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Fractional Flow on TOF-MRA as a Measure of Stroke Risk in Children with Intracranial Arterial Stenosis
Conventional angiography is the criterion standard for measuring intracranial arterial stenosis. We evaluated signal intensity ratios from TOF-MRA as a measure of intracranial stenosis and infarct risk in pediatric stroke. A retrospective study was undertaken in children with intracranial arterial s...
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| Published in: | American journal of neuroradiology : AJNR 2020-03, Vol.41 (3), p.535-541 |
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| creator | Ibrahim, A Y Amirabadi, A Shroff, M M Dlamini, N Dirks, P Muthusami, P |
| description | Conventional angiography is the criterion standard for measuring intracranial arterial stenosis. We evaluated signal intensity ratios from TOF-MRA as a measure of intracranial stenosis and infarct risk in pediatric stroke.
A retrospective study was undertaken in children with intracranial arterial stenosis, who had TOF-MRA and conventional angiography performed within 6 months. Arterial diameters were measured for percentage stenosis. ROI analysis on TOF-MRA measured signal intensity in pre- and poststenotic segments, with post-/pre-signal intensity ratios calculated. The Pearson correlation was used to compare percentage stenosis on MRA with conventional angiography and signal intensity ratios with percentage stenosis; the point-biserial correlation was used for infarcts compared with percentage stenosis and signal intensity ratios. Sensitivity, specificity, and positive and negative predictive values were calculated for determining severe (≥70%) stenosis from MRA and signal intensity ratios against the criterion standard conventional angiography.
1.00: 97.1%, 77.8%, 71.7%, and 97.4%; combination: 75.5%, 100%, 100%, and 76.8%, respectively. Signal intensity ratios decreased with increasing grade of stenosis (none/mild-moderate/severe/complete, |
| doi_str_mv | 10.3174/ajnr.A6441 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7077901</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2369877000</sourcerecordid><originalsourceid>FETCH-LOGICAL-c378t-f70a3401e5207ee90c56798853d05e3e82883ffac99bd5473fc341cb3242b9273</originalsourceid><addsrcrecordid>eNpVkU1LAzEQhoMoWqsXf4DkKMJqstlskotQitWCUmgreAtpOmvTbhNNtor_3q1f6GkG5uGZYV6ETii5YFQUl2bp40WvLAq6gzpUsTJTXD3uog6himclJfIAHaa0JIRwJfJ9dMBySnlBZQdVg2hs44I3NR7U4Q0Hj6ejQXY_7mGTsMH3YNImAg4VnjQxrACPXVph53F_4ep5BI_fXLPAQ9-0pmi8a0292EDcNpMGfEguHaG9ytQJjr9rFz0Mrqf92-xudDPs9-4yy4RsskoQwwpCgedEAChieSmUlJzNCQcGMpeSVZWxSs3mvBCssqygdsbyIp-pXLAuuvryPm9ma5hb2F5V6-fo1ia-62Cc_j_xbqGfwqsWRAhFaCs4-xbE8LKB1Oi1Sxbq2ngIm6RzViopRPvKFj3_Qm0MKUWoftdQorfB6G0w-jOYFj79e9gv-pME-wDVjomz</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2369877000</pqid></control><display><type>article</type><title>Fractional Flow on TOF-MRA as a Measure of Stroke Risk in Children with Intracranial Arterial Stenosis</title><source>Open Access: PubMed Central</source><creator>Ibrahim, A Y ; Amirabadi, A ; Shroff, M M ; Dlamini, N ; Dirks, P ; Muthusami, P</creator><creatorcontrib>Ibrahim, A Y ; Amirabadi, A ; Shroff, M M ; Dlamini, N ; Dirks, P ; Muthusami, P</creatorcontrib><description>Conventional angiography is the criterion standard for measuring intracranial arterial stenosis. We evaluated signal intensity ratios from TOF-MRA as a measure of intracranial stenosis and infarct risk in pediatric stroke.
A retrospective study was undertaken in children with intracranial arterial stenosis, who had TOF-MRA and conventional angiography performed within 6 months. Arterial diameters were measured for percentage stenosis. ROI analysis on TOF-MRA measured signal intensity in pre- and poststenotic segments, with post-/pre-signal intensity ratios calculated. The Pearson correlation was used to compare percentage stenosis on MRA with conventional angiography and signal intensity ratios with percentage stenosis; the point-biserial correlation was used for infarcts compared with percentage stenosis and signal intensity ratios. Sensitivity, specificity, and positive and negative predictive values were calculated for determining severe (≥70%) stenosis from MRA and signal intensity ratios against the criterion standard conventional angiography.
