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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1238v1 29/10/1831 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Huynh, T.J. Articles by Aviv, R.I. Search for Related Content PubMed PubMed Citation Articles by Huynh, T.J. Articles by Aviv, R.I. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 29:1831-1836, November-December 2008 © 2008 American Society of Neuroradiology BRAIN CT Perfusion Quantification of Small-Vessel Ischemic Severity T.J. Huynh a , B. Murphy c ,d ,e , J.A. Pettersen f , H. Tu b , D.J. Sahlas f , L. Zhang g , S.P. Symons h , S. Black f , T.-Y. Lee c ,d ,e and R.I. Aviv h a Department of Medicine, University of Toronto, Toronto, Ontario, Canada b Department of Medicine, Queen's University, London, Ontario, Canada c Department of Medicine, University of Western Ontario, London, Ontario, Canada d Robarts Research Institute, London, Ontario, Canada c Lawson Health, Research Institute, London, Ontario, Canada e Division of Neurology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada f Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Ontario, Canada g Department of Neuroradiology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada Please address correspondence to Richard Aviv, MD, Sunnybrook Health Science Centre, 2075 Bayview Ave, Toronto, ON, Canada, M4N 3M5; e-mail: richard.aviv@sunnybrook.ca BACKGROUND AND PURPOSE: Cerebral blood flow (CBF) abnormalities are previously demonstrated in white matter disease. A gradation of change may exist between patients with mild and more severe white matter disease. An association between blood brain barrier dysfunction, increasing age and white matter disease is also suggested. The purpose of this study was to quantify and correlate white matter disease severity and CT perfusion (CTP)-derived CBF and to determine whether permeability surface abnormality increases with white matter disease severity. MATERIALS AND METHODS: One hundred twenty patients with strokelike symptoms underwent CTP and MR imaging. Of these, 35 patients (15 women, 20 men; age, 66 ± 15.7 years) with rapidly resolving symptoms and normal imaging characteristics consistent with transient ischemic attack were retrospectively reviewed and constituted the study cohort. Two blinded neurologists rated white matter severity, assigning age-related white matter change (ARWMC) scores. Patients were dichotomized a priori into mild and moderate-to-severe. CBF, cerebral blood volume (CBV), mean transit time (MTT), and permeability surface product maps were calculated for periventricular and subcortical white matter regions and average white and gray matter. Associations with white matter severity were tested by uni- and multivariate logistic regression analyses. Receiver operating characteristic analysis was performed. RESULTS: White matter disease was mild in 26 patients and moderate-to-severe in 9. Age was associated with increased likelihood of having moderate-to-severe white matter disease ( P = .02). ARWMC correlated with subcortical ( r = –0.50, P < .001) and average CBF ( r = –0.55, P < .001). White matter severity was associated with subcortical ( P = .03) and average ( P = .03) white matter CBF, with a trend toward periventricular white matter CBF ( P = .05). Uni- and multivariate analysis controlling for the confounding effect of age demonstrated significant association between white matter severity and subcortical ( P = .032) white matter CBF. Area under the curve was 0.82. No permeability surface abnormality was found. CONCLUSIONS: CTP-derived subcortical white matter CBF is independently associated with white matter disease severity. Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X
American Journal of Neuroradiology – American Journal of Neuroradiology
Published: Nov 1, 2008
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