ObjectivesThis study analyzed differences in the mean cerebral blood flow (mCBF) and arterial transit time (ATT) of the anterior and posterior circulations between patients with intracranial atherosclerotic stenosis (ICAS) and control subjects. We also investigated the correlation between ATT and mCBF in the two groups, and evaluated whether the blood flow velocity of the extracranial carotid/vertebral arteries can influence mCBF.MethodsA total of 32 patients with ICAS were prospectively enrolled at the Radiology Department of the China-Japan Friendship Hospital between November 2020 and September 2021. All patients had extensive arterial stenosis, with 17 having cerebral arterial stenosis in the anterior circulation and 15 in the posterior circulation. Thirty-two healthy subjects were enrolled as a control group. Enhanced arterial spin labeling (eASL) imaging was performed using a 3.0-T GE magnetic resonance imaging scanner, and all patients underwent carotid and vertebral Doppler ultrasound examinations. CereFlow software was used for post-processing of the eASL data, to obtain cerebral perfusion parameters such as mCBF and ATT. Independent samples t-tests were used to analyze and compare mCBF and ATT of the anterior circulation (frontal lobe, parietal lobe, and insula) and posterior circulation (occipital lobe, cerebellum) between the patient and control groups. The relationships of ATT and mCBF in the two groups were evaluated with Pearson’s correlation. The blood flow velocity of the extracranial internal carotid/vertebral arteries, including the peak systolic velocity (PSV), end diastolic velocity (EDV), mean PSV (mPSV), and mean EDV (mEDV), was compared between the control and study groups using t-tests. Multiple linear regression analysis was then applied to determine the factors associated with mCBF in the two groups.ResultsThe mCBFs of the anterior and posterior circulations in the patient group were lower than those of the control group. The ATTs in the patient group were all significantly longer than those of the control group (p < 0.05). Except for the insula in the control group, significant correlations were found between ATT and mCBF in all other investigated locations in the two groups (p < 0.05). The blood flow velocity of the extracranial internal carotid/vertebral arteries differed significantly between the control and patient groups (p < 0.05). The multiple linear regression analysis revealed that in patients with ICAS, mPSV of the vertebral arteries and local ATT correlated with mCBF of the occipital lobes and the cerebellum, respectively (p < 0.05). In contrast, there was no significant correlation within the anterior circulation (frontal lobes, parietal lobes, and insula).ConclusionThere was a significant relationship between ATT and mCBF in patients with ICAS. Extracranial blood flow may influence intracranial hemodynamics in the posterior circulation in patients with ICAS. The maintenance of extracranial blood flow is of great significance in the preservation of intracranial hemodynamics.
The floating plaque in carotid artery is an uncommon condition that can be detected by a duplex ultrasonography scan and is a high-risk factor for embolic cerebrovascular disease. The histopathological features of floating plaque in carotid artery vary. To the best of our knowledge, there is still considerable controversy about the treatment of floating carotid plaque. In this case, the floating carotid plaque was located in the edge of atherosclerotic plaque in common carotid artery, pathological finding following carotid endarterectomy confirmed that the mobile substances were formed by the contents of the plaque protruding into the carotid lumen after the rupture of the fibrous cap, without mural thrombus. This pathological change was different from those of the mobile substances, which were commonly considered as mural thrombotic substances of ulcer plaque caused by the ruptures of fibrous cap of vulnerable plaque. According to pathological differences, we investigated pathogenesis of ischemic cerebrovascular disease caused by floating carotid plaque and possible treatments.
Background: The assessment of cerebral blood flow (CBF) is crucial in the evaluation of intracranial atherosclerotic disease. This study was performed to compare single postlabeling delay (PLD) 3-dimensional pseudo-continuous arterial spin labeling (3D-pCASL) and 7-delay 3D-pCASL magnetic resonance imaging in patients with intracranial atherosclerotic stenosis.Methods: A total of 26 patients with moderate to severe atherosclerotic stenosis or occlusion of an intracranial artery were prospectively enrolled in the study. Perfusion parameters were obtained in various regions of interest (ROIs), namely CBF for single PLDs of 1,525 ms (CBF 1525 ms ), 2,025 ms (CBF 2025 ms ), and 2,525 ms (CBF 2525 ms ) with 3D-pCASL, as well as arterial transit time (ATT) and transit-corrected CBF (CBF transit-corrected ) for 7-delay 3D-pCASL. The consistency of the perfusion parameters between single-PLD 3D-pCASL and 7-delay 3D-pCASL was investigated, and the relationship between vascular stenosis and perfusion parameters was explored.Results: Bland-Altman plots compared the CBF values derived from single-PLD 3D-pCASL to those from CBF transit-corrected . ATT significantly correlated with the difference between CBF transit-corrected and CBF 1525 ms , CBF 2025 ms, and CBF 2525 ms , respectively (P<0.05). Binary logistic regression analysis revealed that the CBF transit-corrected and ATT correlated with the presence of moderate or more severe stenotic vascular territories (P<0.05). Conclusions:The single-PLD 3D-pCASL and the 7-delay 3D-pCASL showed inconsistencies in the assessment of CBF, and the perfusion parameters generated under the standard single-PLD 3D-pCASL were more affected by ATT. Moreover, CBF transit-corrected and ATT were consistent with stenotic vascular territories, which is useful in the evaluation of intracranial atherosclerotic disease.
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