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Published on: January 4, 2013
How vascular territories change in intracranial atherosclerosis - a CT perfusion flow territory mapping study
Davor Pavlin-Premrl1, Vincent Thijs2, Peter J Mitchell3
1Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology, Austin Hospital, Heidelberg, Australia.
Background:
Intracranial atherosclerosis is common and has a high recurrence rate. It has been theorized that vascular territory volumes change in ICAD due to collateral activation, but this has not been demonstrated. CT perfusion territory flow mapping is a recently developed technique that uses the collision of wavefronts from perfusion data of different territories to calculate territory volumes. We aimed to investigate how territory volumes change in ICAD.
Methods:
This was a multi-centre international case-control study where we measured arterial territory volumes in 72 patients with ICAD, as well as 49 controls using CT perfusion-based flow territory mapping. ICAD-affected and ICAD-adjacent territory volumes were compared to their homologous pairs and to control patient territories. Correlation between territory volumes and percentage vessel stenosis was tested.
Results:
The territory volumes in the ICAD-affected regions were significantly smaller (p<0.001) and adjacent territories significantly larger (p<0.001) than homologous contralateral territories. ICAD-affected territory volume ratios were also significantly smaller than control territory ratios, median 0.84 (IQR 0.63-0.99) vs 0.97 (IQR 0.87-1.09), p<0.001. For the largest group (MCA affected territories), the median of the ICAD affected sides was 232.3mls (IQR 162.4-275.9mls) and the median of the unaffected sides was 270.1mls (IQR 241.0-303.7mls). Adjacent territory ratios were significantly larger than control territory ratios 1.19 (IQR 0.95-1.55) vs 0.97 (IQR 0.87-1.09), p<0.001.
Conclusions:
This study demonstrates that the presence of ICAD is associated with reduction in volume of the affected arterial territory with increases in the adjacent territory volumes.
