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Permeability Imaging as a Biomarker of Leptomeningeal Collateral Flow in Patients with Intracranial Arterial Stenosis


Different methods of angiography are of great clinical utility; however, it still remains unstandardized as which method would be suitable to determine cerebral collateral circulation. Here we compared digital subtraction angiography (DSA), computer tomography angiography (CTA) and dynamic contrast-enhanced T1-weighted imaging magnetic resonance imaging (MRI) findings in seven patients with severe intracranial arterial stenosis, and determine whether volume transfer constant (K trans) maps of permeability imaging could be used as the biomarkers of cerebral collateral circulation. We retrospectively reviewed seven adult patients with severe intracranial arterial stenosis or occlusion with a complete parenchymal and vascular imaging work-up. DSA, CTA source imaging (CTA-SI), arterial spin labeling (ASL), and K trans maps were used to assess their collateral flow. Cohen’s Kappa coefficient was calculated to test the consistency of their collateral scores. A reasonable agreement was found between DSA and K trans maps (Kappa = 0.502, P < 0.001) when all 15 regional vascular sites were included, and a better agreement found after exclusion of perforating artery territories (N = 10 sites, Kappa = 0.766, P < 0.001). The agreement between CTA-SI and DSA was moderate on all 15 sites (Kappa = 0.413, P < 0.001) and 10 sites (Kappa = 0.329, P < 0.001). The agreement between ASL and DSA was least favorable, no matter for all 15 sites (Kappa = 0.270, P < 0.001) or 10 sites (Kappa = 0.205, P = 0.002). K trans maps are useful and promising for leptomeningeal collateral assessment, when compared to CTA-SI or ASL. Further studies are requited for verify its validity in a large registry of patients.

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Fig. 1
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Digital subtraction angiography


Magnetic resonance imaging


Computer tomography


Computer tomography angiography


CTA source imaging


Blood brain barrier


Arterial spin labeling


Dynamic contrast-enhanced T1-weighted imaging


Alberta stroke program early CT score


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This study was supported by National Natural Science Foundation of China (Grant Nos. 81371286 and 81101034).

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Correspondence to Weiwei Zhang or Xin Lou.

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Hui Chen and Bing Wu have contributed equally to this study.

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Chen, H., Wu, B., Zhu, G. et al. Permeability Imaging as a Biomarker of Leptomeningeal Collateral Flow in Patients with Intracranial Arterial Stenosis. Cell Biochem Biophys 71, 1273–1279 (2015). https://doi.org/10.1007/s12013-014-0343-4

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  • Magnetic resonance imaging
  • Collateral circulation
  • Intracranial stenosis
  • Permeability
  • K trans