Perfusion computed tomography: 4 cm <i>versus</i> 8 cm coverage size in subjects with chronic carotid artery stenosis

Szarmach, Arkadiusz; Halena, Grzegorz; Kaszubowski, Mariusz; Piskunowicz, Maciej; Szurowska, Edyta; Frydrychowski, Andrzej F.; Winklewski, Paweł J.

doi:10.1259/bjr.20150949

Cited by 5 publications

(7 citation statements)

References 24 publications

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“…Our CT perfusion technique has been previously described in detail (Szarmach et al, 2016;Szarmach et al, 2017;Szarmach et al, 2018). Briefly, all CT examinations were performed with the use of the same scanner (64-MDct Light Speed VCT XT, GE Healthcare Technologies, Wisconsin, USA).…”

Section: Methodsmentioning

confidence: 99%

“…Our perfusion application offers two different models of evaluation: the "neuro brain stroke" and the "neuro brain tumour". The first mode applies the maximal slope method (Fiorella et al, 2004;Szarmach et al, 2016;Szarmach et al, 2017) for measurement of CBF, CBV, MTT or TTP, while the second one calculates microvascular permeability (PS) and the fractional blood volume based on the Johnson and Wilson model (St Lawrence & Lee, 1998a;St Lawrence & Lee, 1998b).…”

Section: Methodsmentioning

confidence: 99%

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Computed tomography indicators of cerebral microperfusion improve long term after carotid stenting in symptomatic patients

et al. 2019

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Objectives: We tested the hypothesis that computed tomography (CT) perfusion markers of cerebral microcirculation would improve 36 months after internal carotid artery stenting for symptomatic carotid stenosis while results obtained 6–8 weeks after the stenting procedure would yield a predictive value. Methods: We recruited consecutive eligible patients with >70% symptomatic carotid stenosis with a complete circle of Willis and normal vertebral arteries to the observational cohort study. We detected changes in the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and permeability surface area-product (PS) before and after carotid stenting. We have also compared the absolute differences in the ipsilateral and contralateral CT perfusion markers before and after stenting. The search for regression models of “36 months after stenting” results was based on a stepwise analysis with bidirectional elimination method. Results: A total of 34 patients completed the 36 months follow-up (15 females, mean age of 69.68±S.D. 7.61 years). At 36 months after stenting, the absolute values for CT perfusion markers had improved: CBF (ipsilateral: +7.76%, contralateral: +0.95%); CBV (ipsilateral: +5.13%, contralateral: +3.00%); MTT (ipsilateral: –12.90%; contralateral: –5.63%); TTP (ipsilateral: –2.10%, contralateral: –4.73%) and PS (ipsilateral: –35.21%, contralateral: –35.45%). MTT assessed 6–8 weeks after stenting predicted the MTT value 36 months after stenting (ipsilateral: R2=0.867, contralateral R2=0.688). Conclusions: We have demonstrated improvements in CT perfusion markers of cerebral microcirculation health that persist for at least 3 years after carotid artery stenting in symptomatic patients. MTT assessed 6–8 weeks after stenting yields a predictive value.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Computed tomography indicators of cerebral microperfusion improve long term after carotid stenting in symptomatic patients

et al. 2019

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“…Furthermore, both experienced neuroradiologists independently drew two standardized elliptical mirrored ROIs in the same patients twice (before and after acetazolamide administration; Fig 1 and 2, SF1). Finally, in all subjects, we used a coverage size of 40 mm, which is well suited for detecting perfusion parameters owing to the high density of the scans (Szarmach et al, 2016).…”

Section: Delayed Acetazolamide Testmentioning

confidence: 99%

“…The number of studied subjects involved in the study is relatively small and heterogeneous in terms of medical history, including previous history of stroke, carotid artery endarterectomy and stenting. The study population is nevertheless representative for a group of patients with chronic carotid artery stenosis (Szarmach et al, Szarmach et al, 2016;Szarmach et al, 2017a;Szarmach et al, 2017b). Moreover, the study group is very homogeneous with respect to low CBV and CBF values due to strict inclusion criteria (carotid stenosis >90% on the ipsilateral side, less than 50% on the contralateral side, complete circle of Willis and normal vertebral arteries).…”

