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Research ArticleBrain

Chronic Middle Cerebral Artery Occlusion: A Hemodynamic and Metabolic Study with Positron-Emission Tomography

M. Tanaka, E. Shimosegawa, K. Kajimoto, Y. Kimura, H. Kato, N. Oku, M. Hori, K. Kitagawa and J. Hatazawa
American Journal of Neuroradiology November 2008, 29 (10) 1841-1846; DOI: https://doi.org/10.3174/ajnr.A1234
M. Tanaka
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E. Shimosegawa
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K. Kajimoto
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Y. Kimura
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H. Kato
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N. Oku
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M. Hori
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K. Kitagawa
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J. Hatazawa
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    Fig 1.

    Locations of regions of interest: cortical territories of the ACA, MCA, PCA, and the corona radiata. The watershed areas between the ACA and MCA (AWS) and the watershed areas between the MCA and PCA (PWS) were excluded from the analysis.

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    Fig 2.

    Angiographic assessment of the patients. This diagram shows schematic representations of the circle of Willis and the major intracranial vessels in each patient. Black lesions indicate the location of the stenosis or occlusion. Acom indicates the anterior communicating artery; Pcom, the posterior communicating artery; Rt; right, Lt; left; M1-M3, collaterals reconstituting the M1, M2, or M3 segments; None, little or no significant reconstitution of the territory of the occluded vessel.

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    Table 1:

    Clinical backgrounds of the 13 patients

    Patient No.AgeSexPresentationOnset PET (months)Occlusion SiteCause of OcclusionSite of InfarctInfarct Size (mm)
    146MNo symptomR M1 pUnknownL corona radiata29
    262MNo symptomL M1 pAtheroscleroticNone
    366MNo symptomL M1 pAtheroscleroticNone
    462MNo symptomL M1 pAtheroscleroticR corona radiata6
    548MMinor stroke182L M1 pAtheroscleroticL putamen25
    644MMinor stroke38L M1 pAtheroscleroticL putamen, corona radiata29
    772MMinor stroke1081L M1 pAtheroscleroticL frontal cortex23
    863MTIA27R M1 dAtheroscleroticR temporo-occipital cortex22
    939MTIA238R M1 pAtheroscleroticNone
    1058MNo symptomR M1 pAtheroscleroticL putamen4
    1164FMinor stroke129R M1 pAtheroscleroticR internal capsule, corona radiata5
    1256FMinor stroke273R M1 pAtheroscleroticR corona radiata, frontal subcortex30
    1369FTIA36R M1 pAtheroscleroticR frontal cortex10
    • Note:—TIA indicates transient ischemic attack; L, left; R, right; p, proximal; d, distal.

    • View popup
    Table 2:

    Cerebral blood flow and metabolism in the symptomatic and asymptomatic patients

    Asymptomatic PatientsSymptomatic PatientsP
    CBF (mL · 100 g−1 · min−1)44.7 ± 6.040.5 ± 8.7.36
    OEF (%)42.9 ± 5.748.5 ± 5.7.11
    CBV (mL · 100 g−1)3.3 ± 0.43.3 ± 0.7.92
    CMRO2 (mL · 100 g−1 · min−1)4.9 ± 1.44.9 ± 1.8.97
    CBF/CBV (min−1)9.7 ± 2.89.1 ± 3.4.77
    • Note:—CBF indicates cerebral bloodflow; OEF, oxygen extraction fraction; CBV, cerebral blood volume; CMRO2, cerebral metabolic rate of oxygen.

