Cerebrovascular reactivity in the caudate nucleus, lentiform nucleus and thalamus in patients with carotid artery disease

J Neuroradiol. 2017 Mar;44(2):143-150. doi: 10.1016/j.neurad.2016.07.003. Epub 2016 Oct 13.

Abstract

Background and purpose: To assess the effect of unilateral large vessel disease upon the cerebral hemodynamic autoregulatory status in the basal ganglia of patients with steno-occlusive internal carotid artery (ICA) disease.

Materials and methods: Twenty-five healthy volunteers and 38 patients with a unilateral symptomatic steno-occlusive ICA lesion and were investigated; 20 with a stenosis >50% and 18 with an occlusion. Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) were assessed with pseudo-continuous arterial spin labeling (ASL) magnetic resonance (MR) imaging before and after administration of acetazolamide.

Results: When compared to controls, the CVR in patients with ICA stenosis was significantly lower in the middle cerebral artery (MCA) territory (P<0.05), and in the caudate (P<0.05) and lentiform nucleus (P<0.05) of the hemisphere ipsilateral to the stenosis. The CVR in the caudate nucleus contralateral to the stenosis was significantly lower (P<0.05) as well. In patients with ICA occlusion, the CVR in the hemisphere ipsilateral to the occlusion as well as in the contralateral hemisphere was significantly lower in the MCA territory (P<0.05), the caudate (P<0.05) and lentiform nucleus (P<0.05), and in the thalamus (P<0.05).

Conclusion: Perfusion ASL MR imaging shows impaired cerebral hemodynamic autoregulation of the basal ganglia in patients with steno-occlusive ICA disease both in the hemisphere ipsilateral as well as in the hemisphere contralateral to the stenosis or occlusion.

Keywords: Carotid artery disease; Cerebrovascular reactivity; Magnetic resonance imaging; Perfusion.

MeSH terms

  • Acetazolamide / administration & dosage
  • Aged
  • Carotid Artery Diseases / complications
  • Carotid Artery Diseases / diagnostic imaging*
  • Caudate Nucleus / blood supply*
  • Caudate Nucleus / diagnostic imaging*
  • Cerebrovascular Circulation
  • Contrast Media / administration & dosage
  • Corpus Striatum / blood supply*
  • Corpus Striatum / diagnostic imaging*
  • Female
  • Humans
  • Magnetic Resonance Angiography
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Middle Cerebral Artery / diagnostic imaging
  • Spin Labels
  • Thalamus / blood supply*
  • Thalamus / diagnostic imaging*

Substances

  • Contrast Media
  • Spin Labels
  • Acetazolamide