The Association between Dynamic Changes of MCA Stenosis and Its Surrounding Small Vessels in Brain

Abstract

Abstract:

Objective To analyze the relationship between the stenotic or occluded middle cerebral artery (MCA) and a newly discovered imaging phenomenon, which called small vessels around stenotic or occluded site (SVSOS), in patients with multiple high-resolution magnetic resonance imaging (HRMRI) examinations. Methods Retrospectively reviewed 20 patients with multiple HRMRI examinations for MCA stenosis or occlusion in Peking Union Medical College from July 2007 to March 2015, and analyzed the relationship between stenotic or occluded MCA and SVSOS. Results Seven patients’ MCA changed from stenosis to occlusion with multiple HRMRI examinations (35.00%), while 13 patients’ MCA remained stenotic. Six cases with SVSOS were witnessed in patients with MCA change (85.71%), while 3 patients without MCA change had SVSOS (23.08%). There was significant difference in two groups (P =0.02). Conclusion Small vessels around stenotic or occluded site (SVSOS) might be associated with the aggravation of stenosis degree.

Key words: High-resolution magnetic resonance imaging; Middle cerebral artery; Small vessels around stenotic or occluded site

摘要：

目的探讨用高分辨磁共振成像（high-resolution magnetic resonance imaging，HRMRI）随访大脑中动脉（middle cerebral artery，MCA）狭窄或闭塞病例时发现的MCA狭窄或闭塞与其周围微小血管的关系。方法收集2007年7月-2015年3月于北京协和医院因MCA狭窄或闭塞多次行HRMRI检查的病例（共20 例），分析其MCA狭窄或闭塞的变化与其周围微小血管的关系。结果 20例患者中7例的MCA由狭窄转变为闭塞（35.00%），其中有6例出现狭窄或闭塞周围微小血管（85.71%）；13例MCA的狭窄无明显变化，其中有3例的狭窄或闭塞周围微小血管状况出现变化（23.08%）；两组比较差异具有显著性（P =0.02）。结论大脑中动脉狭窄或闭塞的周围微小血管可能与狭窄度的加重相关。

关键词: 高分辨磁共振成像; 大脑中动脉; 狭窄或闭塞周围微小血管

ZHENG Bo-Wen, XU Yu-Yuan, LI Ming-Li, et al.. The Association between Dynamic Changes of MCA Stenosis and Its Surrounding Small Vessels in Brain[J]. Chinese Journal of Stroke, 2016, 11(08): 626-630.

郑博文，许玉园，李明利，高山，冯逢，徐蔚海. 大脑中动脉狭窄的动态演变与其周围微小血管的关系[J]. 中国卒中杂志, 2016, 11(08): 626-630.

References

1 Gorelick PB，Wong KS，Bae HJ，et al. Large artery

intracranial occlusive disease：a large worldwide

burden but a relatively neglected frontier[J]. Stroke，2008，39：2396-2399.

2 Deg na n AJ，Gal lagher G，Teng Z，et a l. MR

angiography and imaging for the evaluation of middle

cerebral artery atherosclerotic disease[J]. AJNR Am J

Neuroradiol，2012，33：1427-1435.

3 Tian L，Yue X，Xi G，et al. Multiple intracranial

arterial stenosis influences the long-term prognosis

of symptomatic middle cerebral artery occlusion[J].

BMC Neurol，2015，15：68.

4 McVerry F，Liebeskind DS，Muir KW. Systematic

review of methods for assessing leptomeningeal

collateral flow[J]. AJNR Am J Neuroradiol，2012，33：

576-582.

5 Calleja AI，Cor tijo E，García-Bermejo P，et al.

Collateral ci rculation on per fusion-computed

tomography-source images predicts the response

to stroke intravenous thrombolysis[J]. Eur J Neurol，

2013，20：795-802.

6 Kim Y，Sin DS，Park HY，et al. Relationship between

flow diversion on transcranial Doppler sonography

and leptomeningeal collateral circulation in patients

with middle cerebral artery occlusive disorder[J]. J

Neuroimaging，2009，19：23-26.

7 Hwang YH，Kang DH，Kim YW，et al. Impact of

time-to-reperfusion on outcome in patients with poor

collaterals[J]. AJNR Am J Neuroradiol，2015，36：

495-500.

8 Bodle JD，Feldmann E，Swartz RH，et al. Highresolution

magnetic resonance imaging：an emerging

tool for evaluating intracranial arterial disease[J].

Stroke，2013，44：287-292.

9 Cho ZH，Lee YB，Kang CK，et al. Microvascular

imaging of asymptomatic MCA steno-occlusive

patients using ultra-high-field 7T MRI[J]. J Neurol，

2013，260：144-150.

10 Yang WQ，Huang B，Liu XT，et al. Reproducibility

of high-resolution MRI for the middle cerebral artery

plaque at 3T[J]. Eur J Radiol，2014，83：e49-55.

11 Liu D，Li Y，Shi Z，et al. Presence of anterior

temporal artery associates with good outcome in

acute atherosclerotic M1-middle cerebral artery

occlusion[J]. Neuroradiology，2014，56：1023-1030.

12 Lima FO，Furie KL，Silva GS，et al. Prognosis of

untreated strokes due to anterior circulation proximal

intracranial arterial occlusions detected by use of

computed tomography angiography[J]. JAMA Neurol，

2014，71：151-157.

13 Huang X，Liu W，Zhu W，et al. Distal hyperintense

vessels on FLAIR：a prognostic indicator of acute

ischemic stroke[J]. Eur Neurol，2012，68：214-220.

14 Haussen DC，Koch S，Saraf-Lavi E，et al. FLAIR

distal hyperintense vessels as a marker of perfusiondiffusion

mismatch in acute stroke[J]. J Neuroimaging，

2013，23：397-400.

15 Xu WH，Li ML，Niu JW，et al. Deep tiny flow voids

along middle cerebral artery atherosclerotic occlusions：

a high-resolution MR imaging study[J]. J Neurol Sci，

2014，339：130-133.

16 Xu WH，Li ML，Niu JW，et al. Luminal thrombosis

in middle cerebral artery occlusions：a high-resolution

MRI study[J]. Ann Transl Med，2014，2：75.

17 Xu WH，Li ML，Gao S，et al. In vivo high-resolution

MR imaging of symptomatic and asymptomatic

middle cerebral artery atherosclerotic stenosis[J].

Atherosclerosis，2010，212：507-511.

18 Xu WH，Li ML，Gao S，et al. Middle cerebral artery

intraplaque hemorrhage：prevalence and clinical

relevance[J]. Ann Neurol，2012，71：195-198.

19 Huttner HB，Schwab S. Malignant middle cerebral

artery infarction：clinical characteristics，treatment

strategies，and future perspectives[J]. Lancet Neurol，

2009，8：949-958.

20 Liu J，Wang Y，Akamatsu Y，et al. Vascular remodeling

after ischemic stroke：mechanisms and therapeutic

potentials[J]. Prog Neurobiol，2014，115：138-156.

21 Wa n g YQ，Gu o X，Qi u MH，e t a l . VEGF

overexpression enhances striatal neurogenesis in brain

of adult rat after a transient middle cerebral artery

occlusion[J]. J Neurosci Res，2007，85：73-82.

22 Gr el l AS，Thigar ajah R，Edvinsson L，e t a l.

Regulatory mechanism of endothelin receptor B in

the cerebral arteries after focal cerebral ischemia[J].

PLoS One，2014，9：e113624.

23 Liebeskind DS. Collateral perfusion：time for novel

paradigms in cerebral ischemia[J]. Int J Stroke，2012，

7：309-310.

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