Feasibility of Noninvasive Diagnosis of Spinal Vascular Diseases Using Time-Resolved Angiography With Stochastic Trajectories.

Background and Purpose: To determine the feasibility of time-resolved angiography with stochastic trajectories (TWIST) in the diagnosis of spinal dural arteriovenous fistula (SDAVF) and perimedullary arteriovenous fistula (PAVF). Methods: A total of 11 negative patients with TWIST examination were retrospective analyzed and then 18 patients with suspected spinal vascular diseases underwent TWIST. For negative patients, Adamkiewicz artery (AKA), great anterior radiculomedullary vein (GARV) and anterior spinal artery (ASA) were retrospective analyzed. In patients, the results of TWIST were compared with those of DSA. Results: The displaying rates of the ASA, AKA and GARV in 11 negative patients were 100, 90.9, and 90.9%, respectively. The AKA and GARV were separated on TWIST. Of 18 patients, 11 and three were diagnosed with SDAVF and PAVF, respectively. The spinal cord vascular malformation diagnosed on TWIST was consistent with DSA with an excellent intermodality agreement (Kappa = 0.92, p < 0.001). The feeding artery and side of all 11 SDAVF patients were displayed on TWIST and the results were consistent with DSA. For PAVF patients, the feeding artery in two patients and the sides as displayed on TWIST were consistent with DSA. Conclusions: TWIST enables the differentiation of the spinal artery and vein and the differential diagnosis of SDAVF and PAVF.

Correlation Between Internal Carotid Artery Tortuosity and Imaging of Cerebral Small Vessel Disease.

Background and Purpose: An association between artery tortuosity and neuroimaging of cerebral small vessel disease (SVD) has been reported, especially in the posterior circulation. However, few studies involved the whole magnetic resonance imaging (MRI) spectrum of SVD in association with anterior circulation arterial tortuosity. This study aimed to investigate the relationship between internal carotid artery (ICA) tortuosity and the neuroimaging of SVD. Methods: Data of 1,264 consecutive patients in whom cerebral vessel diseases were suspected and who underwent both MRI and computed tomography angiography were reviewed from a prospective registry. Internal carotid artery tortuosity was evaluated using the tortuosity index (TI), which was defined as the ratio of the vessel centerline length divided by the straight length. Magnetic resonance imaging was used to assess cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), enlarged perivascular spaces (EPVSs), and lacunes. Results: The TIs of the ICA for patients with and without SVD MRI markers were 1.81 ± 0.42 and 1.72 ± 0.33, respectively (P < 0.001). Univariate analysis showed that the ICA TI were positively correlated with each SVD MRI marker (P < 0.001), and the correlation coefficients (r s ) were 0.57, 0.42, 0.30, and 0.26 for EPVSs, WMHs, CMBs, and lacunes, respectively. The adjusted ORs of the ICA TI were 1.52 (95% CI 1.44-1.60, P < 0.001) for EPVS grade 1, 2.05 (95% CI 1.93-2.18, P < 0.001) for EPVS grades 2-4, and 1.09 (95% CI 1.03-1.15, P = 0.004) for WMH grade 3. Conclusions: The TI of ICA was higher in patients with neuroimaging of SVD. Internal carotid arteries tortuosity was associated with MRI-defined markers of SVD, including EPVS and high-grade WMH, and positively correlated with EPVS severity. Arterial tortuosity might be a risk factor for SVD. This finding may have potential clinical significance for identifying patients with suspected SVD.

Correlation Between the Number of Lenticulostriate Arteries and Imaging of Cerebral Small Vessel Disease.

Background and purpose: Hypoperfusion plays an important role in the pathophysiology of cerebral small vessel disease (SVD). Lenticulostriate arteries (LSAs) are some of the most important cerebral arterial small vessels. This study aimed to investigate whether the number of LSAs was associated with the cerebral perfusion in SVD patients and determine the correlation between the number of LSAs and SVD severity. Methods: Five hundred and ninety-four consecutive patients who underwent digital subtraction angiography were enrolled in this study. The number of LSAs was determined. Computed tomography perfusion (CTP) was used to calculate the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). Magnetic resonance imaging (MRI) was performed to assess cerebral infarct, cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), enlarged perivascular spaces (EPVSs), and lacunes. An SVD compound score was calculated to express the level of cerebral SVD load. Results: The SVD scores were negatively correlated with the number of the LSAs (P < 0.001, r s = -0.44). The number of LSAs was inversely associated with the presence of any type of SVD (P < 0.001). The adjusted ORs of the SVD severity were 0.31 for LSA group 1 (LSA > 20) vs. group 2 (LSA = 10-20) and 0.47 for LSA group 2 (LSA = 10-20) vs. group 3 (LSA < 10). MTT and TTP were significantly higher and CBF was significantly lower when the number of LSAs was between 5 and 10 on each side of the basal ganglia (P < 0.001, <0.001, and <0.001, respectively). The CBV was slightly lower when the number of LSAs was between 5 and 10, while it was significantly lower when the number was <5 on each side of the basal ganglia (P < 0.05, <0.0001, respectively). Conclusion: LSA count was lower in SVD patients than the non-SVD participants and there was a positive correlation between the cerebral perfusion and the number of LSAs. The LSA number was negatively associated with SVD severity, hypoperfusion might play an important role. This finding may have potentially important clinical implications for monitoring LSA in SVD patients.

