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. 2018 Jan 10;17(1):13-20.
doi: 10.2463/mrms.mp.2016-0074. Epub 2017 Mar 27.

4D Flow MR Imaging of Ophthalmic Artery Flow in Patients with Internal Carotid Artery Stenosis

Tetsuro Sekine  1   2 , Ryo Takagi  2 , Yasuo Amano  2 , Yasuo Murai  3 , Erika Orita  2 , Yoshimitsu Fukushima  2 , Yoshio Matsumura  2 , Shin-Ichiro Kumita  2
Affiliations

4D Flow MR Imaging of Ophthalmic Artery Flow in Patients with Internal Carotid Artery Stenosis

Tetsuro Sekine et al. Magn Reson Med Sci. .

Abstract

Background and purpose: To assess the clinical feasibility of time-resolved 3D phase contrast (4D Flow) MRI assessment of the ophthalmic artery (OphA) flow in patients with internal carotid artery stenosis (ICS).

Materials and methods: Twenty-one consecutive patients with unilateral ICS were recruited. 4D Flow MRI and acetazolamide-stress brain perfusion single photon emission computed tomography (SPECT) were performed. The flow direction on the affected-side OphA was categorized into native flow (anterograde or unclear) and non-native flow (retrograde flow) based on 4D Flow MRI. In the affected-side middle cerebral artery (MCA) territory, the ratio of rest cerebral blood flow to normal control (RCBFMCA) and cerebral vascular reserve (CVRMCA) were calculated from SPECT dataset. High-risk patients were defined based on the previous large cohort study (RCBFMCA < 80% and CVRMCA < 10%).

Results: Eleven patients had native OphA flow (4 anterograde, 7 unclear) and the remaining 10 had non-native OphA flow. RCBFMCA and CVRMCA each were significantly lower in non-native flow group (84.9 ± 18.9% vs. 69.8 ± 7.3%, P < 0.05; 36.4 ± 20.6% vs. 17.0 ± 15.0%, P < 0.05). Four patients in the non-native flow group and none in the native flow group were confirmed as high-risk (Sensitivity/Specificity, 1.00/0.65).

Conclusion: The 6 min standard 4D Flow MRI assessment of OphA in patients with ICS can predict intracranial hemodynamic impairment.

Keywords: Single Photon Emission Computed Tomography; atherosclerosis; magnetic resonance angiography; ophthalmic artery; time-resolved three-dimensional phase contrast.

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Conflict of interest statement

Conflicts of Interest

We declare that we have no conflict of interest.

Figures

Fig. 1.
Fig. 1.
The analysis of time-resolved 3D phase-contrast (4D-Flow). Magnitude image (top left), in-plane vector overlay image (top right), velocity-time graph of velocity on the voxel (bottom left), and quantitative values (bottom right). We set the voxel contour at the left ophthalmic artery (red dot, arrowheads on the magnitude image) after masking the nonvascular lesion with the dedicated threshold. The in-plane vector overlying the image provides the color-coded flow direction and flow velocity at each voxel (red is fast and blue is slow). The velocity-time graph can provide the velocity along the cursor in each direction—right to left (RL), anteroposterior (AP), foot to head (FH) - during the cardiac cycle. We could then easily detect the flow direction from this information.
Fig. 2.
Fig. 2.
Comparison of rest cerebral blood flow (CBF) (A), cerebral vascular reserve (CVR) (B) and both combined (C) in the territory of middle cerebral artery (MCA) between the native and non-native, retrograde, flow in the affected-side the ophthalmic artery (OphA). Rest cerebral blood flow to normal control (RCBFMCA), the ratio of rest CBF in the affected-side MCA territory to the default value obtained from healthy participants; CVRMCA, The cerebral vascular reserve in the affected-side MCA territory calculated by dividing (stress CBF – rest CBF) by the rest CBF. High-risk patients were defined based on the previous large cohort study (RCBFMCA < 80% and CVRMCA < 10%).
Fig. 3.
Fig. 3.
A 62-year-old woman with left internal carotid artery stenosis. Magnetic resonance angiography shows that the left internal carotid artery disappears (A). The vector map of time-resolved 3D phase-contrast (4D-Flow) MRI shows the antegrade flow of the affected-side the ophthalmic artery (OphA) (B). The rest and acetazolamide stress single photon emission computed tomography (SPECT) images show that cerebral blood flow and cerebral vascular reserve did not decrease in the territory of middle cerebral artery (MCA) (C).
Fig. 4.
Fig. 4.
A 58-year-old man with left internal carotid artery stenosis. Magnetic resonance angiography shows that the left internal carotid artery disappears (A). The vector map of time-resolved 3D phase-contrast (4D-Flow) MRI shows that retrograde flow of the affected-side the ophthalmic artery (OphA) (B). The rest and acetazolamide stress single photon emission computed tomography (SPECT) images show that cerebral blood flow and cerebral vascular reserve decrease in the territory of middle cerebral artery (MCA) (arrow-heads in C).
See this image and copyright information in PMC

References

    1. Hendrikse J, Hartkamp MJ, Hillen B, Mali WP, van der Grond J. Collateral ability of the circle of willis in patients with unilateral internal carotid artery occlusion: border zone infarcts and clinical symptoms. Stroke 2001; 32:2768–2773. - PubMed
    1. Vernieri F, Pasqualetti P, Matteis M, et al. Effect of collateral blood flow and cerebral vasomotor reactivity on the outcome of carotid artery occlusion. Stroke 2001; 32:1552–1558. - PubMed
    1. Liebeskind DS. Collateral circulation. Stroke 2003; 34:2279–2284. - PubMed
    1. Tsai CL, Lee JT, Cheng CA, et al. Reversal of ophthalmic artery flow as a predictor of intracranial hemodynamic compromise: implication for prognosis of severe carotid stenosis. Eur J Neurol 2013; 20:564–570. - PubMed
    1. Persoon S, Luitse MJ, de Borst GJ, et al. Symptomatic internal carotid artery occlusion: a long-term follow-up study. J Neurol Neurosurg Psychiatr 2011; 82:521–526. - PubMed

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