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White matter lesions in watershed territories studied with MRI and parenchymography: a comparative study

  • Diagnostic Neuroradiology
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Abstract

Brain aging affects an increasing segment of the population and the role of chronic cerebrovascular disease is considered to be one of the main parameters involved. For this purpose we compared retrospectively MRI data with digitized subtraction angiography (DSA) data in a group of 50 patients focusing onto the watershed area of the carotid artery vascular territories. In order to evaluate the presence of white matter lesions (WML) in the hemispheric watershed areas, coronal fluid-attenuated inversion-recovery or axial T2 weighted MRI images of patients with symptomatic cerebrovascular insufficiency areas were compared with the capillary phase of DSA studies in anterior–posterior projection. Presence of cerebrovascular occlusive disease was evaluated on DSA using North American symptomatic carotid endarterectomy trial criteria and including evaluation of collateral vascular supply. Pathological MRI findings in the region of the watershed territories correlated overall in 66% of cases with a defect or delayed filling on DSA. In the case of asymmetrical MRI findings, there was a pathological finding of the capillary phase in the watershed area in 92% of DSA studies. Hypoperfusion in the capillary phase of the watershed area as seen on DSA correlated with the stenosis degree of the concerned carotid artery. Our findings suggest that asymmetrical findings of WML in the watershed areas as seen on MRI are caused by hemodynamic effect and a differentiation between small vessel disease and a consequence of distant stenosis may be possible under such conditions.

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Abbreviations

FLAIR:

Fluid-attenuated inversion-recovery

WML:

White matter lesions

DSP:

Digitized subtraction parenchymography

DSA:

Digitized subtraction angiography

ICA:

Internal carotid artery

NASCET:

North American symptomatic carotid endarterectomy trial

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Acknowledgements

Dr. Lövblad is supported by a grant from the Swiss National Science Foundation (Grant 3100–066348.01.).

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Authors and Affiliations

  1. Department of Radiology, University Hospital of Geneva, Rue Micheli-du-Crest 24, 1211, Geneva 14, Switzerland

    K Minkner, K. O. Lovblad, H Yilmaz, A. Alimenti, J Delavelle & D. A. Rüfenacht

  2. Clinic of Neurology, University Hospital of Geneva, Rue Micheli-du-Crest 24, 1211, Geneva 14, Switzerland

    L Sekoranja & R Sztajzel

Authors
  1. K Minkner
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  2. K. O. Lovblad
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  3. H Yilmaz
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  4. A. Alimenti
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  5. L Sekoranja
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  6. J Delavelle
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  7. R Sztajzel
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  8. D. A. Rüfenacht
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Correspondence to K. O. Lovblad.

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Minkner, K., Lovblad, K.O., Yilmaz, H. et al. White matter lesions in watershed territories studied with MRI and parenchymography: a comparative study. Neuroradiology 47, 425–430 (2005). https://doi.org/10.1007/s00234-005-1358-8

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  • DOI: https://doi.org/10.1007/s00234-005-1358-8

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