This Article Full Text Full Text (PDF) All Versions of this Article: 39/12/3248    most recent STROKEAHA.108.520593v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chng, S. M. Articles by Golay, X. Search for Related Content PubMed PubMed Citation Articles by Chng, S. M. Articles by Golay, X.

(Stroke. 2008;39:3248.)
© 2008 American Heart Association, Inc.

Original Contributions

Territorial Arterial Spin Labeling in the Assessment of Collateral Circulation

Comparison With Digital Subtraction Angiography

Soke Miang Chng, MD; Esben Thade Petersen, MSc; Ivan Zimine, PhD; Yih-Yian Sitoh, MD; C.C. Tchoyoson Lim, MD Xavier Golay, PhD

From the Department of Neuroradiology (S.M.C., E.T.P., I.Z., Y.-Y.S., C.C.T.L., X.G.), National Neuroscience Institute, Singapore; CFIN, Department of Neuroradiology (E.T.P.), Aarhus University Hospital, Denmark; and the Laboratory of Molecular Imaging (X.G.), Singapore Bioimaging Consortium, Singapore.

Correspondence to Xavier Golay, PhD, Lysholm Department of Neuroradiology, 8-11 Queen Square, London WC1N 3BG, UK. E-mail x.golay{at}ion.ucl.ac.uk

Background and Purpose— Collateral circulation plays a vital role in patients with steno-occlusive disease, in particular for predicting stroke outcome. Digital subtraction angiography (DSA) is the gold standard for the assessment of collateral circulation, despite its invasive nature. Recently, the development of a new class of arterial spin labeling (ASL) methods allowed independent measurement of territorial flow information without the need for contrast media injection. Here, we compared combined territorial ASL (TASL) and MR angiography (MRA) against DSA in the assessment of collateral circulation.

Methods— Eighteen patients presenting with extra- or intracranial arterial steno-occlusive disease were recruited. All DSA studies were performed using a biplane angiography unit. MR imaging consisted of time-of-flight MRA and TASL, performed at 3T. Collateral circulation on both modalities was evaluated in consensus in a double-blinded manner by 3 neuroradiologists.

Results— Good agreement was found between DSA and TASL in the assessment of collateral flow: Cramer coefficient, V=0.53 (P<0.0001) and Contingency coefficient, C=0.67, with kappa=0.70 and kappa=0.72 in the assessment of flow and collaterals, respectively. TASL and DSA successfully evaluated 89% and 98% of the vessels, respectfully. Failure was linked to motion-related artifacts in TASL, and highly tortuous vessels in DSA. Generally, combined MRA-TASL was comparable to DSA in diagnostic quality.

Conclusions— TASL provided radiological information comparable to DSA on collateral flow, with the advantage that it could be performed during routine MRI studies. TASL may provide insight on collateral perfusion in patients who may not otherwise be candidates for DSA, and may potentially replace it.

Key Words: magnetic resonance imaging • arterial spin labeling • territorial ASL • digital subtraction angiography • atherosclerosis • cerebrovascular accident • collateral circulation

This article has been cited by other articles:

				J. Hendrikse, E. T. Petersen, A. Cheze, S. M. Chng, N. Venketasubramanian, and X. Golay Relation Between Cerebral Perfusion Territories and Location of Cerebral Infarcts Stroke, May 1, 2009; 40(5): 1617 - 1622. [Abstract] [Full Text] [PDF]