title: Permeability Imaging as a Biomarker of Leptomeningeal Collateral Flow in Patients with Intracranial Arterial Stenosis.
abstract: Different methods of angiography are of great clinical utility; however, it still remains unstandardized as which method would be suitable to determine cerebral collateral circulation. Here we compared digital subtraction angiography (DSA), computer tomography angiography (CTA) and dynamic contrast-enhanced T1-weighted imaging magnetic resonance imaging (MRI) findings in seven patients with severe intracranial arterial stenosis, and determine whether volume transfer constant (K(trans)) maps of permeability imaging could be used as the biomarkers of cerebral collateral circulation. We retrospectively reviewed seven adult patients with severe intracranial arterial stenosis or occlusion with a complete parenchymal and vascular imaging work-up. DSA, CTA source imaging (CTA-SI), arterial spin labeling (ASL), and K(trans) maps were used to assess their collateral flow. Cohen's Kappa coefficient was calculated to test the consistency of their collateral scores. A reasonable agreement was found between DSA and K(trans) maps (Kappa = 0.502, P < 0.001) when all 15 regional vascular sites were included, and a better agreement found after exclusion of perforating artery territories (N = 10 sites, Kappa = 0.766, P < 0.001). The agreement between CTA-SI and DSA was moderate on all 15 sites (Kappa = 0.413, P < 0.001) and 10 sites (Kappa = 0.329, P < 0.001). The agreement between ASL and DSA was least favorable, no matter for all 15 sites (Kappa = 0.270, P < 0.001) or 10 sites (Kappa = 0.205, P = 0.002). K(trans) maps are useful and promising for leptomeningeal collateral assessment, when compared to CTA-SI or ASL. Further studies are requited for verify its validity in a large registry of patients.
authors.affiliation: Third Military Medical University, Chongqing, China.|Department of Neurology, Military General Hospital of Beijing PLA, No. 5, Nanmencang, Dongcheng District, Beijing, 100700, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Radiology, Military General Hospital of Beijing PLA, Beijing, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Wu
authors.affiliation: Department of Neurology, Military General Hospital of Beijing PLA, No. 5, Nanmencang, Dongcheng District, Beijing, 100700, China.
authors.forename: Guangming
authors.initials: G
authors.lastname: Zhu
authors.affiliation: Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
authors.affiliation: Department of Radiology, Military General Hospital of Beijing PLA, Beijing, China.
authors.forename: Xinhuai
authors.initials: X
authors.lastname: Wu
authors.affiliation: GE Healthcare, Beijing, China.
authors.forename: Zihua
authors.initials: Z
authors.lastname: Su
authors.affiliation: GE Healthcare, Beijing, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Neurology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Chenglin
authors.initials: C
authors.lastname: Tian
authors.affiliation: Department of Radiology, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of Neurology, Military General Hospital of Beijing PLA, No. 5, Nanmencang, Dongcheng District, Beijing, 100700, China. drweiweizhang@163.com.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China. drxinluo@163.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Lou
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002560:Cerebrovascular Circulation; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008576:Meningeal Arteries / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology*; D008875:Middle Aged; D010539:Permeability; D012189:Retrospective Studies; D012886:Skull / Q000098:blood supply*
keywords: Collateral circulation; Intracranial stenosis; K trans; Magnetic resonance imaging; Permeability