Selective MR Angiography and Intracranial Collateral Blood Flow

Fürst, G.; Steinmetz, Helmuth; Fischer, H; Skutta, Bernd; Sitzer, Matthias; Aulich, A.; Kahn, Thomas; Mödder, Ulrich

doi:10.1097/00004728-199303000-00004

Cited by 38 publications

(16 citation statements)

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“…3,20,21 Sensitivity in anterior circulation varies from 89.2% to 95% and that in the posterior circulation from 81.3% to 97%. 12,13,22 In severe occlusive carotid disease, the accuracy of CVIQ in detecting intracranial collateral flow in this study is comparable to the above techniques, especially in anterior circulation (Table 4). Comparison of moderate disease with these techniques was not possible because previous studies were performed in severe carotid disease only.…”

Section: Discussionsupporting

confidence: 62%

“…12,13 Transcranial ultrasound techniques (transcranial Doppler ultrasonography and transcranial color-coded duplex sonography) are well known to suffer significant failure as a result of an impenetrable temporal acoustic window. 14 -16 Despite the reported high accuracy of these techniques in the detection of intracranial collaterals, the successful application can be as low as 30%, 16,17 giving a major limitation in the usefulness of these techniques.…”

Section: Discussionmentioning

confidence: 99%

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Color Velocity Imaging Quantification in the Detection of Intracranial Collateral Flow

Metreweli

2002

Stroke

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Background and Purpose-The development of intracranial collateral circulation is associated with a lower risk of stroke.A noninvasive technique that can reliably detect the presence of intracranial collaterals would be a valuable factor in the assessment of risk in patients with occlusive cerebrovascular disease. Methods-Color velocity imaging quantification was used to measure the blood flow volume of the common carotid and vertebral arteries in 40 patients with carotid occlusive disease. The blood flow volumes in these arteries were correlated with angiographic evidence of collaterals to establish the best cutoffs for detecting intracranial collateral circulation. Results-A blood flow volume of either Ն370 mL/min in the common carotid artery or Ն120 mL/min in the vertebral artery was indicative of the presence of intracranial collaterals. The sensitivity and specificity for the common carotid artery were 92.3% [95% confidence interval (CI), 62.1 to 99.6] and 92.1% (95% CI, 77.5 to 97.9), respectively. The sensitivity and specificity for the vertebral artery were 75.0% (95% CI, 35.6 to 95.5) and 87.5% (95% CI, 66.5 to 96.7), respectively. Conclusions-Color velocity imaging quantification offers a noninvasive, accurate method for detecting the presence of intracranial collateral circulation and quantifying its magnitude. This technique would be a useful adjunct in screening or continuous monitoring of patients with severe carotid occlusive disease.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Color Velocity Imaging Quantification in the Detection of Intracranial Collateral Flow

Metreweli

2002

Stroke

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“…Magnetic resonance angiography (MRA) has proved to be a valuable technique for the study of flow in the circle of Willis in patients with an ICA occlusion, 4,5,10,11 whereas flow in the OphA can be reliably assessed with transcranial Doppler sonography (TCD). 11,12 In addition, we investigated whether changes in flow patterns were accompanied by changes in cerebrovascular reactivity as assessed with TCD. A decreased cerebrovascular reactivity indicates a reduced reserve capacity of cerebral autoregulation and has been shown to be related to the risk of recurrent cerebral ischemia in patients with an ICA occlusion.…”

mentioning

confidence: 99%

A Longitudinal Study of Collateral Flow Patterns in the Circle of Willis and the Ophthalmic Artery in Patients With a Symptomatic Internal Carotid Artery Occlusion

