Evaluating the morphological changes of intracranial arteries and whole-brain perfusion in undetermined isolated vertigo

Abstract

PurposeTo determine the morphological changes of intracranial arteries and whole-brain perfusion in undetermined isolated vertigo (UIV) patients using 320-detector row computed tomography (CT).MethodsA total of 150 patients who underwent CT angiography (CTA) and CT perfusion (CTP) imaging were divided into UIV group and benign paroxysmal positional vertigo (BPPV) group. Sixty individuals with sex- and age-matched without vertigo and cerebral diseases served as the control. The morphological changes of intracranial arteries, perfusion parameters and vascular risk factors (VRFs) were analyzed, calculated and compared.ResultsIn UIV patients, hypertension (HT), hyperlipidemia and number of VRFs ≥ 3 occurred more commonly (P < 0.0125, respectively). The incidence of vertebral artery dominance (VAD), vertebral artery stenosis (VAS) and basilar artery curvature (BAC) were significantly higher (P < 0.0125, respectively). HT was an independent risk predictor of non-VAD (OR: 5.411, 95%CI: 1.401; 20.900, P = 0.014). HT and VAD associated with BAC served as risk predictors (OR: 4.081, 95%CI: 1.056;15.775, P = 0.041 and OR: 6.284, 95%CI: 1.848; 21.365, P = 0.003, respectively). The absolute difference in relative values of CTP parameters from cerebellum and brainstem were significantly different (P < 0.05), and hypoperfusion was found in the territories of the non-VAD side and the BAC cohort (P < 0.05, respectively).ConclusionsOn the basis of multiple VRFs, morphological changes of vertebrobasilar artery (VBA) and the unilateral hypoperfusion of the cerebellum and brainstem, that acts as a herald for IV occurrence, which should be paid cautious attention to UIV patients.

Perfusion by delayed time to peak in vertebrobasilar dolichoectasia patients with vertigo

“…Undetermined isolated vertigo patients with BA tortuosity has the hypoperfusion in the territories of the BA has been reported in a retrospective study with the utilization of the whole‐brain computed tomography perfusion (CTP) 11. Grams et al12 found that PWI included Tmax and CBF parametric maps added diagnostic value by depicting regions with delayed perfusion or post‐ischemic hyperperfusion in transient ischemic attack patients with negative DWI.…”

“…Undetermined isolated vertigo patients with BA tortuosity has the hypoperfusion in the territories of the BA has been reported in a retrospective study with the utilization of the whole-brain computed tomography perfusion (CTP). 11 Grams et al 12 found that PWI included Tmax and CBF parametric maps added diagnostic value by depicting regions with delayed perfusion or post-ischemic hyperperfusion in transient ischemic attack patients with negative DWI. Choi et al 13 demonstrated that patients with acute transient vestibular syndrome (12%) showed unilateral cerebellar hypoperfusion on PWI without an infarction on DWI, and 80% of them had a focal stenosis or hypoplasia of the corresponding vertebral artery.…”

“…A higher fluid attenuated inversion recovery vascular hyperintensity (FVH) grade representing slow arterial blood flow has been observed common in patients with transient ischemic attack (TIA)/stroke related to VBD and the moderate/severe dilated BA had the higher grade of FVH 10. Similarly, CT perfusion was utilized in undetermined isolated vertigo patients to find the hypoperfusion in the territories of the basilar artery curve cohort 11. Recent studies have found that perfusion weighted imaging (PWI) added diagnostic value by depicting regions with delayed perfusion with negative DWI in acute transient vestibular syndrome of unknown cause or TIA patients 12, 13.…”

“…10 Similarly, CT perfusion was utilized in undetermined isolated vertigo patients to find the hypoperfusion in the territories of the basilar artery curve cohort. 11 Recent studies have found that perfusion weighted imaging (PWI) added diagnostic value by depicting regions with delayed perfusion with negative DWI in acute transient vestibular syndrome of unknown cause or TIA patients. 12,13 However, the utilization of PWI to detect the hypoperfusion in posterior circulation which contribute to identify ischemia caused by VBD has less been reported yet.…”

Anatomical Anomalies of Carotid-Vertebral Arteries in Patients with Dizziness and Impaired Hearing

“…The sense of balance and spatial orientation is conditioned by efficient functioning of individual elements of the system of balance and proper communication between them. Proper blood supply to each of its elements is one of the basic and necessary conditions of efficient functioning of this system [10][11][12].…”