An Investigation For Middle Cerebral Artery Stenosis,hemorrhage And Perfusion In Basal Ganglia

Background and Aims:The incidence of intracerebral hemorrhage(ICH)in basal ganglia is high in China responsible for about 80% of ICH.The causes of ICH include hypertensive angiopathy,amyloid angiopathy,undetermined etiology,cavernomas and arteriovenous malformations,anticoagulation and systemic disease.The undetermined etiology is responsible for about 21%.The incidences of the causes were declined due to progressive and effective medical therapy and healthier lifestyles in many societies and while the incidence of ICH in basal ganglia did not decline in the past decades.It is important to investigate the undetermined etiology.The studies in intracranial artery stenosis(ICAS)and ischemic stroke provided clues that among subjects with ICH,19.2% had ICAS.ICAS and prior ischemic stroke might increase the risk of ICH.The resutls suggested the possible association between ICH and ICAS.The incidence of ICAS is also high in China responsible for about 46.6% of ischemic stroke in which 63% is middle cerebral artery(MCA)stenosis.MCA is the main irrigable artery to basal ganglia.Is there the association between MCA stenosis and ICH in basal ganglia? To answer the question,our study investigated the potential association between MCA stenosis and ICH in basal ganglia in Chinese.Methods:Totally,973 in-hospital subjects were enrolled in this study from January 2015 to November 2018,including 115 subjects with ICH in basal ganglia,350 subjects with acute IS in basal ganglia and/or MCA territory,161 subjects with prior IS in basal ganglia and/or MCA territory and 347 normal subjects.The ICAS was measured using the WASID(in warfarin aspirin symptomatic intracranial disease trial)method and ECAS using the NASCET(north American symptomatic carotid endarterectomy)method.ICAS and ECAS were further classified into mild(<50%),moderate(50-70%),and severe(>70%)stenosis.Variables included in the multiple logistic regression models were age,sex,hypertension,diabetes mellitus,hyperlipidemia merged by triglyceride,total cholesterol and low-density lipoprotein,MCA stenosis,ICAS except for MCA,and ECAS.Multiple logistic regression models were used to analyze the potential association between MCA stenosis and ICH in basal ganglia.Results:Multiple logistic regression analyses showed that the MCA stenosis was significantly associated with the increased risk of ICH in basal ganglia(mild MCA stenosis: odds ratio [OR]=2.929,95% confidence interval [CI]=1.278–6.709,P=0.011,moderate MCA stenosis OR=9.899,95% CI=2.171–45.143,P=0.003,and severe MCA stenosis OR=5.070,95% CI=1.079–23.827,P=0.040,respectively).When MCA stenosis was mild and moderate,the risk of ICH in basal ganglia might be elevated with the increased MCA stenosis.When MCA stenosis was severe,the risk of ICH in basal ganglia might decline.Conclusion:The MCA stenosis was significantly associated with the increased risk of ICH in basal ganglia.The association is nonlinear and might be affect by the perforator artery perfusion.Background and Aims:The middle cerebral artery(MCA)stenosis vary the perfusion in basal ganglia.However,the pattern of variation is unknown.Some studies found MCA stenosis decreased the perfusion in basal ganglia with decreased cerebral blood flow(CBF)and cerebral blood volume(CBV).When collateral circulation was sufficient,CBV was normal or mild elevated and mean transit time(MTT)prolonged.However,the perfusion in basal ganglia might be variable in MCA stenosis.A follow-up studies found that the perfusion in basal ganglia might be elevated,declined or normal.Some factors might be important for the variable pattern of perfusion in basal ganglia including ratio of MCA stenosis,length of stenosis,length of proximal MCA to stenosis,loci of plaques,composition of stenosis,diameter of proximal and distal MCA,length of MCA,cerebrovascular autoregulation and collateral circulation.Our study investigated the patterns of perfusion in basal ganglia in MCA stenosis and the potential association between perfusion patterns in basal ganglia and the possible factors by using CT perfusion method.Methods:Totally,172 in-hospital subjects were enrolled in this study.The ratio of MCA stenosis,length of stenosis,length of proximal MCA to stenosis,diameter of proximal and distal MCA and MCA length were measured by using CT angiography.The perfusion in basal ganglia were measured by using CT perfusion,including CBF,CBV,MTT and time to drain(TTD).The loci of plaques and composition of stenosis were measured by using high resolution magnetic resonance imaging.Logistic regression models were used to analyze the potential association between perfusion in basal ganglia and the factors.Results:There were four patterns of perfusion in basal ganglia in MCA stenosis including elevated CBF and CBV,the decreased CBF and CBV,normal CBF and CBV and decreased CBF with normal CBV.The pattern of elevated CBF and CBV was about 20-30% depended on variable nucleus in basal ganglia.The four patterns of perfusion in basal ganglia in MCA stenosis were not significantly associated with ratio of MCA stenosis,length of stenosis,length of proximal MCA to stenosis,diameter of proximal and distal MCA,length of MCA,composition of stenosis and loci of plaques.The prolonged MTT in globus pallidus was significantly associated with MCA occlusion or subtotal occlusion.The prolonged TTD in globus pallidus was significantly associated with MCA occlusion or subtotal occlusion and intraplaque hematoma.The prolonged TTD in putamen was significantly associated with MCA occlusion or subtotal occlusion.The MTT and TTD in head of caudate nucleus and thalamus was not significantly associated with factors above.Conclusion:There were four patterns of perfusion in basal ganglia in MCA stenosis including elevated CBF and CBV,the decreased CBF and CBV,normal CBF and CBV and decreased CBF with normal CBV.The pattern of elevated CBF and CBV was about 20-30% depended on variable nucleus in basal ganglia.The association between elevated CBF and CBV and intracerebral hemorrhage in basal ganglia would be further investigated.The antegrade residual flow of perforator artery,cerebrovascular autoregulation and collateral circulation might modulate the perfusion in basal ganglia and be not significantly associated with ratio of MCA stenosis,length of stenosis,length of proximal MCA to stenosis,loci of plaques,composition of stenosis,diameter of proximal and distal MCA and length of MCA.We constructed a theoretical model to recognize the perfusion patterns in basal ganglia and clinical explanation.Background and Aims:The middle cerebral artery(MCA)stenosis vary the perfusion in basal ganglia and thus the measurement of perfusion was important.However,CT perfusion was not available in many hospitals and a predictable tool for CT perfusion was necessary based on CT scan.Artificial intelligence(AI)has a vital role to play in health promotion.Our study investigated the AI method in obtaining quickly perfusion in basal ganglia.Methods:Totally,158 in-hospital subjects were enrolled in this study.The basal ganglia including caudate head,putamen,globus pallidus and thalamus in computed tomography(CT)were segmented by squares and tagged based on CT perfusion data.the training data was imported to train the designed neural network model and validation dada was used to validate the model.Results:The accuracy of the designed neural network model was about 60% and was unavailable to apply in clinical practice.Conclusion:The accuracy of the designed neural network model was about 60% and was unavailable to apply in clinical practice.The larger data and higher quality image data is necessary to improve the neural network model.