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Advanced Neurology T-ASL in etiological diagnosis of multiple infarcts

infarcts had been found to be within both the anterior In conclusion, the diagnostic information provided
and posterior circulations, a thorough investigation by T-ASL is valuable for identifying the symptomatic
for cardiac or cryptogenic embolism might have been perfusion territories and stroke etiology, which could
performed. However, T-ASL showed that the BA was the help in guiding therapeutic management in patients with
only symptomatic perfusion territory. Considering the stroke.
marked stenosis of the BA, large artery atherosclerosis was
confirmed as the stroke etiology, and antiplatelet agents Funding
rather than anticoagulants were indicated for this patient. This work was not supported financially by any research
This correct identification of the symptomatic perfusion grant.
territory was therapeutically important.
The differences in the perfusion territories of the Conflict of interest
brain-feeding arteries among individuals [1,2] , especially The authors declare no conflicts of interest.
in patients with cerebrovascular steno-occlusive
disease, are primarily due to the status of the collateral Author contributions
circulation. Anatomic and imaging studies have shown Conceptualization: Jun Ni, Yuehui Hong
that the pattern of the circle of Willis is strongly related
to the expected perfusion pattern [1,2] . For example, a Methodology: Bo Hou, Jun Ni
hypoplastic A1 of the anterior cerebral artery might Resources: Bo Hou, Xiaoyuan Fan, Yuehui Hong
share less blood flow of the hemisphere. In addition,
the secondary collaterals that comprise the ophthalmic Investigation: Yuehui Hong, Bo Hou
artery and leptomeningeal vessels also play a pivotal role Formal analysis: Lixin Zhou, Jun Ni
in the pathophysiology of ischemic stroke, especially for Writing - original draft: Yuehui Hong
patients with steno-occlusive cerebrovascular disease. An
enhanced capacity for cerebral blood flow requires time to Writing - review & editing: Lixin Zhou, Jun Ni
develop and depends on the temporal course of numerous
compensatory hemodynamic, metabolic, and neural Availability of data and materials
mechanisms . Data will be available on contacting the corresponding
[3]
Therefore, the assessment of collaterals and perfusion author.
in patients with cerebrovascular disease is critical. The Ethics approval and consent to participate
variation of perfusion related to the circle of Willis is
readily assessed using magnetic resonance angiography. The requirement for ethics approval was waived by the
However, the collaterals through the leptomeningeal local ethics committee in view of the retrospective nature
vessels are difficult to assess by magnetic resonance of this study. All procedures performed were part of
angiography. This pitfall is profound in patients with routine clinical care.
steno-occlusive cerebrovascular disease. With the advent
of advanced imaging modalities, the current knowledge Consent for publication
of the collateral circulation has expanded. T-ASL MRI is a Written informed consent was not obtained because of
non-invasive method to visualize the perfusion territories the retrospective nature of this report. We ensured the
of the individual cerebral arteries. This technique uses anonymity of the patient, and the data presented do not
magnetically labeled blood as an endogenous contrast contain any identifiers.
agent. As the labeled arterial protons of the individual
cerebral artery flow through the brain, a perfusion- References
weighted image reflecting the perfusion territory of this 1. van der Zwan A, Hillen B, Tulleken CA, et al., 1993, A
cerebral artery is depicted. The advantages of T-ASL include quantitative investigation of the variability of the major
its non-invasiveness and consistency with the anatomic cerebral arterial territories. Stroke, 24(12): 1951–1959.
MRI findings [2,4,5] . Therefore, the relationship between https://doi.org/10.1161/01.str.24.12.1951
the infarct location on MRI and the perfusion territories
on T-ASL maps can be identified. In the previous studies 2. van Laar PJ, Hendrikse J, Golay X, et al., 2006, In vivo
of patients with stroke, the additional information from flow territory mapping of major brain feeding arteries.
T-ASL changed the territorial classification in 11-19% of Neuroimage, 29(1): 136–144.
the cerebral infarcts [5,6] , especially in patients with cortical https://doi.org/10.1016/j.neuroimage.2005.07.011
or border zone infarcts .
[5]

Volume 1 Issue 1 (2022) 3 https://doi.org/10.36922/an.v1i1.10