Observation And Analysis Of Cerebral Watershed Perfusion In Pa-Tients With Internal Carotid Artery Stenosis

PurposeTo observe and analyze the perfusion of cerebral watershed in patients with internal carotid artery(ICA)stenosis using arterial spin labeling perfusion imaging.Method47 patients with unilateral ICA stenosis>50%were continuously selected,including 28 patients with moderate ICA stenosis(50?69%),19 patients with severe ICA stenosis(?70%or Occlusion).During the same period 118 patients without ICA stenosis or ICA stenosis<50%were included in the control group.Magnetic resonance angiography and cervical ultrasound were used to determine the degree of intracranial and extracranial artery stenosis,respectively.All patients underwent cerebrovascular assessment and fluid-attenuated inversion recovery vascular hyperintensities(FVH)assessment.The severity of white matter hyperintensity and lacune were also assessed.Cerebral blood flow in the left and right symmetry areas of white matter in anterior horn,white matter in occipital horn,corona radiate and centrum semiovale were measured using arterial spin labeling imaging.Difference of cerebral perfusion between the left and right cere-bral hemispheres was represented by asymmetry index(AI).Demographic data,risk factors for cerebrovascular disease,and data of relevant blood tests were recorded.Clinical data and imaging data of ICA stenosis group were compared with the control group,respectively.ResultsThe average age of the ICA stenosis group was higher than that of the control group.The proportion of diabetes and coronary artery disease was higher than that of the con-trol group,and the difference was significant(P<0.05).There was no significant differ-ence between the ICA stenosis group and the control group in fetal-type posterior cere-bral artery,periventricular white matter hyperintensity score,and completeness of circle of Willis(P>0.05).The difference between the ICA stenosis group and the control group in FVH score,deep white matter hyperintensity score,concomitant other intracranial artery stenosis were significant(P<0.01).The AI of the four cerebral watersheds in the ICA stenosis group was higher than that of the control group,but there was no signifi-cant difference in the areas of white matter in anterior horn,white matter in occipital horn,and corona radiate.The difference in AI of centrum semiovale was significant.Logistic regression multivariate analysis showed coronary artery disease(OR=6.62,95%CU:1.33?32.93,P=0.021),history of smoking(OR=3.91,95%CI:1.43?10.68,P=0.008),and concomitant other intracranial artery stenosis(OR=4.91,95%CI:1.70?14.19,P=0.003)was independently associated with ICA stenosis.Deep white matter hyperintensity score(OR=1.63,95%CI:1.14?2.33,P=0.007),FVH score(OR=1.61,95%CI:1.16?2.22,P=0.004),AI of centrum semiovale(OR=2.67,95%CI:1.04?6.82,P=0.041)in the ICA stenosis group were higher.There were 12 patients with diabetes in the moderate ICA stenosis group(42.86%),and the proportion was significantly higher than the control group(17.80%).The dif-ference was significant(P<0.01).The difference in FVH score,concomitant other intra-cranial artery stenosis,and deep white matter hyperintensity score were significant(P<0.01).The AI of centrum semiovale in the ICA stenosis group was higher,but the difference was not significant(P=0.084).After logistic regression analysis,the deep white matter hyperintensity score was higher in the moderate ICA stenosis group(OR=1.56,95%CI:1.09-2.23,P=0.014).The AI of centrum semiovale was not signifi-cantly different between the two group(OR=1.76,95%CI:0.64-4.86,P=0.212).There was significant difference in diabetes and coronary heart disease in the ICA severe stenosis group compared with the control group(P<0.05).The difference of FVH score and concomitant other intracranial artery stenosis between the two group were significant(P<0.05).The AI of centrum semiovale was higher in the severe ICA steno-sis group,and the difference was significant(P<0.01).After logistic regression analysis,the FVH score(OR=1.12,95%CI:1.18-2.52,P=0.005),AI of centrum semiovale(OR=8.53,95%CI:1.32?55.05,P=0.024)in severe ICA stenosis group were higher.Conclusion1.Cerebral perfusion in cortical cerebral watershed and corona radiate did not reduce significantly in patients with either moderate or severe ICA stenosis.2.Cerebral perfusion in centrum semiovale did not reduce significantly in patients with moderate ICA stenosis,but reduced significantly in patients with severe stenosis.