Reliability of perfusion MR imaging in symptomatic carotid occlusive disease: Cerebral blood volume, mean transit time and time-to-peak

Perfusion MR imaging offers an easy quantitative evaluation of relative regional cerebral blood volume (rrCBV), relative mean transit time (rMTT) and time-to-peak (TTP). The purpose of this study was to investigate the reliability of these parameters in assessing the hemodynamic disturbance of carotid occlusive disease in comparison with normative data. Dynamic contrast-enhanced T2*-weighted perfusion MR imaging was performed in 19 patients with symptomatic unilateral internal carotid artery occlusion and 20 control subjects. The three parameters were calculated from the concentration-time curve fitted by gamma-variate function. Lesion-to-contralateral ratios of each parameter were compared between patients and control subjects. Mean +/- SD of rrCBV, rMTT and TTP ratios of patients were 1.089 +/- 0.118, 1.054 +/- 0.031 and 1.062 +/- 0.039, respectively, and those of control subjects were 1.002 +/- 0.045, 1.000 +/- 0.006, 1.001 +/- 0.006, respectively. The rMTT and TTP ratios of all patients were greater than 2 SDs of control data, whereas in only 6 patients (32%), rrCBV ratios were greater than 2 SDs of control data. The three parameter ratios of the patients were significantly high compared with those of control subjects, respectively (p < 0.01 for rrCBV ratios, p < 0.0001 for rMTT ratios, and p < 0.0001 for TTP ratios). Our results indicate that rMTT and TTP of patients, in contrast to rrCBV, are distributed in narrow ranges minimally overlapped with control data. The rMTT and TTP could be more reliable parameters than rrCBV in assessing the hemodynamic disturbance in carotid occlusive disease.