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Research ArticleBrain

Measurement of Cerebral Blood Flow in Chronic Carotid Occlusive Disease: Comparison of Dynamic Susceptibility Contrast Perfusion MR Imaging with Positron Emission Tomography

Pratik Mukherjee, Hyunseon Christine Kang, Tom O. Videen, Robert C. McKinstry, William J. Powers and Colin P. Derdeyn
American Journal of Neuroradiology May 2003, 24 (5) 862-871;
Pratik Mukherjee
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Hyunseon Christine Kang
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Tom O. Videen
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Robert C. McKinstry
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William J. Powers
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Colin P. Derdeyn
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  • Fig 1.
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    Fig 1.

    T2*-weighted gradient-echo single shot echo-planar transverse image (800/47; flip angle, 60 degrees), obtained at the level of the sylvian fissures in patient 7 (Table 1), who had left carotid occlusion, shows AIF selection at the M1 and M2 segments of the MCA. Pixels chosen for AIF determination are illustrated in yellow. Ten to 12 pixels were chosen in the MCA, both for an AIF ipsilateral to the occlusion and an AIF contralateral to the occlusion.

  • Fig 2.
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    Fig 2.

    CBF in patient 4 (Table 1), who had occlusion of the left internal carotid artery.

    A, CBF measured with dynamic susceptibility contrast-enhanced MR imaging (MR CBF, left) and CBF measured with [15O]-H2O PET (PET CBR, right). Axial view MR image and PET scan are co-registered to the same location, filtered to the same spatial resolution as the PET scan, and displayed with the same color scale. Diffusely decreased CBF in the left hemisphere, ipsilateral to the occluded carotid artery, can be identified on both the MR image and PET scan, with more severely reduced CBF focally within a chronic infarct in the left frontal lobe.

    B, Large regions of interest (gray circles) for CBF measurement are shown on MR image obtained in the hemisphere contralateral to the carotid occlusion. Homologous regions of interest were placed in the hemisphere ipsilateral to the occlusion (see Methods).

    C, Small subcortical regions of interest (gray circles) in normal appearing white matter of the hemisphere contralateral to the carotid occlusion are shown on MR image. These subcortical white matter regions were used to determine normal white matter CBF for the purpose of scaling relative CBF values measured by MR imaging to physically meaningful units of mL/100 mL/min (see Methods).

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    Fig 3.

    CBF in patient 5, a 71-year-old man who had chronic right carotid occlusion.

    A, Graph compares CBF values measured by MR imaging (MR CBF) with those measured by PET (PET CBF). CBF values measured by PET have been corrected for the finite permeability of water through the blood-brain barrier (see Methods). CBF values measured by MR imaging were calculated with AIFs from the proximal MCA, both ipsilateral to the occluded carotid artery (Ipsi AIF, open circles) and contralateral to the occluded carotid artery (Contra AIF, closed squares). The line of identity, with a slope of 1 and a y intercept of 0, is depicted by a solid line. The slopes of the regression line for the data from the ipsilateral AIF (dashed line) and for the data from the contralateral AIF (dotted line) are both close to 1 (Table 2). No statistically significant difference was observed in the slopes or y intercepts of the two regression lines (P > .05). The linear relationship between CBF values measured by MR imaging and those measured by PET is statistically significant for both the ipsilateral AIF (r = 0.88, P < .0001) and the contralateral AIF (r = 0.88, P < .0001). CBF values measured by PET in the subcortical white matter regions used in scaling the CBF values measured by MR imaging was 21.1 mL/100 mL/min, which is close to the assumed value of 22 mL/100 mL/min (see Methods).

    B, Plots of the relaxivity ΔR2* versus time for the AIF in the M1 or M2 segment of the MCA ipsilateral to the carotid occlusion (open circles), and that contralateral to the occlusion (closed squares), show that they are almost identical. ΔR2* was determined as the negative log of susceptibility after baseline normalization. Because susceptibility is a relative measurement and not an absolute quantity, ΔR2* is expressed in arbitrary units. The amplitude of the observed change in ΔR2* is not quantitatively comparable between the ipsilateral and contralateral sides because of differences in factors such as vessel orientation and the extent of partial volume averaging of the blood vessel with surrounding tissue and/or CSF within the selected AIF pixels.

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    Fig 4.

    Delay and dispersal of the AIF ipsilateral to the occluded carotid artery affects calculated CBF values measured by MR imaging (MR CBF). Conventions used are as described in the legend to Figure 3.

    A, In a 65-year-old man with symptomatic left carotid occlusion (patient 7), CBF values measured by MR imaging systematically overestimated CBF values measured by PET (PET CBF). The linear regression between CBF values measured by MR imaging and those measured by PET has a slope of 1.65 for the ipsilateral AIF (Ipsi AIF, r = 0.79, P < .0001) and 2.14 for the contralateral AIF (Contra AIF, r = 0.81, P < .0001). This difference in slopes is statistically significant (P < .05). CBF value measured by PET in the subcortical white matter regions used in scaling the CBF values measured by MR imaging was 21.9 mL/100 mL/min, which is very close to the assumed value of 22 mL/100 mL/min.

    B, AIFs in patient 7 show a delay in the peak of the ipsilateral AIF (open circles) and a broader peak of the ipsilateral AIF, compared with the contralateral AIF (closed squares).

  • Fig 5.
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    Fig 5.

