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Assessment of Collateral Flow in Patients with Carotid Stenosis Using Random Vessel-Encoded Arterial Spin-Labeling:

Shanshan Lu1, Chunqiu Su1, Yuezhou Cao2

  • 1From the Department of Radiology (S.L., C.S.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.

AJNR. American Journal of Neuroradiology
|January 18, 2024
PubMed

Insights

Planning-free random vessel-encoded arterial spin-labeling (rVE-ASL) effectively assesses collateral flow in internal carotid artery disease (ICAD). This technique shows good agreement with digital subtraction angiography (DSA) and identifies flow alterations linked to symptomatic ICAD.

Area of Science:

  • Neuroimaging
  • Vascular Neurology
  • Medical Physics

Background:

  • Collateral circulation is crucial for mitigating stroke risk in steno-occlusive internal carotid artery disease (ICAD).
  • Assessing collateral flow is vital for understanding stroke risk in ICAD patients.

Purpose of the Study:

  • To evaluate the effectiveness of planning-free random vessel-encoded arterial spin-labeling (rVE-ASL) in assessing collateral flow in patients with ICAD.
  • To compare rVE-ASL with digital subtraction angiography (DSA) for collateral flow assessment.

Main Methods:

  • Prospective recruitment of 40 ICAD patients.
  • Comparison of rVE-ASL and DSA using Contingency (C) and Cramer V (V) coefficients for collateral flow assessment.
  • Analysis of flow territory alterations in symptomatic versus asymptomatic patients stratified by stenosis severity and symptoms using the Fisher exact test.

Main Results:

  • Strong agreement between rVE-ASL and DSA in evaluating collateral flow (C = 0.762, V = 0.833, P < .001).
  • Higher likelihood of flow alterations in patients with internal carotid artery (ICA) stenosis ≥90% (P < .001).
  • Symptomatic patients exhibited significantly more flow alterations in the middle cerebral artery (MCA) territory (63.2%) compared to asymptomatic patients (23.8%, P = .012).
  • Collateral flow to the MCA territory predominantly originated from the contralateral internal carotid artery (70.6%) and vertebrobasilar artery (47.1%).

Conclusions:

  • rVE-ASL offers comparable collateral flow assessment to DSA in ICAD.
  • MCA territory flow alterations may indicate symptomatic ICAD, highlighting the clinical relevance of rVE-ASL findings.
Abstract

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