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Research ArticleNEUROVASCULAR/STROKE IMAGING

Assessment of Collateral Flow in Patients with Carotid Stenosis Using Random Vessel-Encoded Arterial Spin-Labeling: Comparison with Digital Subtraction Angiography

Shanshan Lu, Chunqiu Su, Yuezhou Cao, Zhenyu Jia, Haibin Shi, Yining He and Lirong Yan
American Journal of Neuroradiology January 2024, DOI: https://doi.org/10.3174/ajnr.A8100
Shanshan Lu
aFrom the Department of Radiology (S.L., C.S.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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  • ORCID record for Shanshan Lu
Chunqiu Su
aFrom the Department of Radiology (S.L., C.S.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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  • ORCID record for Chunqiu Su
Yuezhou Cao
bDepartment of Interventional Radiology (Y.C., Z.J., H.S.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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  • ORCID record for Yuezhou Cao
Zhenyu Jia
bDepartment of Interventional Radiology (Y.C., Z.J., H.S.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Haibin Shi
bDepartment of Interventional Radiology (Y.C., Z.J., H.S.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Yining He
cDepartment of Radiology (Y.H., L.Y.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Lirong Yan
cDepartment of Radiology (Y.H., L.Y.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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  • ORCID record for Lirong Yan
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  • FIG 1.
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    FIG 1.

    A 71-year-old male asymptomatic patient with left ICA stenosis. A, TOF-MRA shows the absence of the left A1 segment of the circle of Willis in this patient. B–D, DSA reveals a left ICA stenosis of 60%, but with a normal antegrade flow (grade III). The right ICA angiogram reveals normal antegrade flow to the left ACA territory. E, Vascular territory maps generated by rVE-ASL display flow territories of left ICA (red), right ICA (green), and VBA (blue), along with detected feeding arteries on the labeling plane. The right ICA supplies the left ACA territory, consistent with the findings on DSA.

  • FIG 2.
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    FIG 2.

    An 81-year-old male patient with dizziness for 2 years. A–D, DSA images reveal a very high-grade stenosis of the right ICA indicated by the white short arrow. The right ICA angiogram shows decreased flow to the right MCA territory (white arrows). The VBA angiogram shows significant collateral flow to the right MCA territory (white hollow arrow). The extent of collaterals is classified as grade I. E, Evident flow alterations are shown on vascular territory maps generated by rVE-ASL. The territory of right MCA is supplied by the right ICA (green) and VBA (blue), while the territory of right ACA is supplied by left ICA (red), consistent with the DSA findings. The extent of collaterals is also classified as grade I on rVE-ASL. The locations of the detected feeding arteries are shown in the bottom right of figure (E).

  • FIG 3.
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    FIG 3.

    A 60-year-old man with left limb weakness for 3 days. A, TOF-MRA shows the occlusion in the right ICA and the absence of the right A1 segment of the circle of Willis in this patient. B–D, DSA confirms the occlusion of the right ICA, and the extent of collaterals is classified as grade I. The left ICA angiogram shows collateral flow to the right ACA and MCA territory via the AcomA and the leptomeningeal anastomoses (white arrows). The VBA angiogram shows collateral flow to the right MCA territory via the PcomA and leptomeningeal anastomoses (white hollow arrow). E, Vascular territory maps of rVE-ASL show flow territories of left ICA (red) and VBA (blue), while the flow territory of the right ICA (green) is absent. The territory of right MCA is mainly supplied by the left ICA, followed by VBA, consistent with the findings on DSA. The extent of collaterals is also classified as grade I on rVE-ASL. The locations of the detected feeding arteries are shown in the bottom right of figure (E).

Tables

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    Table 1:

    Distribution of collaterals grades by rVE-ASL and DSA

    rVE-ASL collateral gradeDSA collateral grade
    0123Total
    000000
    10122014
    201405
    30002121
    Total01362140
    • Note:— 0: poor, no visible collaterals; 1: intermediate, partial collateral flow to the side of stenosis/occlusion; 2: good, full collateral flow to the side of stenosis/occlusion; 3: normal antegrade flow.

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    Table 2:

    Flow alterations on rVE-ASL stratified by stenosis ratio

    Stenosis RatioWith Flow Alterations, n (%)Without Flow Alterations, n (%)P Value
    Flow territory of MCA on the side of ICAD< 90% (n = 24)2 (8.3)22 (91.7)<.001
    ≥ 90% (n = 16)15 (93.8)1 (6.2)
    Flow territory of ACA on the side of ICAD< 90% (n = 24)0 (0.0)24 (100.0)<.001
    ≥ 90% (n = 16)8 (50.0)8 (50.0)
    • View popup
    Table 3:

    Flow alterations on rVE-ASL stratified by symptoms

    Patient GroupWith Flow Alterations, n (%)Without Flow Alterations, n (%)P Value
    Flow territory of MCA on the side of ICADSymptomatic (n = 19)12 (63.2)7 (36.8).012
    Asymptomatic (n = 21)5 (23.8)16 (76.2)
    Flow territory of ACA on the side of ICADSymptomatic (n = 19)5 (26.3)14 (73.7).442
    Asymptomatic (n = 21)3 (14.3)18 (85.7)
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Shanshan Lu, Chunqiu Su, Yuezhou Cao, Zhenyu Jia, Haibin Shi, Yining He, Lirong Yan
Assessment of Collateral Flow in Patients with Carotid Stenosis Using Random Vessel-Encoded Arterial Spin-Labeling: Comparison with Digital Subtraction Angiography
American Journal of Neuroradiology Jan 2024, DOI: 10.3174/ajnr.A8100

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Assessment of Collateral Flow in Patients with Carotid Stenosis Using Random Vessel-Encoded Arterial Spin-Labeling: Comparison with Digital Subtraction Angiography
Shanshan Lu, Chunqiu Su, Yuezhou Cao, Zhenyu Jia, Haibin Shi, Yining He, Lirong Yan
American Journal of Neuroradiology Jan 2024, DOI: 10.3174/ajnr.A8100
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