Section: Delayed Acetazolamide Testmentioning

confidence: 99%

“…The population suffering from chronic carotid artery stenosis that we investigated represents an interest-ing pathophysiological state. It is characterized by low global cerebral blood flow (CBF), low global cerebral blood volume (CBV) and lack of significant differences at baseline regarding mean transit time (MTT), CBF and CBV between the ipsilateral and contralateral hemisphere to stenosis (Frydrychowski et al, 2013;Szarmach et al, 2016;Szarmach et al, 2017a,b). Thus, the subjects from the described population are most likely very close to blood supply breakdown leading to stroke.…”

Section: Introductionmentioning

confidence: 99%

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Regional resting state perfusion variability and delayed cerebrovascular uniform reactivity in subjects with chronic carotid artery stenosis

et al. 2018

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The aim of this study was to assess regional perfusion at baseline and regional cerebrovascular resistance (CVR) to delayed acetazolamide challenge in subjects with chronic carotid artery stenosis.Sixteen patients (ten males) aged 70.94±7.71 with carotid artery stenosis ≥90% on the ipsilateral side and ≤50% on the contralateral side were enrolled into the study. In all patients, two computed tomography perfusion examinations were carried out; the first was performed before acetazolamide administration and the second 60 minutes after injection.The differences between mean values were examined by paired two-sample t-test and alternative nonparametric Wilcoxon’s test. Normality assumption was examined using W Shapiro-Wilk test.The lowest resting-state cerebral blood flow (CBF) was observed in white matter (ipsilateral side: 18.4±6.2; contralateral side: 19.3±6.6) and brainstem (ipsilateral side: 27.8±8.5; contralateral side: 29.1±10.8). Grey matter (cerebral cortex) resting state CBF was below the normal value for subjects of this age: frontal lobe – ipsilateral side: 30.4±7.0, contralateral side: 33.7±7.1; parietal lobe – ipsilateral side: 36.4±11.3, contralateral side: 42.7±9.9; temporal lobe – ipsilateral side: 32.5±8.6, contralateral side: 39.4±10.8; occipital lobe – ipsilateral side: 24.0±6.0, contralateral side: 26.4±6.6). The highest resting state CBF was observed in the insula (ipsilateral side: 49.2±17.4; contralateral side: 55.3±18.4). A relatively high resting state CBF was also recorded in the thalamus (ipsilateral side: 39.7±16.9; contralateral side: 41.7±14.1) and cerebellum (ipsilateral side: 41.4±12.2; contralateral side: 38.1±11.3). The highest CVR was observed in temporal lobe cortex (ipsilateral side: +27.1%; contralateral side: +26.1%) and cerebellum (ipsilateral side: +27.0%; contralateral side: +34.6%). The lowest CVR was recorded in brain stem (ipsilateral side: +20.2%; contralateral side: +22.2%) and white matter (ipsilateral side: +18.1%; contralateral side: +18.3%). All CBF values were provided in milliliters of blood per minute per 100 g of brain tissue [ml/100g/min]. Resting state circulation in subjects with carotid artery stenosis is low in all analysed structures with the exception of insula and cerebellum. Acetazolamide challenge yields relatively uniform response in both hemispheres in the investigated population.Grey matter is more reactive to acetazolamide challenge than white matter or brainstem.

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Relative Cerebral Blood Transit Time Decline and Neurological Improvement in Patients After Internal Carotid Artery Stenting

Szarmach

Małkiewicz

Zdun-Ryżewska

et al. 2019

Advances in Experimental Medicine and Biology

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Perfusion computed tomography: 4 cm versus 8 cm coverage size in subjects with chronic carotid artery stenosis

Cited by 5 publications

References 24 publications

Computed tomography indicators of cerebral microperfusion improve long term after carotid stenting in symptomatic patients

Computed tomography indicators of cerebral microperfusion improve long term after carotid stenting in symptomatic patients

Regional resting state perfusion variability and delayed cerebrovascular uniform reactivity in subjects with chronic carotid artery stenosis

Relative Cerebral Blood Transit Time Decline and Neurological Improvement in Patients After Internal Carotid Artery Stenting

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