| Objective:To use time of flight Magnetic Resonance Angiography(TOF-MRA),territory arterial spin labeling(tASL),three-dimensional arterial spin labeling(3D ASL)Multi-modal combined scanning to quantitatively evaluate the compensatory capacity of collateral circulation in patients with external internal carotid artery external stenosis(EICASS)or external internal carotid artery occlusion(EICAO)and the effects of collateral circulation and anatomical structure of the circle of Willis on compensatory capacity.Method:The patients were enrolled in the Department of Neurology,Neurosurgery,First Hospital of Jilin University from 2018-01 to 2019-01,and undergoed TOF-MRA,Computed Tomography Angiography(CTA)and Transcranial Doppler(TCD)confirmed 40 patients with EICASS(>70%)or EICAO and 30 normal volunteers.All patients were examined using the GE Discovery750 3.0T MRI Scanning Device,which included: T1 WI axial position,T2 WI axial position,T2-FLAIR axial position,DWI axial position,3D TOF-MRA,3D ASL(post-label delay time(PLD)= 1.5s,2.5s)and tASL.The patient's general clinical data and cerebrovascular risk factors were analyzed and the patient's image data were processed as follows: 1 To assess the integrity and variability of Willis circle vascular components by TOF-MRA,and the diameter of the P1 segment of the bilateral PCA,the bilateral PcomA,and the A1 segment of the bilateral ACA was measured by the RadiAnt DICOM Viewer software;2 using of digital subtraction angiography(DSA)to observe the opening of the primary and secondary collaterals of the patient;3 using GE Subtraction(SUB)tool on AW4.5 workstation,sketching PLD 2.5s and PLD 1.5s perfusion map,get PLD2.5s cerebral vascular perfusion recovery area silhouette map,and use mathematical analysis data software MATLAB(Mathworks,Natick,Mass)Semi-automatic delineation of the silhouette image of the affected side to calculate the silhouette volume ratio of the affected side;4 semi-automatic delineation of the cerebral hemisphere compensation range of theaffected side by the ICA and Vertebral-Basilar artery(VBA)using Matlab software Segmentation and calculation of the healthy side ICA and VBA compensation volume ratio.In this study,patients were divided into transient ischemic attack(TIA)group and cerebral infarction group according to clinical manifestations.The diameters of the circle of Willis in the affected side and healthy side were compared between the patient group.The differences in the diameters of the Willis ring between the patient group and the normal volunteers were compared.The effects of Willis ring variation,openness and diameter of each component on the ICA and VBA compensatory capacity of the healthy side were studied.Results:1,40 patients,31 males(77.5%),male: female ratio 3.4:1,with an average of61.28±8.735 years old.There were 30 patients in the normal group,including 14 males(46.7%),with an average age of 54.18±13.17.There were significant differences in gender,smoking,alcoholism,hypertension,diabetes,high homocysteine ??and previous cerebral infarction between the two groups(P<0.05).There were 23 cases(57.5%)in the TIA group and 17 cases(42.5%)in the cerebral infarction group.There was a statistically significant difference between the two groups in terms of gender and previous cerebral infarction(P<0.05).2.There was no significant difference in the location of the disease and vascular stenosis between the TIA group and the cerebral infarction group.(P > 0.05),but the NIHSS score was statistically significant(P <0.05).The NIHSS score of the cerebral infarction group was higher than that of the TIA group.3.Opening of the Willis circle: TIA group: AcomA is open,PcomA is open,both are open,and both are not open.There are 7(30.4%),8(34.8%),6(26.1%)and 2people(8.7%)respectively.There were 5 cases(29.4%),3 cases(17.6%),7 cases(41.2%)and 2 cases(11.8%)in the cerebral infarction group.There was no significant difference in the opening of the circle of Willis between the two groups(P>0.05).Secondary collateral opening: TIA group: OA is open,LMA is open,both are open,and both are open.There are 0 cases(0.0%),12 cases(52.2%),and 4 cases(17.4%),7(30.4%)respectively.There were 2 patients(11.8%),6 patients(35.3%),5 patients(29.4%),and 4.patients(23.5%)in the cerebral infarction group.There was no significant difference in the opening of the secondary collaterals between the two groups(P>0.05).4.In the TIA patient group,the diameter of the vascular diameter of the affected side and the healthy side of the Willis circle was found to be statistically different between A1 segment and the PcomA(P<0.05),and the diameter of the healthy side was larger than the diameter of the affected side.There was only a statistical difference in the A1 segment of the cerebral infarction group(P<0.05).5.There was no significant difference in the diameter of the circle of Willis between the two groups in TIA and cerebral infarction(P>0.05).The two groups were compared with the normal control group.The TIA group found statistical differences in the A1 segment,the bilateral PcomA and the bilateral P1 segment.In the cerebral infarction group,the diameter of the contralateral A1,the affected side PcomA and the bilateral P1 segments were larger than those of the normal volunteers,and the difference was statistically significant(P<0.05).6.There was no significant difference in the ratio of ICA and VBA compensatory volume between TIA and cerebral infarction(P>0.05).There was a statistical difference in the silhouette volume between the two groups(P<0.05).7.Whether AcomA is open or not mainly affects the ICA compensatory ability of the healthy side;The PcomA open situation has impacts on the healthy side ICA and VBA compensation range.When PcomA is open,the healthy side ICA compensation volume is smaller(0.208±0.171/0.338±0.130),while when PcomA is open,the VBA compensation range is larger(0.223(0.142,0.421).)/ 0.056 ± 0.042),the differences were statistically significant(P <0.05).For the secondary collateral branch,when the LMA is open,the silhouette volume is significantly larger than that of the control group(0.189±0.084/0.095±0.069),but it has no significant effect on the compensatory capacity of the healthy side ICA and VBA;while the OA is open or not,the three are not effected.8.There was a linear correlation between the diameter of the A1 segment of the healthy side and the compensatory capacity of the healthy side.There was a linear correlation between the diameter of the affected side PcomA and the compensatory capacity of the VBA,and it waspositively correlated.The correlation coefficients were 0.581 and 0.727,respectively.9.For the patient group,there was no statistical difference in the volume of ICA compensatory volume(P=0.078)with or without A1 segment,but the compensation for A1 segment was slightly larger(0.378±0.097/0.236±0.170).).However,compared with the absence of the A1 segment of the normal control group,there was a statistically significant range of the ICA compensation between the two groups(P=0.002).Conclusions:1.TOF-MRA,tASL and 3D ASL combined scanning can provide a reliable diagnostic basis for quantitative assessment of collateral circulation compensation ability in patients with ICA stenosis.2.There was no statistically significant difference in collateral circulation compensation between the TIA group and the cerebral infarction group(lateral circulatory opening,Willis ring vascular diameter and healthy ICA,VBA compensation range),but LMA for the improvement of the cerebral blood flow is of great significance.3,ICA severe stenosis or occlusion will cause changes in the diameter of the various components of the circle of Willis,and the difference in collateral circulation and anatomical structure has different effects on compensatory capacity. |
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