< .05 was considered statistically significant.
Seventy stenotic segments were found in 48 studies in 41 children (median age, 11.0 years; range, 5 months to 17.0 years; male/female ratio, 22:19): 20/41 (48.8%) bilateral, 11/41 (26.8%) right, and 10/41 (24.4%) left, with the most common site being the proximal middle cerebral artery (22/70, 31%). Moyamoya disease accounted for 27/41 (65.9%). Signal intensity ratios and conventional angiography stenosis showed a moderate negative correlation (
= -0.54,
< .001). Receiver operating characteristic statistics showed an area under the curve of 0.86 for using post-/pre-signal intensity ratios to determine severe (≥70%) carotid stenosis, yielding a threshold of 1.00. Sensitivity, specificity, and positive and negative predictive values for severe stenosis were the following-MRA: 42.8%, 58.8%, 30.0%, and 71.4%; signal intensity ratio >1.00: 97.1%, 77.8%, 71.7%, and 97.4%; combination: 75.5%, 100%, 100%, and 76.8%, respectively. Signal intensity ratios decreased with increasing grade of stenosis (none/mild-moderate/severe/complete,
< .001) and were less when associated with infarcts (0.81 ± 0.52 for arteries associated with downstream infarcts versus 1.31 ± 0.55 for arteries without associated infarcts,
< .001).
Signal intensity ratios from TOF-MRA can serve as a noninvasive measure of intracranial arterial stenosis and allow identification of high-risk lesions in pediatric stroke.</description><identifier>ISSN: 0195-6108</identifier><identifier>EISSN: 1936-959X</identifier><identifier>DOI: 10.3174/ajnr.A6441</identifier><identifier>PMID: 32115418</identifier><language>eng</language><publisher>United States: American Society of Neuroradiology</publisher><subject>Adolescent ; Algorithms ; Carotid Stenosis - complications ; Carotid Stenosis - diagnostic imaging ; Carotid Stenosis - pathology ; Child ; Female ; Humans ; Infant ; Magnetic Resonance Angiography - methods ; Male ; Middle Cerebral Artery - diagnostic imaging ; Middle Cerebral Artery - pathology ; Pediatrics ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Stroke - etiology ; Stroke - pathology</subject><ispartof>American journal of neuroradiology : AJNR, 2020-03, Vol.41 (3), p.535-541</ispartof><rights>2020 by American Journal of Neuroradiology.</rights><rights>2020 by American Journal of Neuroradiology 2020 American Journal of Neuroradiology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c378t-f70a3401e5207ee90c56798853d05e3e82883ffac99bd5473fc341cb3242b9273</citedby><cites>FETCH-LOGICAL-c378t-f70a3401e5207ee90c56798853d05e3e82883ffac99bd5473fc341cb3242b9273</cites><orcidid>0000-0002-7062-9571 ; 0000-0002-1759-3848 ; 0000-0001-6324-9776 ; 0000-0001-5927-3132 ; 0000-0001-5718-6465 ; 0000-0002-3791-5920</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7077901/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7077901/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32115418$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ibrahim, A Y</creatorcontrib><creatorcontrib>Amirabadi, A</creatorcontrib><creatorcontrib>Shroff, M M</creatorcontrib><creatorcontrib>Dlamini, N</creatorcontrib><creatorcontrib>Dirks, P</creatorcontrib><creatorcontrib>Muthusami, P</creatorcontrib><title>Fractional Flow on TOF-MRA as a Measure of Stroke Risk in Children with Intracranial Arterial Stenosis</title><title>American journal of neuroradiology : AJNR</title><addtitle>AJNR Am J Neuroradiol</addtitle><description>Conventional angiography is the criterion standard for measuring intracranial arterial stenosis. We evaluated signal intensity ratios from TOF-MRA as a measure of intracranial stenosis and infarct risk in pediatric stroke.
A retrospective study was undertaken in children with intracranial arterial stenosis, who had TOF-MRA and conventional angiography performed within 6 months. Arterial diameters were measured for percentage stenosis. ROI analysis on TOF-MRA measured signal intensity in pre- and poststenotic segments, with post-/pre-signal intensity ratios calculated. The Pearson correlation was used to compare percentage stenosis on MRA with conventional angiography and signal intensity ratios with percentage stenosis; the point-biserial correlation was used for infarcts compared with percentage stenosis and signal intensity ratios. Sensitivity, specificity, and positive and negative predictive values were calculated for determining severe (≥70%) stenosis from MRA and signal intensity ratios against the criterion standard conventional angiography.
< .05 was considered statistically significant.
