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Flow-related anaerobic metabolic changes in patients with severe stenosis of the internal carotid artery
J van der Grond1, B C Eikelboom, W P Mali
1Department of Radiology, University Hospital Utrecht, Netherlands. j.vandergrond@rrn.azu.nl
Insights
Severe carotid stenosis impacts cerebral blood flow and metabolism. Combining MR imaging techniques reveals correlations between reduced blood flow and metabolic changes, aiding in understanding hemodynamic effects.
Area of Science:
- Neuroimaging
- Cerebrovascular Medicine
- Medical Diagnostics
Background:
- Severe internal carotid artery (ICA) stenosis (>70% diameter reduction) poses significant cerebrovascular risks.
- Understanding the hemodynamic impact of carotid lesions is crucial for patient management.
Purpose of the Study:
- To investigate if combining cerebral blood flow and metabolism measurements offers new insights into the hemodynamic effects of severe ICA stenosis.
- To assess the relationship between carotid lesions, cerebral hemodynamics, and metabolic changes.
Main Methods:
- Fifty-six patients with unilateral severe ICA stenosis and 14 controls underwent MR imaging, 1H MR spectroscopy, and MR angiography.
- Anaerobic metabolic changes were assessed via N-acetyl aspartate/choline and lactate/N-acetyl aspartate ratios.
- Quantitative blood flow was measured in major cerebral arteries (CCA, ICA, basilar, MCA).
Main Results:
- Significantly decreased blood flow was observed in the ipsilateral CCA, ICA, and MCA compared to the contralateral side.
- Basilar artery flow increased, while contralateral MCA flow decreased relative to controls.
- A significant correlation was found between anaerobic metabolic changes and reduced ipsilateral blood flow in CCA, ICA, and MCA.
Conclusions:
- Cerebral metabolism is less impaired in patients with higher ipsilateral cerebral artery flow.
- The combined use of MR spectroscopy and MR angiography enhances understanding of cerebral hemodynamics and metabolism in vascular disorders.
- This approach provides valuable insights into the functional consequences of carotid stenosis.
Background And Purpose:
We sought to investigate whether the combination of blood flow measurements in the major cerebral arteries and measurements of cerebral metabolism can provide new insight into the hemodynamic effect of carotid lesions in patients with severe stenosis (> 70% reduction in diameter) of the internal carotid artery (ICA).
Methods:
Fifty-six patients with unilateral severe stenosis of the ICA and 14 control subjects underwent MR imaging, 1H MR spectroscopy, and MR angiography. Anaerobic metabolic changes were studied by assessing N-acetyl aspartate/choline and lactate/N-acetyl aspartate ratios in the symptomatic and asymptomatic hemispheres. Quantitative flow was measured in the common carotid arteries (CCAs), the ICAs, the basilar artery, and the middle cerebral arteries (MCAs).
Results:
Blood flow was significantly decreased in the CCA, ICA, and MCA on the ipsilateral side compared with the contralateral side. Flow in the basilar artery was increased, whereas flow in the contralateral MCA was decreased compared with control subjects. We found a significant correlation between anaerobic metabolic changes and the reduction in blood flow in the CCA, ICA, and MCA on the ipsilateral side.
Conclusions:
This study shows that cerebral metabolism is less impaired in patients with relatively high flow in the major cerebral arteries on the ipsilateral side than in patients with relatively low flow on that side. The combination of MR spectroscopy and MR angiography can be of additional value in the understanding of cerebral hemodynamics and metabolism in patients with vascular disorders.