Hemodynamic Alterations in Vertebrobasilar Large Artery Disease Assessed by Arterial Spin-Labeling MR Imaging

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Fig 1.
Axial CBF (left; mL/100 g/min) and ATT (middle left; seconds) images. A, A representative control shows anterior and posterior regions had a longer ATT compared with middle cerebral territory, while CBF was relatively uniform across the cortex. B, Patient 16 (P16; no VB) had normal CBF and ATT patterns. C, P2 (mod VB) has reduced CBF and prolonged ATT in the posterior portion of the cortex. A patient with severe VB disease (sev VB, P1) also showed reduced CBF and prolonged ATT. Voxels with zero intensity in C-D occurred due to poor fitting. The 2 right columns show the standard space ROIs that were altered to include only voxels that showed a significant fit for CBF or ATT.
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Fig 2.
Empirical characterization of CBF and ATT for controls (top) and patients with VB disease (bottom). Lower CBF values were associated with longer ATT. The ATT range was greater among patients. Linear and exponential curves are shown. Curve fitting was significant for patients (P < .001) but not controls.

Table 1:

Patient demographics, including history of stroke or TIA, infarcts, and arterial disease

Patient	Age (years)	Sex	Stroke/TIA	Brain Infarct	Carotid Stenosis	VB Stenosis	VB Rating
1	62	M	Multiple TIAs	R thalamus and pons	No	Severe R VA, occlusion L VA	Severe
2	65	M	Stroke	R cerebellar, bilat occipital	No	High-grade R VA	Moderate
3	71	F	Stroke, multiple TIAs	No	No	High-grade R VA, low-grade L VA	Severe
4	49	M	Stroke, then TIA	R cerebellar	No	Occlusion R VA, low-grade L VA	Moderate
5	59	F	Stroke, then TIA	No	No	Bilateral VA, moderate BA	Moderate
6	54	M	Stroke	Bilat cerebellar, R occipital	No	L VA occluded, high-grade R VA	Severe
7	50	M	Multiple TIAs	No	No	Moderate BA	Moderate
8	87	M	Stroke	No	No	No	None
9	79	M	TIA	No	L 20%, R 30%	No	None
10	52	M	TIA	No	No	Low-grade L VA	None
11	76	F	Stroke	No	No	No	None
12	52	F	Stroke	Occipital	No	No	None
13	64	F	TIA	No	No	No	None
14	73	M	TIA	No	R ICA	No	None
15	75	F	TIA	No	L 20%, R 15%	No	None
16	73	M	TIA	No	No	No	None
17	50	F	Stroke	L occipital	No	R VA stenosis	Moderate
18	75	M	Multiple TIAs	R cerebellar	No	Occlusion R VA	Moderate
19	78	M	TIA, then stroke	No	No	Severe BA	Severe
20	70	M	Multiple TIAs	No	No	Medium-grade bilateral VA	Moderate
21	62	M	TIA	No	L 20%, R 20%	No	None

Note:—Expected degree of hypoperfusion is based on blinded and unanimous agreement from 3 neurologists. Bilat indicates bilateral; L, left; R, right; VA, vertebral artery.

Table 2:

CBF and ATT for patients with VB disease and controls separated by group and ROI

	Control (n = 20)		Patient (n = 21)		Between-GroupsP Value	Within-VBP Value
	Mean	SD	Mean	SD	Between-GroupsP Value	Within-VBP Value
CBF (mL/100 g/min)
PAR	29.7	7.5	24.9	10.1	0.096	0.459
OCC	31.8	10.5	21.8	9.9	0.003^a	0.371
CBF-sig (mL/100 g/min)
PAR	31.3	6.5	27.9	8.7	0.161	0.359
OCC	32.4	10.1	22.6	9.6	0.003^a	0.307
ATT (s)
PAR	0.75	0.10	0.84	0.20	0.094	0.763
OCC	0.82	0.11	0.87	0.34	0.599	0.026^b
ATT-sig (s)
PAR	0.73	0.08	0.76	0.13	0.438	0.059
OCC	0.82	0.10	0.81	0.26	0.918	0.010^b

Note:—The percentage of significant voxels for CBF and ATT are shown (ie, % CBF-sig voxels and % ATT-sig voxels). ROI-adjusted CBF-sig and ATT-sig are shown, achieved by excluding voxels with a poor fit. For group comparison, a indicates a significant difference (P < .05). For within-VB analysis, b indicates a significant within-VB difference (P < .05). OCC indicates occipital cortex; PAR, parietal cortex.