Abstract
BACKGROUND AND PURPOSE: Fractional flow measured on 3D-TOF-MRA was proposed to quantify cerebral hemodynamic changes in patients with artery stenosis. We investigated the association between fractional flow and cerebral perfusion changes in patients with symptomatic MCA stenosis.
MATERIALS AND METHODS: This prospective study was approved by the institutional review board, and all participants provided written informed consent. From June 2015 to May 2018, four hundred twenty-nine patients with symptomatic intracranial arterial stenosis were consecutively recruited and underwent conventional brain MR imaging, 3D-TOF-MRA, and brain CTP. A total of 91 patients with unilateral M1 segment stenosis of the MCA and a stenosis degree of 50%∼99% were included in the analysis. Fractional flow was measured by comparing distal and proximal signal intensity changes across the stenosis on 3D-TOF-MRA. The cutoff value for fractional flow for discriminating between normal perfusion and hypoperfusion was obtained from the receiver operating characteristic curve. Associations between fractional flow and hypoperfusion were assessed using univariate and multivariate analyses.
RESULTS: The receiver operating characteristic curve showed a significant fractional flow threshold value at 0.90 (sensitivity, 70.1%; 95% CI, 55.9%–81.2%; specificity, 69.6%; 95% CI, 47.6%–84.1%). Participants with a fractional flow of ≤0.90 were independently associated with cerebral hypoperfusion downstream from the stenosis site (adjusted OR, 3.68; 95% CI, 1.63–11.62; P = .027).
CONCLUSIONS: Fractional flow measured on 3D-TOF-MRA may serve as a noninvasive and practical tool for determining the cerebral hypoperfusion in patents with symptomatic MCA stenosis.
ABBREVIATIONS:
- FF
- fractional flow
- ICAS
- intracranial arterial stenosis
- rMTT
- relative (affected side/contralateral side) MTT
- rTTP
- relative (affected side/contralateral side) TTP
- SAG-C
- stressed autoregulation compensated
- SAG-D
- stressed autoregulation decompensated
- SI
- signal intensity
Footnotes
Disclosures: Xiaoqian Ge—RELATED: Grant: National Natural Science Foundation of China (No. 81271575, 81401374, 81571630) and the SJTU Medical-Engineering Cross-Cutting Research Project (No. YG2015MS53, YG2015QN36).* Huilin Zhao—RELATED: Grant: National Natural Science Foundation of China (grants 81571630, 81401374), Shanghai Jiao Tong University (YG2016MS56), and Renji Hospital (RJZZ18–001).* Zien Zhou—UNRELATED: Grants/Grants Pending: University of New South Wales Sydney, Comments: Scientia PhD Scholarship (2018–2022). Xiao Li—RELATED: Grant: National Natural Science Foundation of China (No. 81271575, 81401374, 81571630) and the SJTU Medical-Engineering Cross-Cutting Research Project (No. YG2015MS53, YG2015QN36).* Beibei Sun—RELATED: Grant: This research was supported by the National Natural Science Foundation of China (No. 81271575, 81401374, 81571630) and the SJTU Medical-Engineering Cross-Cutting Research Project (No. YG2015MS53, YG2015QN36).* Hengqu Wu—RELATED: Grant: National Natural Science Foundation of China (No. 81271575, 81401374, 81571630) and the SJTU Medical-Engineering Cross-Cutting Research Project (No. YG2015MS53, YG2015QN36).* Xiaosheng Liu—RELATED: Grant: the National Natural Science Foundation of China (No. 81271575, 81401374, 81571630) and the SJTU Medical-Engineering Cross-Cutting Research Project (No. YG2015MS53, YG2015QN36).* *Money paid to the institution.
This research was supported by the National Natural Science Foundation of China (No. 81271575, 81401374, 81571630) and the Shanghai Jiao Tong University Medical-Engineering Cross-Cutting Research Project (No. YG2015MS53, YG2015QN36).
- © 2019 by American Journal of Neuroradiology
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