Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Sep 28, 2024; 16(9): 429-438
Published online Sep 28, 2024. doi: 10.4329/wjr.v16.i9.429
Cerebral perfusion in patients with unilateral internal carotid artery occlusion by dual post-labeling delays arterial spin labeling imaging
Gui-Rong Zhang, Yan-Yan Zhang, Wen-Bin Liang, Dun Ding
Gui-Rong Zhang, Yan-Yan Zhang, Wen-Bin Liang, Dun Ding, Department of Medical Imaging, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710043, Shaanxi Province, China
Author contributions: Ding D designed the research study; Zhang YY and Liang WB analyzed the data; Zhang GR analyzed the data and wrote the manuscript. All authors have read and approve the final manuscript.
Supported by The Key Research and Development Program Projects of Shaanxi Province of China, No. S2023-YF-YBSF-0273; and Natural Science Foundation of Shaanxi Province of China, No. 2022JQ-900.
Institutional review board statement: The study was reviewed and approved by the Second Affiliated Hospital of Xi'an Jiaotong University Institutional Review Board, (Approval No. 2022156).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflict of interest was reported by the authors.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at hequren521@163.com. Data sharing consent was not obtained but the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dun Ding, MD, PhD, Assistant Professor, Department of Medical Imaging, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 West Fifth Road, Xi’an 710043, Shaanxi Province, China. hequren521@163.com
Received: July 12, 2024
Revised: August 29, 2024
Accepted: September 6, 2024
Published online: September 28, 2024
Processing time: 76 Days and 19.2 Hours
Abstract
BACKGROUND

Global and regional cerebral blood flow (CBF) changes in patients with unilateral internal carotid artery occlusion (ICAO) are unclear when the dual post-labeling delays (PLD) arterial spin labeling (ASL) magnetic resonance imaging (MRI) technique is used. Manual delineation of regions of interest for CBF measurement is time-consuming and laborious.

AIM

To assess global and regional CBF changes in patients with unilateral ICAO with the ASL-MRI perfusion technique.

METHODS

Twenty hospitalized patients with ICAO and sex- and age-matched controls were included in the study. Regional CBF was measured by Dr. Brain's ASL software. The present study evaluated differences in global, middle cerebral artery (MCA) territory, anterior cerebral artery territory, and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) regions (including the caudate nucleus, lentiform nucleus, insula ribbon, internal capsule, and M1-M6) and brain lobes (including frontal, parietal, temporal, and insular lobes) between ICAO patients and controls at PLD 1.5 s and PLD 2.5 s.

RESULTS

When comparing CBF between ICAO patients and controls, the global CBF in ICAO patients was lower at both PLD 1.5 s and PLD 2.5 s; the CBF on the occluded side was lower in 15 brain regions at PLD 1.5 s, and it was lower in 9 brain regions at PLD 2.5 s; the CBF in the contralateral hemisphere was lower in the caudate nucleus and internal capsule at PLD 1.5 s and in M6 at PLD 2.5 s. The global CBF in ICAO patients was lower at PLD 1.5 s than at PLD 2.5 s. The ipsilateral CBF at PLD 1.5 s was lower than that at PLD 2.5 s in 15 regions, whereas the contralateral CBF was lower at PLD 1.5 s than at PLD 2.5 s in 12 regions. The ipsilateral CBF was lower than the contralateral CBF in 15 regions at PLD 1.5 s, and in M6 at PLD 2.5 s.

CONCLUSION

Unilateral ICAO results in hypoperfusion in the global and MCA territories, especially in the ASPECTS area. Dual PLD settings prove more suitable for accurate CBF quantification in ICAO.

Keywords: Arterial spin labeling; Internal carotid artery occlusion; Ischemic stroke; Cerebral blood flow; Hemodynamic

Core Tip: In this study, the dual post-labeling delays (PLD) arterial spin labeling (ASL) technique was used for cerebral blood flow (CBF) imaging in unilateral internal carotid artery occlusion (ICAO) patients. Intelligent ASL analysis software was used for rapid quantification of regional CBF, including the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) regions. A comparison with the controls suggests that unilateral ICAO resulted in hypoperfusion in the global and middle cerebral artery territory, affecting most of the ASPECTS area on the occluded side and a small part of the ASPECTS area on the nonoccluded side. The dual PLD settings are more suitable for accurate CBF quantification in ICAO.