Seventy stenotic segments were found in 48 studies in 41 children (median age, 11.0 years; range, 5 months to 17.0 years; male/female ratio, 22:19): 20/41 (48.8%) bilateral, 11/41 (26.8%) right, and 10/41 (24.4%) left, with the most common site being the proximal middle cerebral artery (22/70, 31%). Moyamoya disease accounted for 27/41 (65.9%). Signal intensity ratios and conventional angiography stenosis showed a moderate negative correlation (
= -0.54,
< .001). Receiver operating characteristic statistics showed an area under the curve of 0.86 for using post-/pre-signal intensity ratios to determine severe (≥70%) carotid stenosis, yielding a threshold of 1.00. Sensitivity, specificity, and positive and negative predictive values for severe stenosis were the following-MRA: 42.8%, 58.8%, 30.0%, and 71.4%; signal intensity ratio >1.00: 97.1%, 77.8%, 71.7%, and 97.4%; combination: 75.5%, 100%, 100%, and 76.8%, respectively. Signal intensity ratios decreased with increasing grade of stenosis (none/mild-moderate/severe/complete,
< .001) and were less when associated with infarcts (0.81 ± 0.52 for arteries associated with downstream infarcts versus 1.31 ± 0.55 for arteries without associated infarcts,
< .001).
Signal intensity ratios from TOF-MRA can serve as a noninvasive measure of intracranial arterial stenosis and allow identification of high-risk lesions in pediatric stroke.</description><subject>Adolescent</subject><subject>Algorithms</subject><subject>Carotid Stenosis - complications</subject><subject>Carotid Stenosis - diagnostic imaging</subject><subject>Carotid Stenosis - pathology</subject><subject>Child</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Magnetic Resonance Angiography - methods</subject><subject>Male</subject><subject>Middle Cerebral Artery - diagnostic imaging</subject><subject>Middle Cerebral Artery - pathology</subject><subject>Pediatrics</subject><subject>Retrospective Studies</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Stroke - etiology</subject><subject>Stroke - pathology</subject><issn>0195-6108</issn><issn>1936-959X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNpVkU1LAzEQhoMoWqsXf4DkKMJqstlskotQitWCUmgreAtpOmvTbhNNtor_3q1f6GkG5uGZYV6ETii5YFQUl2bp40WvLAq6gzpUsTJTXD3uog6himclJfIAHaa0JIRwJfJ9dMBySnlBZQdVg2hs44I3NR7U4Q0Hj6ejQXY_7mGTsMH3YNImAg4VnjQxrACPXVph53F_4ep5BI_fXLPAQ9-0pmi8a0292EDcNpMGfEguHaG9ytQJjr9rFz0Mrqf92-xudDPs9-4yy4RsskoQwwpCgedEAChieSmUlJzNCQcGMpeSVZWxSs3mvBCssqygdsbyIp-pXLAuuvryPm9ma5hb2F5V6-fo1ia-62Cc_j_xbqGfwqsWRAhFaCs4-xbE8LKB1Oi1Sxbq2ngIm6RzViopRPvKFj3_Qm0MKUWoftdQorfB6G0w-jOYFj79e9gv-pME-wDVjomz</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Ibrahim, A Y</creator><creator>Amirabadi, A</creator><creator>Shroff, M M</creator><creator>Dlamini, N</creator><creator>Dirks, P</creator><creator>Muthusami, P</creator><general>American Society of Neuroradiology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7062-9571</orcidid><orcidid>https://orcid.org/0000-0002-1759-3848</orcidid><orcidid>https://orcid.org/0000-0001-6324-9776</orcidid><orcidid>https://orcid.org/0000-0001-5927-3132</orcidid><orcidid>https://orcid.org/0000-0001-5718-6465</orcidid><orcidid>https://orcid.org/0000-0002-3791-5920</orcidid></search><sort><creationdate>202003</creationdate><title>Fractional Flow on TOF-MRA as a Measure of Stroke Risk in Children with Intracranial Arterial Stenosis</title><author>Ibrahim, A Y ; Amirabadi, A ; Shroff, M M ; Dlamini, N ; Dirks, P ; Muthusami, P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c378t-f70a3401e5207ee90c56798853d05e3e82883ffac99bd5473fc341cb3242b9273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Algorithms</topic><topic>Carotid Stenosis - complications</topic><topic>Carotid Stenosis - diagnostic imaging</topic><topic>Carotid Stenosis - pathology</topic><topic>Child</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Magnetic Resonance Angiography - methods</topic><topic>Male</topic><topic>Middle Cerebral Artery - diagnostic imaging</topic><topic>Middle Cerebral Artery - pathology</topic><topic>Pediatrics</topic><topic>Retrospective Studies</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Stroke - etiology</topic><topic>Stroke - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ibrahim, A Y</creatorcontrib><creatorcontrib>Amirabadi, A</creatorcontrib><creatorcontrib>Shroff, M M</creatorcontrib><creatorcontrib>Dlamini, N</creatorcontrib><creatorcontrib>Dirks, P</creatorcontrib><creatorcontrib>Muthusami, P</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of neuroradiology : AJNR</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ibrahim, A Y</au><au>Amirabadi, A</au><au>Shroff, M M</au><au>Dlamini, N</au><au>Dirks, P</au><au>Muthusami, P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fractional Flow on TOF-MRA as a Measure of Stroke Risk in Children with Intracranial Arterial Stenosis</atitle><jtitle>American journal of neuroradiology : AJNR</jtitle><addtitle>AJNR Am J Neuroradiol</addtitle><date>2020-03</date><risdate>2020</risdate><volume>41</volume><issue>3</issue><spage>535</spage><epage>541</epage><pages>535-541</pages><issn>0195-6108</issn><eissn>1936-959X</eissn><abstract>Conventional angiography is the criterion standard for measuring intracranial arterial stenosis. We evaluated signal intensity ratios from TOF-MRA as a measure of intracranial stenosis and infarct risk in pediatric stroke.