Correlation Between Intracranial Arterial Calcification and Imaging of Cerebral Small Vessel Disease.

Background and Purpose: Vascular calcification is part of the atherosclerotic process. Intracranial artery calcification is closely associated with cerebral small vessel disease (SVD). The present study aimed to investigate the distribution pattern of intracranial arterial calcification and its association with magnetic resonance imaging (MRI) markers of SVD in patients with acute ischemic cerebrovascular disease. Methods: Two hundred and seventy six consecutive patients with transient ischemic attack (TIA) or acute ischemic stroke who underwent both computed tomography (CT) angiography and MRI were enrolled in this study. Intracranial arterial calcium scores were evaluated using Agatston method. MRI was performed to assess cerebral infarction, white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVSs). Results: Intracranial artery calcification was present in 200 (72.46%) patients, with the highest prevalence in the internal carotid arteries (ICA) (64.8%). The severity of intracranial arterial calcification was associated with the presence of WMHs (P = 0.0001), lacunes (P = 0.0001), and CMBs (P = 0.0001); however, there was no association between calcifications and the presence of EPVSs (P = 0.058). The correlation coefficients (rs) were 0.350, 0.142, 0.285, and 0.251 for WMHs, EPVSs, lacunes, and CMBs, respectively. The adjusted odds ratios (ORs) of intracranial arterial calcification were: 2.747 for WMH (grade 1-2), 3.422 for WMH (grade 3), 2.902 for lacunes, 2.449 for CMB, 0.88 for EPVS (grade 1), and 0.295 for EPVS (grade 2-4). Conclusion: Intracranial artery calcification is common in patients with ischemic cerebrovascular disease and the intracranial carotid artery is most frequently affected. Intracranial arterial calcifications might be associated with imaging markers of SVD and are highly correlated with WMHs, lacunes, and CMBs. Quantification of calcification on CT provides additional information on the pathophysiology of SVD. Intracranial arterial calcification could act as a potential marker of SVD.

Prevalence of unruptured cerebral aneurysms in Chinese adults aged 35 to 75 years: a cross-sectional study.

BACKGROUND: The reported prevalence of unruptured cerebral aneurysms (UCAs) varies widely. OBJECTIVE: To measure the prevalence of UCAs by using 3-dimensional time-of-flight magnetic resonance angiography in adults aged 35 to 75 years. DESIGN: Cross-sectional study done between June 2007 and June 2011. SETTING: Two communities chosen at random from 2 districts (1 urban and 1 suburban) in Shanghai, China. PARTICIPANTS: 4813 adults aged 35 to 75 years. MEASUREMENTS: Three-dimensional time-of-flight magnetic resonance angiography, interpreted by 3 observers blinded to the participants' information, was used to identify the location and size of UCAs and to estimate the overall, age-specific, and sex-specific prevalence. RESULTS: 369 UCAs were found in 336 participants (130 men and 206 women); 4477 participants had no evidence of UCAs. The prevalence was 7.0% overall (95% CI, 6.3% to 7.7%), with 5.5% for men (CI, 4.6% to 6.4%) and 8.4% for women (CI, 7.3% to 9.5%). The overall prevalence of UCAs was higher in women than in men (P < 0.001) and peaked at ages 55 to 64 years in men and women. The UCAs were mostly located in the internal carotid artery (81%), and 90.2% had a maximum diameter less than 5 mm. Mean diameter was larger in women than in men (3.7 mm vs. 3.2 mm; P < 0.009). LIMITATION: Participants were from 2 communities selected from 2 districts in Shanghai, and adults older than 75 years were not studied. CONCLUSION: The overall prevalence of UCAs was 7.0% in Chinese adults aged 35 to 75 years, and most lesions had a diameter less than 5 mm. PRIMARY FUNDING SOURCE: National Natural Science Foundation of China.

Incidental findings of persistent primitive trigeminal artery on 3-dimensional time-of-flight magnetic resonance angiography at 3.0 T: an analysis of 25 cases.

BACKGROUND AND PURPOSE: Currently, the presence of persistent primitive trigeminal artery (PPTA) is detected by digital subtraction angiography (DSA); most publications on this cerebrovascular variation have been individual case reports. This study is to evaluate the efficacy of 3-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) at 3.0 T for the detection and classification of PPTA based on a large case series. MATERIALS AND METHODS: Between June 2007 and October 2008, 4,650 patients underwent magnetic resonance angiography (MRA) examination at 3.0 T in our hospital. MRA was performed using 3D-TOF with volume rendering (VR) and maximum intensity projection (MIP) technique. The PPTA was classified according to the Saltzman classification system. The occurrence of cerebral vascular diseases accompanying PPTA was studied. RESULTS: Among the 4,650 patients with MRA examined, 25 were identified as having PPTA; the prevalence of PPTA was .54%. The Saltzman classification of PPTAs was as follows: type I, 24%; type II, 16%; type III, 60%. Sixteen percent of the cases with PPTA were accompanied with intracranial aneurysm. CONCLUSION: A 3D-TOF MRA at 3.0 T can be used for the detection of PPTA and making a classification of PPTA indirectly. The incidence of PPTA with type III was greater than that of other types of PPTA. Intracranial aneurysm appeared to be associated with PPTA.