    • View popup
    Table 3:

    Background hemodynamic parameters and clinical characteristics in the normal and increased OEF groups

    Normal OEF (n = 9)Increased OEF (n = 4)
    Hemoglobin (g/dL)13.5 ± 1.611.8 ± 0.5
    O2 content (mL/dL)17.8 ± 2.515.6 ± 0.9
    Mean blood pressure (mm Hg)93.7 ± 10.189.2 ± 5.7
    PaCO2 during C15O2 inhalation (mm Hg)39.6 ± 2.340.0 ± 1.8
    PaCO2 during 15O2 inhalation (mm Hg)39.9 ± 2.840.9 ± 2.2
    Age (mean ± SD) (yr)55.8 ± 11.661.8 ± 5.9
    Sex (male/female) (No.)*9/01/3
    Symptomatic (No.)53
    Hypertension (No.)64
    Diabetes mellitus (No.)20
    • Note:—OEF indicates oxygen extraction traction; PaCO2, partial pressure of carbon dioxide.

    • * P < .05.

    • View popup
    Table 4:

    Cerebral blood flow and metabolism in the normal and increased OEF groups

    Normal OEF (n = 9)Increased OEF (n = 4)
    Ipsilateral MCA
        CBF (mL · 100 g−1 · min−1)42.6 ± 8.140.9 ± 8.1
        OEF (%)43.1 ± 3.953.7 ± 3.1
        CBV (mL · 100 g−1)*4.3 ± 1.36.3 ± 1.4
        CMRO2 (mL · 100 g−1 · min−1)3.3 ± 0.63.4 ± 0.5
        CBF/CBV (min−1)*10.5 ± 2.96.6 ± 1.2
    Ipsilateral corona radiata
        CBF30.6 ± 9.228.9 ± 4.9
        OEF39.2 ± 7.746.8 ± 5.5
        CBV*3.1 ± 1.35.0 ± 0.7
        CMRO22.1 ± 0.52.1 ± 0.3
        CBF/CBV*11.5 ± 6.06.0 ± 1.5
    Contralateral MCA
        CBF46.8 ± 5.742.7 ± 11.4
        OEF†41.8 ± 3.950.0 ± 4.3
        CBV4.3 ± 1.25.5 ± 1.6
        CMRO23.5 ± 0.53.3 ± 0.7
        CBF/CBV11.6 ± 3.38.4 ± 3.9
    Ipsilateral ACA
        CBF41.3 ± 6.236.0 ± 8.9
        OEF†40.8 ± 3.850.4 ± 5.7
        CBV4.6 ± 1.45.5 ± 1.2
        CMRO23.0 ± 0.32.8 ± 0.6
        CBF/CBV10.0 ± 4.16.7 ± 2.0
    Ipsilateral PCA
        CBF43.8 ± 8.341.0 ± 7.2
        OEF†44.3 ± 4.253.5 ± 4.4
        CBV4.4 ± 1.56.3 ± 1.7
        CMRO23.2 ± 0.53.4 ± 0.6
        CBF/CBV10.0 ± 3.46.7 ± 1.2
    • Note:—CBF indicates cerebral bloodflow; OEF, oxygen extraction fraction; CBV, cerebral blood volume; CMRO2, cerebral metabolic rate of oxygen; MCA, middle cerebral artery; ACA, anterior cerebral artery; PCA, posterior cerebral artery.

    • * P < .05.

    • † P < .01.

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M. Tanaka, E. Shimosegawa, K. Kajimoto, Y. Kimura, H. Kato, N. Oku, M. Hori, K. Kitagawa, J. Hatazawa
Chronic Middle Cerebral Artery Occlusion: A Hemodynamic and Metabolic Study with Positron-Emission Tomography
American Journal of Neuroradiology Nov 2008, 29 (10) 1841-1846; DOI: 10.3174/ajnr.A1234

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Chronic Middle Cerebral Artery Occlusion: A Hemodynamic and Metabolic Study with Positron-Emission Tomography
M. Tanaka, E. Shimosegawa, K. Kajimoto, Y. Kimura, H. Kato, N. Oku, M. Hori, K. Kitagawa, J. Hatazawa
American Journal of Neuroradiology Nov 2008, 29 (10) 1841-1846; DOI: 10.3174/ajnr.A1234
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