Yonsei Med J.  2018 Jan;59(1):80-84. 10.3349/ymj.2018.59.1.80.

Mismatch between TOF MR Angiography and CT Angiography of the Middle Cerebral Artery may be a Critical Sign in Cerebrovascular Dynamics

• Igase K
• Igase M
• Matsubara
• Sadamoto K

• KMID: 2418852
• DOI: http://doi.org/10.3349/ymj.2018.59.1.80

Abstract

PURPOSE
Although time-of-flight (TOF)-magnetic resonance angiography (MRA) can clearly depict intracranial arteries, the arterial flow of middle cerebral artery (MCA) is occasionally not detected. We evaluated this phenomenon with reference to cerebrovascular dynamics.
MATERIALS AND METHODS
Seventeen patients with suspected occlusion of MCA or internal carotid artery on TOF-MRA were enrolled. All patients underwent CT angiography (CTA) and quantitative cerebral blood flow (CBF) examination for measurement of resting CBF and cerebrovascular reactivity (CVR). Depending on appearance, patients were categorized into three groups. Group A (n=6) had MCA delineation on both MRA and CTA, while groups B (n=6) and C (n=5) had no signal on MRA, but Group B had a MCA delineation on CTA.
RESULTS
No significant difference between resting CBF and CBF after the administration of acetazolamide was seen among 3 groups. In contrast, mean CVR in group B was -19.7±18.1%, which was significantly lower than group A [36.4±21.7% (p < 0.05)], but not than group C (21.4±35.2%). Furthermore, all patients in group B displayed a so-called steal phenomenon.
CONCLUSION
This study is the first to show that visualization of MCA on TOF-MRA closely correlates with CVR, and that a vascular pattern showing no MCA signal intensity on MRA but with MCA delineation on CTA indicates a critical cerebrovascular condition.

Keyword

Signal loss; TOF-MRA; occlusion; cerebral artery; cerebral blood flow

MeSH Terms

Acetazolamide/administration & dosage
Aged
Aged, 80 and over
Carotid Artery, Internal/physiopathology
*Cerebrovascular Circulation
*Computed Tomography Angiography
Female
Humans
*Magnetic Resonance Angiography
Male
Middle Aged
Middle Cerebral Artery/*diagnostic imaging
Acetazolamide

Figure

• 

  Fig. 1 Categorized 3 groups corresponding to their visualization on TOF-MRA (A, C, and E) and CTA (B, D, and F) are shown. Group A (A and B) had a MCA signal on TOF-MRA (arrow) and an anterograde MCA delineation on CTA (arrowhead); group B (C and D) had no MCA signal (arrow) and MCA delineation (arrowhead); and group C (E and F) had no MCA signal (arrow) and no MCA delineation (arrowhead) on both modalities. TOF-MRA, time-of- flight-magnetic resonance angiography; CTA, CT angiography, MCA, middle cerebral artery.

• 

  Fig. 2 CBF maps after acetazolamide administration in each group are depicted, coinciding with those of Fig. 1, where group A revealing almost sufficient vascular response in the lesion side, whereas group C showing partly decreased in comparison with contralateral side. Note that CBF maps of group B revealed intensely decreased vascular response in comparison with other 2 groups. CBF, cerebral blood flow.

• 

  Fig. 3 Mean CBF values of 3 categorized groups (A, B, and C) at rest and after acetazolamide administration were revealed in left and right, respectively. There were no significant differences in both rest and acetazolamide challenge (left and right) among all groups. In respect to CBF values after acetazolamide challenge (right), only group B had significant difference compared with the value before acetazolamide administration (*p<0.05). CBF, cerebral blood flow.

• 

  Fig. 4 Mean CVRs in all categorized groups (A, B, and C) are shown. Mean CVR in group B was significantly lower than that in group A (*p<0.05); note that only the mean CVR in group B showed a negative value, which is regarded as a steal phenomenon. CVR: cerebrovascular response.

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