    CBF in all seven patients.

    A, Pooled data from all seven patients shows a statistically significant correlation between CBF values measured by MR imaging (MR CBF) and CBF values measured by PET (PET CBF), when CBF values measured by MR imaging are calculated with an AIF ipsilateral to the carotid occlusion (Ipsi AIF, open circles) (r = 0.60, P < .0001) and with an AIF contralateral to the occlusion (Contra AIF, closed squares) (r = 0.54, P < .0001). No significant differences were observed between the correlation coefficients, slopes, or y intercepts of the regression lines for the ipsilateral AIF (dashed line) and the contralateral AIF (dotted line). Both regression lines have slopes significantly <1 (P < .001) and y intercepts significantly >0 (P < .001). Relative MR CBF values were scaled to absolute units by assuming a normal white matter flow rate of 22 mL/100 mL/min (see Methods).

    B, Use of white matter flow rates measured with PET for each patient to scale relative CBF values measured with MR imaging for each patient to absolute units improves the correlation between CBF values measured by MR imaging and those measured by PET, both for the ipsilateral AIF (open circles) (r = 0.85, P < .0001) and the contralateral AIF (closed squares) (r = 0.84, P < .0001). Again, no significant difference was observed between the correlation coefficients, slopes, or y intercepts of the regression lines for the ipsilateral AIF (dashed line) and the contralateral AIF (dotted line). However, both regression lines for PET-scaled CBF values measured by MR imaging versus CBF values measured by PET have slopes significantly >1 (P < .001) and y intercepts significantly <0 (P < .05).

Tables

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    TABLE 1:

    Participant clinical data and position emission tomography hemodynamic parameters

    ParticipantAge/Sex/HandednessSide of OcclusionClinical HistoryPET
    CBFCBVMTTOEF
    167/M/RLAsymptomatic0.850.891.051.02
    265/F/RLAsymptomatic0.840.951.131.03
    358/M/RLLeft parietal infarct0.891.301.461.09
    467/M/LLLeft posteriorfrontal infarct0.871.101.260.93
    571/M/RRAsymptomatic0.961.131.170.98
    676/M/RRRight posterior parietal infarct0.981.171.191.04
    765/M/RLLeft frontoparietal infarct0.801.091.371.06
    • All positron emission tomography hemodynamic parameters are ipsilateral-to-contralateral ratios of mean hemispheric values. Cerebral blood volume, mean transit time, and oxygen extraction fraction ratios that exceed the range observed in 18 normal control participants are shown in bold text. The upper limits for normal hemispheric ratios for cerebral blood volume, mean transit time, and oxygen extraction were 1.21, 1.14, and 1.08, respectively. Hemodynamic impairment is clearly shown for participant 3. Participants 4 through 7 may have some degree of autoregulatory vasodilation, with elevated mean transit times.

    • Note.—PET indicates positron emission tomography; CBF, cerebral blood flow; CBV, cerebral blood volume; MTT, mean transit time; OEF, oxygen extraction fraction; M, male; F, female; R, right; L, left.

    • View popup
    TABLE 2:

    Results of linear regression of cerebral blood flow values measured by MR imaging versus cerebral blood flow values measured by positron emission tomography

    ParticipantIpsilateral AIFContralateral AIF
    rSlopey-int.*rSlopey-int.*
    10.650.489.300.660.479.11
    20.750.702.630.720.674.42
    30.500.4220.80.620.5515.9
    40.881.045.200.850.889.10
    50.880.940.380.880.970.27
    60.801.05−9.440.821.17−14.7
    70.791.65−5.740.812.14−17.7
    Pooled†0.600.55 ± 0.0516.6 ± 1.990.540.54 ± 0.0517.6 ± 2.26
    • For each participant and for the pooled data, the linear correlations between cerebral blood flow values measured by MR imaging and cerebral blood flow values measured by by positron emission tomography, both for ipsilateral and contralateral arterial input functions, are statistically significant (P < .001).

    • * y-intercepts of regression lines are expressed in mL/100 mL/min.

    • † Mean linear regression parameters of pooled data from all seven participants (Fig 5A) and standard errors of the mean for slopes and y-intercepts of regression lines.

    • Note.—AIF indicates arterial input function; y-int., y intercepts of the regression lines. The slopes represent cerebral blood flow values measured by MR imaging versus cerebral blood flow values measured by positron emission tomography and therefore are dimensionless.

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American Journal of Neuroradiology: 24 (5)
American Journal of Neuroradiology
Vol. 24, Issue 5
1 May 2003
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Measurement of Cerebral Blood Flow in Chronic Carotid Occlusive Disease: Comparison of Dynamic Susceptibility Contrast Perfusion MR Imaging with Positron Emission Tomography
Pratik Mukherjee, Hyunseon Christine Kang, Tom O. Videen, Robert C. McKinstry, William J. Powers, Colin P. Derdeyn
American Journal of Neuroradiology May 2003, 24 (5) 862-871;
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Pratik Mukherjee, Hyunseon Christine Kang, Tom O. Videen, Robert C. McKinstry, William J. Powers, Colin P. Derdeyn
Measurement of Cerebral Blood Flow in Chronic Carotid Occlusive Disease: Comparison of Dynamic Susceptibility Contrast Perfusion MR Imaging with Positron Emission Tomography
American Journal of Neuroradiology May 2003, 24 (5) 862-871;

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