Cerebral haemodynamic disturbances in patients with moderate carotid artery stenosis.
ABSTRACT Dynamic MR perfusion imaging can detect cerebral perfusion deficits resulting from severe internal carotid artery (ICA) stenosis. It is unknown, however, whether moderate ICA stenosis (50-69%) also causes haemodynamic disturbance. We investigated whether cerebral perfusion deficits were detectable in patients with moderate ICA stenosis.
Eighteen patients underwent T2* weighted cerebral MR perfusion imaging with a gadolinium based contrast agent. Differences in mean time to peak (mTTP) and relative cerebral blood volume (rCBV) between cerebral hemispheres were calculated for middle cerebral artery territory regions by a reader blinded to the angiographic and clinical findings.
There were significant differences in mTTP between cerebral hemispheres in 15 patients with a mean inter-hemispheric delay in mTTP of 0.49 s (95% confidence intervals, 0.25 and 0.72 s) which was statistically significant ( p <0.001). In 1 patient with bilateral moderate stenosis there was no difference in mTTP.
Moderate ICA stenosis results in significant ipsilateral cerebral perfusion delays detectable by dynamic susceptibility MRI. Follow-up studies might reveal whether these delays improve following carotid endarterectomy.
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ABSTRACT: It has been well accepted that over 50% of cerebral ischemic events are the result of rupture of vulnerable carotid atheroma and subsequent thrombosis. Such strokes are potentially preventable by carotid interventions. Selection of patients for intervention is currently based on the severity of carotid luminal stenosis. It has been, however, widely accepted that luminal stenosis alone may not be an adequate predictor of risk. To evaluate the effects of degree of luminal stenosis and plaque morphology on plaque stability, we used a coupled nonlinear time-dependent model with flow-plaque interaction simulation to perform flow and stress/strain analysis for stenotic artery with a plaque. The Navier-Stokes equations in the Arbitrary Lagrangian-Eulerian (ALE) formulation were used as the governing equations for the fluid. The Ogden strain energy function was used for both the fibrous cap and the lipid pool. The plaque Principal stresses and flow conditions were calculated for every case when varying the fibrous cap thickness from 0.1 to 2 mm and the degree of luminal stenosis from 10% to 90%. Severe stenosis led to high flow velocities and high shear stresses, but a low or even negative pressure at the throat of the stenosis. Higher degree of stenosis and thinner fibrous cap led to larger plaque stresses, and a 50% decrease of fibrous cap thickness resulted in a 200% increase of maximum stress. This model suggests that fibrous cap thickness is critically related to plaque vulnerability and that, even within presence of moderate stenosis, may play an important role in the future risk stratification of those patients when identified in vivo using high resolution MR imaging.Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 02/2007; 2007:1699-702.
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ABSTRACT: High dietary cholesterol and low dietary docosahexaenoic acid (DHA) intake are risk factors for Alzheimer's disease (AD). However, it is unclear how these components influence the course of the disease. We investigated the effects of dietary lipids on beta-amyloid deposition and blood circulation in the brains of 18-month-old APP/PS1 mice. Starting at 6 months of age, mice were fed a regular rodent chow, a Typical Western Diet (TWD) containing 1% cholesterol, or a diet with a high (0.5%) level of DHA for 12 months. Relative cerebral blood volume (rCBV) and flow (CBF) were determined with (2)H MR spectroscopy and gradient echo contrast enhanced MRI. Deposition of beta-amyloid was visualized in fixed brain tissue with immunohistochemistry. The TWD diet increased plaque burden in the dentate gyrus of the hippocampus, but did not significantly reduce rCBV. In contrast, the DHA-enriched diet increased rCBV without changing blood flow indicating a larger circulation in the brain probably due to vasodilatation and decreased the amount of vascular beta-amyloid deposition. Together, our results indicate that the long-term intake of dietary lipids can impact both brain circulation and beta-amyloid deposition, and support the involvement of hemodynamic changes in the development of AD.Neurobiology of Disease 11/2007; 28(1):16-29. · 5.62 Impact Factor
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ABSTRACT: Characterization of the brain's vascular system is of major clinical importance in the assessment of patients with cerebrovascular disease. The aim of this study was to characterize brain hemodynamics using multiparametric methods and to obtain reference values from the healthy brain. A multimodal MRI study was performed in twenty healthy subjects, including dynamic susceptibility contrast (DSC) imaging and blood oxygen level dependence (BOLD) during hypercapnia and carbogen challenges. Brain tissues were defined using unsupervised cluster analysis based on these three methods, and several hemodynamic parameters were calculated for gray matter (GM), white matter (WM), blood vessels & dura (BVD); the three main vascular territories within the GM; and arteries and veins defined within the BVD cluster. The carbogen challenge produced a BOLD signal twice as high as the hypercapnia challenge, in all brain tissues. The three brain tissues differed significantly from each other in their hemodynamic characteristics, supporting the graded vascularity of the tissues, with BVD>GM>WM. Within the GM cluster, a significant delay of ∼1.2 sec of the bolus arrival time was detected within the posterior cerebral artery territory relative to the middle and anterior cerebral arteries territories. No differences were detected between right and left middle cerebral arteries territories for all hemodynamic parameters. Within the BVD cluster, a significant delay of ∼1.9 sec of the bolus arrival time was detected within the veins relative to the arteries. This parameter enabled to differentiate between the various blood vessels, including arteries, veins and choroid plexus. This study provides reference values for several hemodynamic parameters, obtained from healthy brains, and may be clinically important in the assessment of patients with various vascular pathologies.Neuroscience 03/2013; · 3.12 Impact Factor