A retrospective study was undertaken in children with intracranial arterial stenosis, who had TOF-MRA and conventional angiography performed within 6 months. Arterial diameters were measured for percentage stenosis. ROI analysis on TOF-MRA measured signal intensity in pre- and poststenotic segments, with post-/pre-signal intensity ratios calculated. The Pearson correlation was used to compare percentage stenosis on MRA with conventional angiography and signal intensity ratios with percentage stenosis; the point-biserial correlation was used for infarcts compared with percentage stenosis and signal intensity ratios. Sensitivity, specificity, and positive and negative predictive values were calculated for determining severe (≥70%) stenosis from MRA and signal intensity ratios against the criterion standard conventional angiography.
< .05 was considered statistically significant.
Seventy stenotic segments were found in 48 studies in 41 children (median age, 11.0 years; range, 5 months to 17.0 years; male/female ratio, 22:19): 20/41 (48.8%) bilateral, 11/41 (26.8%) right, and 10/41 (24.4%) left, with the most common site being the proximal middle cerebral artery (22/70, 31%). Moyamoya disease accounted for 27/41 (65.9%). Signal intensity ratios and conventional angiography stenosis showed a moderate negative correlation (
= -0.54,
< .001). Receiver operating characteristic statistics showed an area under the curve of 0.86 for using post-/pre-signal intensity ratios to determine severe (≥70%) carotid stenosis, yielding a threshold of 1.00. Sensitivity, specificity, and positive and negative predictive values for severe stenosis were the following-MRA: 42.8%, 58.8%, 30.0%, and 71.4%; signal intensity ratio >1.00: 97.1%, 77.8%, 71.7%, and 97.4%; combination: 75.5%, 100%, 100%, and 76.8%, respectively. Signal intensity ratios decreased with increasing grade of stenosis (none/mild-moderate/severe/complete,
< .001) and were less when associated with infarcts (0.81 ± 0.52 for arteries associated with downstream infarcts versus 1.31 ± 0.55 for arteries without associated infarcts,
< .001).
Signal intensity ratios from TOF-MRA can serve as a noninvasive measure of intracranial arterial stenosis and allow identification of high-risk lesions in pediatric stroke.</abstract><cop>United States</cop><pub>American Society of Neuroradiology</pub><pmid>32115418</pmid><doi>10.3174/ajnr.A6441</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-7062-9571</orcidid><orcidid>https://orcid.org/0000-0002-1759-3848</orcidid><orcidid>https://orcid.org/0000-0001-6324-9776</orcidid><orcidid>https://orcid.org/0000-0001-5927-3132</orcidid><orcidid>https://orcid.org/0000-0001-5718-6465</orcidid><orcidid>https://orcid.org/0000-0002-3791-5920</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Algorithms Carotid Stenosis - complications Carotid Stenosis - diagnostic imaging Carotid Stenosis - pathology Child Female Humans Infant Magnetic Resonance Angiography - methods Male Middle Cerebral Artery - diagnostic imaging Middle Cerebral Artery - pathology Pediatrics Retrospective Studies ROC Curve Sensitivity and Specificity Stroke - etiology Stroke - pathology |
| title | Fractional Flow on TOF-MRA as a Measure of Stroke Risk in Children with Intracranial Arterial Stenosis |
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