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Can 3D Pseudo‐Continuous Territorial Arterial Spin Labeling Effectively Diagnose Patients With Recanalization of Unilateral Middle Cerebral Artery Stenosis?
Author(s) -
Wang Xinyu,
Dou Weiqiang,
Dong Dong,
Wang Xinyi,
Chen Xueyu,
Chen Kunjian,
Mao Huimin,
Guo Yu,
Zhang Chao
Publication year - 2021
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/jmri.27560
Subject(s) - medicine , middle cerebral artery , stenosis , receiver operating characteristic , modified rankin scale , magnetic resonance angiography , occlusion , magnetic resonance imaging , stroke (engine) , nuclear medicine , radiology , cardiology , ischemia , ischemic stroke , mechanical engineering , engineering
Background Unilateral middle cerebral artery (MCA) stenosis, as an independent risk factor for stroke, requires an intervention operation for vessel recanalization. Accurate perfusion measurement is thus essential after the operation. Purpose To explore the feasibility of three‐dimensional (3D) pseudo‐continuous territorial arterial‐spin‐labeling (tASL) in evaluating MCA recanalization. Study Type Prospective and longitudinal. Subjects Forty‐seven patients with unilateral MCA stenosis or occlusion. Field Strength/Sequence A 3.0 T, 3D time‐of‐flight fast‐field‐echo magnetic resonance (MR) angiography sequence, spin‐echo echo‐planar diffusion‐weighted imaging sequence, 3D fast‐spin‐echo pseudo‐continuous ASL (pcASL) and tASL sequences. Assessment All patients underwent MR examination before and after MCA recanalization and scored using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at admission and discharge. An mRS score <2 was defined as a good prognosis. 3D‐pcASL and tASL cerebral blood flow (CBF) maps were obtained, and the corresponding Alberta Stroke Program Early CT Score (ASPECTS)‐based scores were evaluated. Statistical Tests The Kolmogorov–Smirnov test, intra‐class correlation coefficient, paired t ‐test, receiver operating characteristic (ROC) curve, and multivariable logistic regression analysis. Results After recanalization, tASL derived absolute CBFs between the affected and contralateral sides were significantly higher than before the operation (mean: 34.3 ± 8.5 mL/100 g/min vs. 40.6 ± 9.2 mL/100 g/min, 42.6 ± 9.8 mL/100 g/min vs. 43.5 ± 9.9 mL/100 g/min, both P < 0.05). In ROC analysis, tASL provided good prognosis (area under ROC curve [AUC] = 0.829; 95% CI: 0.651–1.000, P < 0.05), while pcASL had lower prognostic value (AUC = 0.760; 95% CI: 0.574–0.946, P < 0.05). The NIHSS score before recanalization, pcASL, and tASL‐based ASPECTS scores were significantly associated with good clinical outcome ( P < 0.05). Multivariable analysis revealed that ASPECTS‐based scores of pcASL and tASL before and after surgery were independent predictors of good clinical outcome (all P < 0.05). Data Conclusion tASL can determine hypoperfusion in the responsible vascular perfusion area and predict clinical outcome. Evidence Level 4 Technical Efficacy Stage 2