappellari M, Donati E, Bono G, Traverso E, Toni D (2012) Systemic thrombolysis in patients with acute ischemic stroke and Internal Carotid ARtery Occlusion: the ICARO study. Stroke 43:125–130CrossRefPubMedGoogle Scholar
- 2.Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama a Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Majoie CB, Dippel DW (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372:11–20CrossRefPubMedGoogle Scholar
- 3.Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372:1009–1018CrossRefPubMedGoogle Scholar
- 4.Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372:1019–1030CrossRefPubMedGoogle Scholar
- 5.Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372:2285–2295CrossRefPubMedGoogle Scholar
- 6.Kwak JH, Zhao L, Kim JK, Park S, Lee DG, Shim JH, Lee DH, Kim JS, Suh DC (2014) The outcome and efficacy of recanalization in patients with acute internal carotid artery occlusion. AJNR Am J Neuroradiol 35:747–753CrossRefPubMedGoogle Scholar
- 7.Bokkers RP, Hernandez DA, Merino JG, Mirasol RV, van Osch MJ, Hendrikse J, Warach S, Latour LL (2012) Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke. Stroke 43:1290–1294CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Griebe M, Kern R, Eisele P, Sick C, Wolf ME, Sauter-Servaes J, Gregori J, Gunther M, Hennerici MG, Szabo K (2013) Continuous magnetic resonance perfusion imaging acquisition during systemic thrombolysis in acute stroke. Cerebrovasc Dis 35:554–559CrossRefPubMedGoogle Scholar
- 9.Detre JA, Samuels OB, Alsop DC, Gonzalez-At JB, Kasner SE, Raps EC (1999) Noninvasive magnetic resonance imaging evaluation of cerebral blood flow with acetazolamide challenge in patients with cerebrovascular stenosis. J Magn Reson Imaging 10:870–875CrossRefPubMedGoogle Scholar
- 10.Yoo RE, Yun TJ, Rhim JH, Yoon BW, Kang KM, Choi SH, Kim JH, Kim JE, Kang HS, Sohn CH, Han MH (2015) Bright vessel appearance on arterial spin labeling MRI for localizing arterial occlusion in acute ischemic stroke. Stroke 46:564–567CrossRefPubMedGoogle Scholar
- 11.Majer M, Mejdoubi M, Schertz M, Colombani S, Arrigo A (2015) Raw arterial spin labeling data can help identify arterial occlusion in acute ischemic stroke. Stroke 46:e141–e144CrossRefPubMedGoogle Scholar
- 12.Junya A, Kazumi K, Kensaku S, Yuki S (2013) DWI-ASPECTS as a predictor of dramatic recovery after intravenous recombinant tissue plasminogen activator administration in patients with middle cerebral artery occlusion. Stroke 44:534–537CrossRefGoogle Scholar
- 13.Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd (1999) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41CrossRefGoogle Scholar
- 14.Dai W, Garcia D, de Bazelaire C, Alsop DC (2008) Continuous flow-driven inversion for arterial spin labeling using pulsed radio frequency and gradient fields. Magn Reson Med 60:1488–1497CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Gibo H, Lenkey C, Rhoton AL Jr (1981) Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg 55:560–574CrossRefPubMedGoogle Scholar
- 16.Tada Y, Satomi J, Abe T, Kuwayama K, Sogabe S, Fujita K, Yamamoto N, Kaji R, Harada M, Nagahiro S (2014) Intra-arterial signal on arterial spin labeling perfusion MRI to identify the presence of acute middle cerebral artery occlusion. Cerebrovasc Dis 38:191–196CrossRefPubMedGoogle Scholar
- 17.Morita N, Harada M, Uno M, Matsubara S, Matsuda T, Nagahiro S, Nishitani H (2008) Ischemic findings of T2*-weighted 3-tesla MRI in acute stroke patients. Cerebrovasc Dis 26:367–375CrossRefPubMedGoogle Scholar
- 18.Zaharchuk G (2012) Arterial spin labeling for acute stroke: practical considerations. Transl Stroke Res 3:228–235CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Alsop DC, Detre JA, Golay X, Günther M, Hendrikse J, Hernandez-Garcia L, Lu H, MacIntosh BJ, Parkes LM, Smits M, van Osch MJP, Wang DJJ, Wong EC, Zaharchuk G (2015) Recommended implementation of arterial spin-labeled perfusion MRI for clinical applications: a consensus of the ISMRM perfusion study group and the European consortium for ASL in dementia. Magn Reson Med 73:102–116CrossRefPubMedGoogle Scholar
- 20.Wang DJ, Alger JR, Qiao JX, Gunther M, Pope WB, Saver JL, Salamon N, Liebeskind DS, Stroke Investigators UCLA (2013) Multi-delay multi-parametric arterial spin-labeled perfusion MRI in acute ischemic stroke—comparison with dynamic susceptibility contrast enhanced perfusion imaging. Neuroimage Clin 3:1–7CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Liu TT, Brown GG (2007) Measurement of cerebral perfusion with arterial spin labeling: part 1. Methods J Int Neuropsychol Soc 13:517–525PubMedGoogle Scholar