Kufer Jan, Preibisch Christine, Göttler Jens, Schmitzer Lena, Hoffmann Gabriel, Kallmayer Michael, Zimmer Claus, Hyder Fahmeed, Kaczmarz Stephan
Department of Diagnostic and Interventional Neuroradiology, School of Medicine and Health, TUM Klinikum Rechts Der Isar, Technical University of Munich (TUM), Munich, Germany.
TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany.
J Neuroimaging. 2025 Sep-Oct;35(5):e70084. doi: 10.1111/jon.70084.
Hemodynamic impairment may contribute to stroke risk and cognitive decline in asymptomatic internal carotid artery stenosis (ICAS). Therefore, multimodal MRI-based quantification of hemodynamic impairment could inform improved treatment decisions. While gross interhemispheric hemodynamic imbalances have been reported in ICAS, identifying more spatially resolved patterns of disease-related alterations may be promising to harness the full potential of hemodynamic MRI.
In this feasibility study, we investigated the spatial topography of ICAS-related impairments by applying scaled subprofile model principal component analysis (SSM-PCA) to cerebral blood flow (CBF), relative oxygen extraction fraction (rOEF), and oxygen extraction capacity (OEF) data of 21 unilateral ICAS patients and 25 healthy controls (HC).
We found spatially extended, partly overlapping disease-related patterns for CBF and OEF, but not rOEF. CBF (area under the curve [AUC] = 0.95) but not OEF (AUC = 0.72) SSM-PCA scores distinguished ICAS patients and HC better than interhemispheric lateralizations (AUC = 0.75/0.73). SSM-PCA scores were only partly explained by interhemispheric lateralization (R = -0.27/0.38), indicating complementary information. Critically, ICAS patients with higher OEF SSM-PCA scores (z ≥ 1) demonstrated higher stenotic degrees and lower cognitive performance (p < 0.05) without differing in interhemispheric lateralization (p > 0.05).
We demonstrated the feasibility of SSM-PCA in ICAS and obtained novel insights into complex hemodynamic impairment patterns and their association with cognitive function.
血流动力学损害可能导致无症状性颈内动脉狭窄（ICAS）患者发生中风风险及认知功能下降。因此，基于多模态磁共振成像（MRI）对血流动力学损害进行量化，有助于做出更优的治疗决策。虽然已有报道称ICAS患者存在半球间血流动力学的总体失衡，但识别更具空间分辨力的疾病相关改变模式，可能有助于充分发挥血流动力学MRI的潜力。
在本可行性研究中，我们通过对21例单侧ICAS患者和25名健康对照（HC）的脑血流量（CBF）、相对氧摄取分数（rOEF）和氧摄取能力（OEF）数据应用比例子剖面模型主成分分析（SSM-PCA），研究了ICAS相关损害的空间分布特征。
我们发现CBF和OEF存在空间扩展且部分重叠的疾病相关模式，但rOEF未发现此现象。CBF（曲线下面积[AUC]=0.95）而非OEF（AUC=0.72）的SSM-PCA评分在区分ICAS患者和HC方面优于半球间侧化（AUC=0.75/0.73）。SSM-PCA评分仅部分由半球间侧化解释（R=-0.27/0.38），表明存在互补信息。至关重要的是，OEF的SSM-PCA评分较高（z≥1）的ICAS患者显示出更高的狭窄程度和更低的认知表现（p<0.05），而半球间侧化无差异（p>0.05）。
我们证明了SSM-PCA在ICAS中的可行性，并获得了关于复杂血流动力学损害模式及其与认知功能关联的新见解。
