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AJNR - American Journal of Neuroradiology

Published ahead of print on November 27, 2008
doi: 10.3174/ajnr.A1389

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American Journal of Neuroradiology 30:559-563, March 2009
© 2009 American Society of Neuroradiology

BRAIN

Simple Assessment of Cerebral Hemodynamics Using Single-Slab 3D Time-of-Flight MR Angiography in Patients with Cervical Internal Carotid Artery Steno-Occlusive Diseases: Comparison with Quantitative Perfusion Single-Photon Emission CT

R. Hirooka^a, K. Ogasawara^b, T. Inoue^a, S. Fujiwara^a, M. Sasaki^a, K. Chida^b, D. Ishigaki^a, M. Kobayashi^b, H. Nishimoto^a, Y. Otawara^b, E. Tsushima^c and A. Ogawa^b

^a Advanced Medical Research Center, Iwate Medical University, Hirosaki University, Japan
^b Department of Neurosurgery, Iwate Medical University, Hirosaki University, Japan
^c Graduate School of Health Sciences, Hirosaki University, Japan

Please address correspondence to Kuniaki Ogasawara, MD, Department of Neurosurgery, Iwate Medical University, Uchimaru, 19-1, Morioka 020-8505, Japan; e-mail: kuogasa{at}iwate-med.ac.jp

BACKGROUND AND PURPOSE: Visualization of the peripheral arteries on single-slab 3D time-of-flight (TOF) MR angiography (MRA) can reflect blood flow velocity. The velocity in the middle cerebral artery (MCA) may correlate with cerebrovascular reactivity (CVR) to acetazolamide, which can be used to assess hemodynamic impairment. The goal of this study was to compare the signal intensity of the MCA on MRA versus CVR quantified by perfusion single-photon emission CT (SPECT).

MATERIALS AND METHODS: The signal intensity of the MCA on single-slab 3D time-of-flight MRA was graded according to the ability to visualize the MCA in 108 cerebral hemispheres of 87 patients with unilateral or bilateral cervical internal carotid artery (ICA) steno-occlusive diseases. SPECT-CVR was also calculated by measuring cerebral blood flow before and after acetazolamide challenge. Ten healthy subjects were studied to obtain control SPECT-CVR values. All subjects provided written informed consent before the study.

RESULTS: CVR was significantly lower in cerebral hemispheres with reduced MCA signal intensity than in those with normal intensity (P < .05). When the reduced signal intensity of the MCA on MRA was defined as abnormal, and when a CVR less than the mean – 2 SD of healthy subjects was defined as reduced, MRA grading resulted in a 86.2% sensitivity and 69.6% specificity, with 51.0% positive-predictive and 93.2% negative-predictive values to detect reduced CVR.

CONCLUSIONS: This simple MRA method can assess hemodynamic impairment with a high negative-predictive value.