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Dynamic computed tomography and functional imaging in cerebral arterial occlusive disease: analysis in the chronic
1Department of Neurology, Misasa-onsen National Hospital, Yonago, Japan.
Insights
Patients with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion and poor collateral circulation show delayed blood flow. This delay correlates with lateral ventricle enlargement in chronic stroke patients.
Area of Science:
- Neurology
- Radiology
- Cerebrovascular Disease
Background:
- Internal carotid artery (ICA) and middle cerebral artery (MCA) occlusive diseases are significant causes of stroke.
- Assessing collateral circulation is crucial for understanding stroke pathophysiology and outcomes.
- Dynamic CT perfusion imaging offers insights into cerebral blood flow dynamics.
Purpose of the Study:
- To evaluate cerebral blood flow dynamics in patients with ICA/MCA occlusion or stenosis using dynamic CT.
- To investigate the relationship between collateral circulation, perfusion parameters, and ventricular changes in chronic stroke.
Main Methods:
- Dynamic CT was performed on 10 patients with chronic ICA/MCA occlusion/stenosis and 14 controls.
- Functional imaging and parameter analysis assessed mean transit time (MTT) and peak time.
- Correlation analysis examined the relationship between anterior horn dilatation and MCA MTT delay.
Main Results:
- Patients with ICA/MCA occlusion and insufficient collateral circulation exhibited significantly delayed MTT and peak time on the affected side (P < 0.01).
- A significant positive correlation (r = 0.62, P < 0.01) was found between the degree of anterior horn dilatation and delayed MCA MTT.
- Control subjects did not show these delays, highlighting the impact of arterial occlusion.
Conclusions:
- Dynamic CT can identify delayed cerebral perfusion in patients with ICA/MCA occlusion and poor collateral supply.
- Delayed MTT in the MCA territory is associated with anterior horn dilatation, suggesting a link between perfusion deficits and structural changes.
- These findings underscore the importance of assessing collateral status and perfusion dynamics in managing cerebrovascular occlusive disease.
Abstract:
Dynamic CT was conducted on 10 patients with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion or stenosis and 14 controls. All the patients were chronic phase and they only presented small infarctions on CT. Those with ICA or MCA occlusions and insufficient collateral circulations showed delayed mean transit time and peak time of the affected side on functional image and in parameter analysis (P less than 0.01) compared with those of controls. A statistically significant positive coefficient of correlation was noted between the degree of the anterior horn dilatation of lateral ventricle and delay in mean transit time of the affected MCA area (r = 0.62, P less than 0.01).