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Assessment of borderzone ischemia with a combined MR imaging‐MR angiography‐MR spectroscopy protocol
Author(s) -
van der Grond Jeroen,
van Everdingen Kaspar J.,
Eikelboom Bert C.,
Kenéz József,
Mali Willem P. Th. M.
Publication year - 1999
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/(sici)1522-2586(199901)9:1<1::aid-jmri1>3.0.co;2-d
Subject(s) - medicine , middle cerebral artery , magnetic resonance imaging , internal carotid artery , magnetic resonance angiography , stenosis , perfusion , ischemia , angiography , radiology , cerebral blood flow , collateral circulation , nuclear medicine
We attempted to assess whether magnetic resonance imaging (MRI)‐MR angiography (MRA)‐MR spectroscopy (MRS) measurements can be used in the differentiation of patients in whom severe carotid lesions result in chronically hypoperfused regions and in whom the collateral capacity is sufficient to maintain a normal cerebral blood flow. Sixty‐six patients with severe stenosis of the internal carotid artery (ICA) and 19 control subjects underwent MRI, 1 H MRS, and MRA. Anaerobic metabolic changes in the middle cerebral artery (MCA) territory were studied by assessing N ‐acetyl‐ L ‐aspartate (NAA)/choline and lactate/NAA ratios. Quantitative flow was measured in the ICA, in the basilar artery, and in the MCA. Thirty‐four patients had borderzone infarcts, 16 patients had territory infarcts, and 16 patients had no infarcts on MRI. Patients with borderzone infarcts had significantly reduced flow in the ICA ( P < 0.001) and in the MCA ( P < 0.05) and decreased NAA/choline ratios ( P < 0.001) in non‐infarcted regions compared with control subjects ( P < 0.001) but also compared with patients with territory infarcts ( P < 0.05) and patients without infarcts ( P < 0.05). Flow measurements in the ICA and MCA and metabolic measurements in the MCA territory can be applied to select patients in whom cerebral perfusion pressure is insufficient to maintain normal cellular integrity. J. Magn. Reson. Imaging 1999;9:1–9 © 1999 Wiley‐Liss, Inc.