Department of Neurology, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, 150001, Harbin, China.
Department of Neurology, Ordos Central Hospital, Ordos, China.
Clin Neuroradiol. 2024 Sep;34(3):613-624. doi: 10.1007/s00062-024-01395-2. Epub 2024 Mar 15.
Cerebral hemodynamics are important for the management of intracranial atherosclerotic stenosis (ICAS). The quantitative flow ratio (QFR) is a novel angiography-derived index for assessing the functional relevance of ICAS without pressure wires and adenosine. Good diagnostic yield with the hyperemic fractional flow reserve (FFR) have been reported, while data on the comparison of QFR to FFR are scarce.
In this prospective study 56 patients with anterior circulation symptomatic ICAS who received endovascular treatment were included. The new method of computing QFR from a single angiographic view, i.e., the Murray law-based QFR (μQFR), was applied to the examined vessels. An artificial intelligence algorithm was developed to realize the automatic delineation of vascular contour. Pressure gradients were measured before and after treatment within the lesion vessel using a pressure guidewire and the FFR was calculated.
There was a good correlation between μQFR and FFR. Preoperative FFR predicted DWI watershed infarction (FFR optimal cut-off level: 0.755). Preoperative μQFR predicted DWI watershed infarction (μQFR optimal cut-off level: 0.51). Preoperative FFR predicted CTP hypoperfusion (FFR best predictive value: 0.62). Preoperative μQFR predicted CTP hypoperfusion (μQFR best predictive value: 0.375).
The μQFR based on DSA images can be used as an indicator to assess the functional status of the lesion in patients with ICAS.
脑血流动力学对于颅内动脉粥样硬化性狭窄（ICAS）的管理很重要。定量血流比（QFR）是一种新型的血管造影衍生指数，可在不使用压力导丝和腺苷的情况下评估 ICAS 的功能相关性。已有研究报道，其对狭窄病变的功能性评估具有较高的诊断效能，而关于 QFR 与 FFR 比较的数据则相对较少。
本前瞻性研究纳入了 56 例接受血管内治疗的前循环症状性 ICAS 患者。应用基于 Murray 定律的 QFR（μQFR），从单一血管造影视图计算新的 QFR 方法，应用于检查血管。开发了一种人工智能算法来实现血管轮廓的自动描绘。使用压力导丝在病变血管内测量治疗前后的压力梯度，并计算 FFR。
μQFR 与 FFR 之间存在良好的相关性。术前 FFR 预测 DWI 分水岭梗死（FFR 最佳截断值：0.755）。术前 μQFR 预测 DWI 分水岭梗死（μQFR 最佳截断值：0.51）。术前 FFR 预测 CTP 低灌注（FFR 最佳预测值：0.62）。术前 μQFR 预测 CTP 低灌注（μQFR 最佳预测值：0.375）。
基于 DSA 图像的 μQFR 可作为评估 ICAS 患者病变功能状态的指标。
