Sogabe Shu, Satomi Junichiro, Tada Yoshiteru, Kanematsu Yasuhisa, Kuwayama Kazuyuki, Yagi Kenji, Yoshioka Shotaro, Mizobuchi Yoshifumi, Mure Hideo, Yamaguchi Izumi, Abe Takashi, Yamamoto Nobuaki, Kitazato Keiko T, Kaji Ryuji, Harada Masafumi, Nagahiro Shinji
Department of Neurosurgery, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Department of Radiology, Tokushima University Graduate School, Tokushima, Japan.
Neuroradiology. 2017 Jun;59(6):587-595. doi: 10.1007/s00234-017-1828-9. Epub 2017 Apr 10.
Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment.
Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4).
Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1-C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3-C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1-C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion.
High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site.
动脉自旋标记（ASL）涉及利用动脉血中水的反转磁化进行灌注成像。如果动脉血到达时间长于标记后延迟时间，标记的自旋在ASL图像上表现为明亮的、高动脉内信号（IASs）；在急性缺血性脑卒中患者的闭塞血管内发现了此类信号。识别颈内动脉（ICA）的闭塞节段对于血管内治疗至关重要。我们检验了我们的假设，即ASL图像上的高IASs可预测闭塞节段。
我们的研究纳入了13例急性ICA闭塞患者，这些患者在发病48小时内接受了血管造影和ASL检查。我们回顾性地在ASL图像和血管造影上识别高IASs，并记录闭塞节段以及ASL图像上高IASs阳性切片的数量。ICA节段分为颈部（C1）、岩部（C2）、海绵窦部（C3）和床突上段（C4）。
在7例颅内ICA闭塞患者中，5例在C1 - C2节段表现出高IASs，提示高IASs可识别闭塞节段近端的血流停滞。在6例颅外ICA闭塞患者中，5例在C3 - C4节段表现出高IASs，提示这些信号可识别通过眼动脉的侧支血流。无一例在C1 - C2节段有高IASs。颅内ICA闭塞患者的高IASs阳性切片平均数量显著高于颅外ICA闭塞患者。
ASL图像上的高IASs可识别急性ICA闭塞患者通过眼动脉的缓慢停滞血流和侧支血流，并有助于预测闭塞部位。
