Cortical Cerebral Blood Flow, Oxygen Extraction Fraction, and Metabolic Rate in Patients with Middle Cerebral Artery Stenosis or Acute Stroke

Z. Liu; Y. Li

doi:10.3174/ajnr.A4624

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Fig 1.
Representative MR angiography and high-resolution T2-weighted imaging findings. A, 3D time-of-flight MRA reveals an occlusive left middle cerebral artery. B, Plaque with heterogeneous signal intensity was present in the MCA lumen on HR-T2WI.
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Fig 2.
Illustration of MR susceptometry for determining Y_v. A, A phase image obtained from susceptibility-weighted imaging. B, Zoomed view of the phase image for the gray matter, with the vein as the representative phase value within the vessel. The rectangle shows the ROI of the gray matter, including the vein.
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Fig 3.
Placement of the ROI for cerebral blood flow measurements on an arterial spin-labeling CBF map. The ROI was positioned from the top (A) to the level of the thalami (B) in a 50-year-old patient with an occlusive MCA. C and D, Anatomic images corresponding to A and B.

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Table 1:

Number, age, clinical characteristics, Hct, and Hb of the healthy subjects and patients

Groups	No.	Age Range (yr)	Mean Age (yr)	Males (No.)	Females (No.)	Hct (×10⁻²)	Hb
Healthy subjects	10	40–67	55.9	5	5	34.9 ± 12.6	13.1 ± 1.2
Mild stenotic MCA
Group 1	13	37–65	50.4	6	7	40.2 ± 4.9	14.2 ± 1.4
Severe stenotic MCA
Group 2	11	45–75	58.0	6	5	39.2 ± 5.1	13.1 ± 2.1
Occluded MCA
Group 3	16	36–72	58.5	8	8	39.8 ± 4.4	13.8 ± 2.3
Patients with acute stroke
Group 4	17	38–73	57.6	9	8	40.3 ± 6.6	13.6 ± 2.1

Note:—Hb indicates hemoglobin.

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Table 2:
Statistical results for the CBF, OEF, and CMRO₂ in healthy subjects
CBF (mL/100 g/min) OEF (%) CMRO₂ (μmol/100 g/min)
Left Right Left Right Left Right
53.4 ± 8.6 54.4 ± 9.6 36.8 ± 3.1 37.4 ± 3.3 146.8 ± 29.7 151.6 ± 32.6
T 1.028 1.269 1.366
P .331 .236 .205

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Table 3:

Statistical results of the paired t test for the CBF, OEF, and CMRO₂ in the 4 patient subgroups

	Contralateral Stenosis
	CBF (mL/100 g/min)		OEF (%)		CMRO₂ (μmol/100 g/min)
Group 1
	51.9 ± 9.5	50.7 ± 11.2	38.5 ± 3.9	40.6 ± 4.2	153.2 ± 24.0	155.5 ± 22.9
T	0.796		4.027		0.377
P	.442		.002		.713
Group 2
	54.6 ± 5.9	47.9 ± 9.8	38.4 ± 1.9	42.6 ± 3.8	150.3 ± 28.5	149.4 ± 46.1
T	4.146		4.690		0.132
P	.002		.001		.898
Group 3
	54.0 ± 10.3	37.2 ± 9.7	37.1 ± 2.9	44.5 ± 3.9	154.0 ± 43.4	125.3 ± 35.3
T	6.295		6.128		2.926
P	<.001		<.001		.010
Group 4
	55.3 ± 9.5	40.8 ± 11.8	38.3 ± 4.1	43.9 ± 3.5	161.2 ± 47.4	135.0 ± 41.3
T	5.898		4.626		2.647
P	<.001		<.001		.018

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Table 4:

Results of the analysis of variance test for the normal-to-lesion ratio of CBF, OEF, and CMRO₂ in the 4 patient subgroups

	Group 1	Group 2	Group 3	Group 4	F	P
rCBF	0.98 ± 0.11	0.87 ± 0.11	0.70 ± 0.17	0.74 ± 0.17	10.617	<.001
rOEF	1.06 ± 0.05	1.11 ± 0.08	1.21 ± 0.14	1.16 ± 0.14	4.316	.009
rCMRO₂	1.03 ± 0.15	0.98 ± 0.15	0.84 ± 0.21	0.86 ± 0.23	3.041	.037

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Table 5:

Results of the Student-Newman-Keuls test for the normal-to-lesion ratio of CBF, OEF, and CMRO₂ in the 4 patient subgroups with increasing MCA stenotic severity

	rCBF	rOEF	rCMRO₂
Group 1
Group 2	>0.05	>0.05	>0.05
Group 3	<0.05	<0.05	>0.05
Group 4	<0.05	>0.05	>0.05
Group 2
Group 3	<0.05	>0.05	>0.05
Group 4	<0.05	>0.05	>0.05
Group 3
Group 4	>0.05	>0.05	>0.05

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Table 6:

Comparison of OEF and CMRO₂ with published literature values determined by using PET for healthy subjects

Study (Reference)	OEF (Mean) (Range)	CMRO₂ (μmol/min/100 g)	No.	Mean Age (yr) (range)
Ito et al^{22,^a}	0.44 ± 0.06	147.0 ± 22.3	70	53.1 (18–77)
	(0.36 ± 0.06–0.51 ± 0.04)
Hattori et al^{23,^a}	0.39 ± 0.06	127.0 ± 17.4	16	35 (21–46)
	(0.30–0.51)
Coles et al^{24,^a}	0.42 ± 0.04	124.8 ± 22.3	7	30 (18–60)
Ibaraki et al^{25,^b}	0.35 ± 0.06	156.0 ± 22.3	8	NA (21–24)
Bremmer et al^{26,^a}	0.43 ± 0.06	135.9 ± 8.9	7	69 (57–80)
Kudomi et al^{27,^b}	0.39 ± 0.05	184.9 ± 20.1	7	25.3 (NA)