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Multiparametric flow analysis using four-dimensional flow magnetic resonance imaging can detect cerebral hemodynamic impairment in patients with internal carotid artery stenosis

  • Diagnostic Neuroradiology
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Abstract

Purpose

MRI-based risk stratification should be established to identify patients with internal carotid artery stenosis (ICS) who require further PET or SPECT evaluation. This study assessed whether multiparametric flow analysis using time-resolved 3D phase-contrast (4D flow) MRI can detect cerebral hemodynamic impairment in patients with ICS.

Methods

This retrospective study analyzed 26 consecutive patients with unilateral ICS (21 men; mean age, 71 years) who underwent 4D flow MRI and acetazolamide-stress brain perfusion SPECT. Collateral flow via the Willis ring was visually evaluated. Temporal mean flow volume rate (Net), pulsatile flow volume (ΔV), and pulsatility index (PI) at the middle cerebral artery were measured. Cerebral vascular reserve (CVR) was calculated from the SPECT dataset. Patients were assigned to the misery perfusion group if the CVR was < 10% and to the nonmisery perfusion group if the CVR was ≥ 10%. Parameters showing a significant difference in both groups were statistically evaluated.

Results

Affected side ΔV, ratio of affected to contralateral side Net (rNet), and ratio of affected to contralateral side ΔV were significantly correlated to CVR (p = 0.030, p = 0.010, p = 0.015, respectively). Absence of retrograde flow at the posterior communicating artery was observed in the misery perfusion group (p = 0.020). Combined cut-off values of the affected side ΔV (0.18 ml) and rNet (0.64) showed a sensitivity and specificity of 100% and 77.8%, respectively.

Conclusion

Multiparametric flow analysis using 4D flow MRI can detect misery perfusion by comprehensively assessing blood flow data, including blood flow volume, pulsation, and collateral flow.

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Availability of data and material

The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.

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Consent for publication

Not applicable.

Code availability

We used GTFlow software which is commercially provided by GyroTools.

Funding

This study was funded by JSPS KAKENHI (Grant Numbers 17K18160, 19K17151, 19K08186), Kurata Grants from the Hitachi Global Foundation (Grant Number 1309), research grants from the Fukuda Foundation for Medical Technology, and research grants from the Terumo Foundation for Life Sciences and Arts.

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Authors and Affiliations

  1. Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Takahiro Ando, Tetsuro Sekine, Erika Orita, Kotomi Iwata, Masatoki Nakaza, Masashi Ogawa & Shin-ichiro Kumita

  2. Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Yasuo Murai

  3. Department of Radiology, Nihon University School of Medicine, 1-6 Surugadai, Kanda, Chiyoda-ku, Tokyo, 101-8309, Japan

    Ryo Takagi & Yasuo Amano

  4. Philips Electronics Japan Healthcare, 2-13-37 Kounan, Minato-ku, Tokyo, 108-8507, Japan

    Makoto Obara

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  1. Takahiro Ando
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  2. Tetsuro Sekine
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  11. Shin-ichiro Kumita
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Contributions

Conceptualization: Takahiro Ando and Tetsuro Sekine; methodology: Takahiro Ando and Tetsuro Sekine; formal analysis and investigation: Takahiro Ando, Tetsuro Sekine, Erika Orita, Kotomi Iwata, and Masatoki Nakaza; writing—original draft preparation: Takahiro Ando and Tetsuro Sekine; writing—review and editing: Takahiro Ando, Tetsuro Sekine, Yasuo Murai, and Yasuo Amano; funding acquisition: Tetsuro Sekine; resources: Takahiro Ando, Sekine Tetsuro, and Yasuo Murai; supervision: Takahiro Ando, Tetsuro Sekine, Masashi Ogawa, Makoto Obara, and Shin-ichiro Kumita.

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Correspondence to Takahiro Ando.

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The author T.S. has a research contract with PMOD Technologies LLC and with Fujifilm Corporation regarding 4D flow MRI software development.

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Ando, T., Sekine, T., Murai, Y. et al. Multiparametric flow analysis using four-dimensional flow magnetic resonance imaging can detect cerebral hemodynamic impairment in patients with internal carotid artery stenosis. Neuroradiology 62, 1421–1431 (2020). https://doi.org/10.1007/s00234-020-02464-2

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