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Published on: December 28, 2014
Arterial input function dispersal generated by brain computed tomography perfusion is associated with cerebral small
Yuji Shiga1, Carlos Garcia-Esperon1, Md Golam Hasnain2
1Hunter Medical Research Institute, Newcastle, Australia; Department of Neurology, John Hunter Hospital, Newcastle, Australia; College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, Australia.
Insights
Prolonged arterial input function dispersal, a measure of contrast passage, is linked to increased small vessel disease burden in patients with stroke or TIA. This finding suggests it may serve as a risk marker for microvascular injury.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Left atrial and ventricular dysfunction impact cerebral hemodynamics, correlating with small vessel disease markers like white matter hyperintensities.
- Arterial input function (AIF) dispersal from CT perfusion reflects cerebral circulation and is linked to cardiac dysfunction.
Purpose of the Study:
- To investigate the association between prolonged AIF dispersal and the burden of small vessel disease (SVD).
- To determine if AIF dispersal can serve as a risk marker for cumulative microvascular injury.
Main Methods:
- Retrospective analysis of 369 patients with acute ischemic stroke or TIA.
- CT perfusion and MRI were used to assess AIF dispersal and SVD burden (including white matter hyperintensities, lacunes, microbleeds, enlarged perivascular spaces).
- Logistic regression and ROC analysis examined the association between AIF dispersal and high SVD burden.
Main Results:
- 31% of patients had high SVD burden.
- Each 1-second increase in AIF dispersal independently increased the odds of high SVD burden (OR 1.12).
- An AIF dispersal cutoff of >29 seconds was associated with high SVD burden (OR 5.13), with an optimal cutoff of 30 seconds (AUC 0.71).
Conclusions:
- AIF dispersal is independently associated with total SVD burden.
- AIF dispersal may be a valuable risk marker for cumulative microvascular injury, complementing its role in indicating cardiac dysfunction.
Introduction:
Left atrial and ventricular dysfunction affect cerebral hemodynamics and are linked to white matter hyperintensities and other small vessel disease markers. Arterial input function dispersal from computed tomography perfusion reflects contrast passage through cerebral circulation and has been associated with cardiac dysfunction. We hypothesized that prolonged arterial input function dispersal is associated with higher small vessel disease burden.
Patients And Methods:
We retrospectively analyzed 369 patients with acute ischemic stroke or transient ischemic attack who underwent computed tomography perfusion and brain magnetic resonance imaging within 7 days of admission. Total small vessel disease score was assessed using a validated score incorporating white matter hyperintensities, lacunes, microbleeds, and enlarged perivascular spaces. Associations with high small vessel disease burden (score 3 or 4) were examined using logistic regression and receiver operating characteristic analysis.
Results:
Among 369 patients, 115 (31%) had high small vessel disease burden. Each 1-s increase in arterial input function dispersal was independently associated with greater odds of high small vessel disease burden (odds ratio 1.12, 95% confidence interval 1.07-1.17, p < 0.001). The prespecified cutoff of arterial input function >29 s was also associated with high small vessel disease burden (odds ratio 5.13, 95% confidence interval 2.78-9.45, p < 0.001). Receiver operating characteristic analysis suggested an optimal cutoff of 30 s (area under the curve 0.71).
Discussion And Conclusion:
Arterial input function dispersal was independently associated with total small vessel disease burden, suggesting it may be a useful risk marker for cumulative microvascular injury in addition to indicating cardiac dysfunction.
