방사선의학 웹진

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MATERIALS AND METHODS:
Of 171 patients, stenosis in internal carotid artery (ICA) and middle cerebral artery (MCA) (ICA-MCA) on MRA and cerebrovascular reserve (CVR) of MCA territory on SPECT was measured using quantification and a 3-grade system. Stenosis and CVR grades were compared with each other, and their prognostic value for subsequent stroke was evaluated.

RESULTS:
Of 342 ICA-MCA, 151 (44%) presented stenosis on MRA; grade 1 in 69 (20%) and grade 2 in 82 (24%) cases. Decreased CVR was observed in 9% of grade 0 stenosis, 25% of grade 1, and 35% of grade 2. The average CVR of grade 0 was significantly different from grade 1 (p<0.001) and grade 2 stenosis (p=0.007). In quantitative analysis, average CVR index was -0.56±7.91 in grade 0, -1.81±6.66 in grade 1 and -1.18±5.88 in grade 2 stenosis. Agreement between stenosis and CVR grades was fair in patients with lateralizing and non-lateralizing symptoms (κ=0.230 and 0.346). Of the factors tested, both MRA and CVR were not significant prognostic factors (p=0.104 and 0.988, respectively), whereas hypertension and renal disease were significant factors (p<0.05, respectively).

CONCLUSION:
A considerable proportion of ICA-MCA stenosis detected on MRA does not cause CVR impairment despite a fair correlation between them. Thus, hemodynamic state needs to be assessed for evaluating significance of stenosis, particularly in asymptomatic patients.

Author information

Seo HJ1,2,3, Pagsisihan JR4, Paeng JC5, Choi SH6, CheonGJ1, Chung JK1, Lee DS1,2, Kang KW1.​

1Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea.
2Department of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University College of Medicine, Seoul, Korea.
3Department of Nuclear Medicine, Korea University College of Medicine, Seoul, Korea.
4Department of Nuclear Medicine, The Medical City, Pasig City, Philippines.
5Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea. paengjc@snu.ac.kr.
6Department of Radiology, Seoul National University Hospital, Seoul, Korea.