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Research ArticleAdult Brain

Improved White Matter Cerebrovascular Reactivity after Revascularization in Patients with Steno-Occlusive Disease

L. McKetton, L. Venkatraghavan, C. Rosen, D.M. Mandell, K. Sam, O. Sobczyk, J. Poublanc, E. Gray, A. Crawley, J. Duffin, J.A. Fisher and D.J. Mikulis
American Journal of Neuroradiology January 2019, 40 (1) 45-50; DOI: https://doi.org/10.3174/ajnr.A5912
L. McKetton
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
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  • ORCID record for L. McKetton
L. Venkatraghavan
bDepartment of Anesthesia and Pain Management (L.V., J.A.F.), University Health Network, Toronto, Ontario, Canada
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  • ORCID record for L. Venkatraghavan
C. Rosen
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
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D.M. Mandell
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
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K. Sam
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
cRussell H. Morgan Department of Radiology and Radiological Science (K.S.), John Hopkins School of Medicine, Baltimore, Maryland
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O. Sobczyk
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
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J. Poublanc
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
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E. Gray
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
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A. Crawley
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
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J. Duffin
dDepartment of Physiology (J.D., J.A.F.)
eInstitute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada.
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J.A. Fisher
bDepartment of Anesthesia and Pain Management (L.V., J.A.F.), University Health Network, Toronto, Ontario, Canada
dDepartment of Physiology (J.D., J.A.F.)
eInstitute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada.
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D.J. Mikulis
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
eInstitute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada.
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    Fig 1.

    BOLD MR imaging CVR maps in standard space overlaid on an anatomic T1-weighted image of 5 representative patients (P3, P12, P20, P31, and P32) who underwent a left (P3) and right (P12, P20, P31, and P32) STA-MCA bypass. The first column shows CVR maps before bypass, and the second column shows CVR maps within a 1-year follow-up after revascularization surgery. CVR units are %ΔBOLD MR signal intensity per millimeter mercury ΔPETCO2. Areas shown in blue demonstrate decreased and paradoxic (negative) CVR as shown in P3 in the left hemisphere and P12, P20, P31, and P32 in the right hemisphere (left column). The resulting CVR maps visually demonstrate improvement (reduction of steal) postbypass (right column).

  • Fig 2.
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    Fig 2.

    Comparisons of pre- and post-unilateral STA-MCA bypass on white matter CVR in the ipsilateral revascularized and contralateral nonrevascularized hemispheres in patients with MMD, Moyamoya syndrome, and steno-occlusive and atherosclerotic disease. The white matter CVR in revascularized and nonrevascularized hemispheres is shown in different vascular territories: MCA (A), ACA (B), and PCA (C). The box denotes the interquartile range (25%–75%), the horizontal line in the box denotes the median, and the whiskers denote the minimum and maximum values. Double asterisks indicate P < .01; 4 asterisks, P < .0001.

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American Journal of Neuroradiology: 40 (1)
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Vol. 40, Issue 1
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L. McKetton, L. Venkatraghavan, C. Rosen, D.M. Mandell, K. Sam, O. Sobczyk, J. Poublanc, E. Gray, A. Crawley, J. Duffin, J.A. Fisher, D.J. Mikulis
Improved White Matter Cerebrovascular Reactivity after Revascularization in Patients with Steno-Occlusive Disease
American Journal of Neuroradiology Jan 2019, 40 (1) 45-50; DOI: 10.3174/ajnr.A5912

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Improved White Matter Cerebrovascular Reactivity after Revascularization in Patients with Steno-Occlusive Disease
L. McKetton, L. Venkatraghavan, C. Rosen, D.M. Mandell, K. Sam, O. Sobczyk, J. Poublanc, E. Gray, A. Crawley, J. Duffin, J.A. Fisher, D.J. Mikulis
American Journal of Neuroradiology Jan 2019, 40 (1) 45-50; DOI: 10.3174/ajnr.A5912
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