Rutgers

Klijn

Kappelle

et al. 2000

Stroke

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Background and Purpose-The purpose of the present study was to assess whether the direction of flow via the circle of Willis and the ophthalmic artery (OphA) changed over time in patients with a symptomatic occlusion of the internal carotid artery (ICA) who did not experience recurrent cerebral ischemic symptoms. Methods-Sixty-two patients with a symptomatic ICA occlusion were investigated within 6 months after symptoms occurred. The investigations were repeated after 6 and 12 months. The directions of flow in the A1 segment and the posterior communicating artery (PCoA), both on the side of the symptomatic ICA occlusion, were assessed with the use of magnetic resonance angiography. The pattern of collateral flow via the circle of Willis was categorized as via the A1 segment only, via the PCoA only, via the A1 segment plus the PCoA, or no collateral flow via the circle of Willis. The direction of flow in the OphA was investigated with transcranial Doppler sonography. CO 2 reactivity was determined with transcranial Doppler sonography to investigate whether changes in flow patterns were accompanied by changes in cerebrovascular reactivity. Results-There were no statistically significant changes over time in the direction of blood flow in the A1 segment and the PCoA or in the pattern of collateral flow via the circle of Willis. On average, 72% of patients with a unilateral ICA occlusion (nϭ41) had willisian collateral flow compared with 37% of patients with a bilateral ICA occlusion (nϭ21; PϽ0.05). Patients with a unilateral ICA occlusion tended to a lower prevalence of reversed flow via the OphA over time. CO 2 reactivity did not change significantly in any patient group. In patients with a unilateral ICA occlusion, decreased CO 2 reactivity was associated with a higher prevalence of absent willisian collateral flow and a lower prevalence of collateral flow via the A1 segment plus the PCoA. Conclusions-The absence of recurrent cerebral ischemic symptoms in patients with a symptomatic ICA occlusion is not associated with an improvement in collateral flow via the circle of Willis or the OphA during 1.5-year follow-up.

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“…Anatomical studies have demonstrated high sensitivity of MRA to detect the anatomical presence or absence of arterial segments of the circle of Willis [25,26,27]. In these studies TOF MRA was compared with conventional angiography.…”

Section: Discussionmentioning

confidence: 99%

Diagnosing Cerebral Collateral Flow Patterns: Accuracy of Non-Invasive Testing

et al. 2008

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Objective: With routine use of non-invasive methods to assess the internal carotid artery, it becomes increasingly important to clarify the diagnostic accuracy of transcranial Doppler (TCD) ultrasound and magnetic resonance angiography (MRA) compared with intra-arterial digital subtraction angiography (iaDSA) for the detection of collateral flow via the major intracerebral collateral branches. Subjects and Methods: In a prospective study, we compared TCD via a temporal bone window and MRA (flow direction sensitive phase contrast and time of flight) examinations of the intracranial collateral flow with iaDSA in a cohort of 97 consecutive patients with recent transient or minor disabling cerebral ischaemia associated with an occlusion of the carotid artery (38 contralateral stenosis >70%). Results: iaDSA allowed the evaluation of collateral flow via the anterior and posterior circle of Willis in 97 and 67 patients, respectively, TCD in 76 of 97 and 66 of 67 patients, MRA in 95 of 97 and 66 of 67 patients. MRA and TCD collateral flow measurements via the anterior part of the circle of Willis yielded a sensitivity of 83 and 82%, a specificity of 77 and 79% and a similar accuracy of 80%. MRA and TCD collateral flow measurements via the posterior communicating artery yielded a sensitivity of 33 and 76%, a specificity of 88 and 47% and an accuracy of 47 and 68%. Conclusion: As compared with iaDSA, combined MRA and TCD has a moderate to good diagnostic value for the examination of intracranial collateral flow in patients with symptomatic carotid occlusion.

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Selective MR Angiography and Intracranial Collateral Blood Flow

Cited by 38 publications

References 0 publications

Color Velocity Imaging Quantification in the Detection of Intracranial Collateral Flow

Color Velocity Imaging Quantification in the Detection of Intracranial Collateral Flow

A Longitudinal Study of Collateral Flow Patterns in the Circle of Willis and the Ophthalmic Artery in Patients With a Symptomatic Internal Carotid Artery Occlusion

Diagnosing Cerebral Collateral Flow Patterns: Accuracy of Non-Invasive Testing

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