Blood Flow Volume Measurement in Cervical and Intracranial Arteries using Quantitative Magnetic Resonance Angiography and Duplex Sonography (Bocaccia) – A Prospective Observational Study

Jiří Fiedler; Martin Reiser; Petr Košťál; Jiří Kubále; Svatopluk Ostrý; Tomáš Hrbáč; Petra Kešnerová; Táňa Fadrná; Kateřina Langová; Roman Herzig; David Školoudík

doi:10.1055/a-1113-7343

Ultraschall in der Medizin - European Journal of Ultrasound, Inhaltsverzeichnis

Ultraschall Med 2021; 42(01): 65-74
DOI: 10.1055/a-1113-7343

Original Article

Blood Flow Volume Measurement in Cervical and Intracranial Arteries using Quantitative Magnetic Resonance Angiography and Duplex Sonography (Bocaccia) – A Prospective Observational Study

Messung des Blutflussvolumens in zervikalen und intrakraniellen Arterien mittels quantitativer Magnetresonanzangiografie und Duplex-Sonografie (Bocaccia) – eine prospektive Beobachtungsstudie

Jiří Fiedler

¹Department of Neurosurgery, Comprehensive Stroke Center, University Hospital Plzeň, Czech Republic

,

Martin Reiser

²Department of Neurology, Comprehensive Stroke Center, Hospital České Budějovice, Czech Republic

,

Petr Košťál

¹Department of Neurosurgery, Comprehensive Stroke Center, University Hospital Plzeň, Czech Republic

,

Jiří Kubále

³Department of Radiology, Comprehensive Stroke Center, Hospital České Budějovice, Czech Republic

,

Svatopluk Ostrý

²Department of Neurology, Comprehensive Stroke Center, Hospital České Budějovice, Czech Republic

,

Tomáš Hrbáč

⁴Department of Neurosurgery, Comprehensive Stroke Center, University Hospital Ostrava, Czech Republic

,

Petra Kešnerová

⁵Department of Neurology, 2nd Medical Faculty, Charles-University, Praha, Czech Republic

,

Táňa Fadrná

⁶Center for Research and Science, Faculty of Health Sciences, Palacký-University Olomouc, Czech Republic

,

Kateřina Langová

⁷Department of Biophysics, Faculty of Medicine and Dentistry, Institute of Molecular and Translational Medicine, Palacký-University Olomouc, Czech Republic

,

Roman Herzig

⁸Department of Neurology, Comprehensive Stroke Center, Charles-University Faculty of Medicine in Hradec Kralove, Czech Republic

,

David Školoudík

⁶Center for Research and Science, Faculty of Health Sciences, Palacký-University Olomouc, Czech Republic

› Institutsangaben

Abstract

Purpose Cerebral blood flow volume is an important factor for the accurate diagnosis of neurovascular diseases and treatment indication. This study aims to assess correlations of blood flow volume measurements in cervical and intracranial arteries between duplex sonography and quantitative magnetic resonance angiography (qMRA).

Materials and Methods Consecutive patients with suspicion of cerebral vascular pathology underwent qMRA and duplex sonography of cervical and intracranial arteries with measurement of blood flow volume in bilateral common (CCA), internal (ICA) and external carotid arteries, vertebral and basilar arteries, middle, anterior, posterior cerebral and posterior communicating arteries using 2 different ultrasound machines. Ten patients underwent all examinations twice. Correlations between blood flow volume measurements were evaluated using Spearman’s correlation coefficient and inter-class correlation coefficient (ICC).

Results In total, 21 subjects (15 males, mean age: 56.3 ± 6.2 years) were included in the study. Duplex sonography inter-investigator correlation was excellent (ICC = 0.972, p < 0.0001) as well as intra-investigator correlations of both qMRA and duplex sonography (ICC ˃ 0.990, p < 0.0001). Mostly high correlations were recorded between qMRA and duplex sonography in particular cervical arteries but only low to moderate correlations were obtained for intracranial arteries. The mean differences between blood flow volume measurements were 10.9 ± 8.1 % in the CCA and its branches when using qMRA and 15.0 ± 11.9 % when using duplex sonography, 13.5 ± 11.8 %/35.4 ± 34.2 % in the ICA siphon and its branches when using qMRA/duplex sonography, and 24.1 ± 19.7 %/44.9 ± 44.0 % in both vertebral arteries and the basilar artery when using qMRA/duplex sonography.

Conclusion Duplex sonography as well as qMRA allow for highly reproducible measurement of blood flow volume in cervical and intracranial arteries in routine clinical practice.

Zusammenfassung

Ziel Das zerebrale Blutflussvolumen ist ein wichtiger Parameter für die Diagnosestellung bei neurovaskulären Erkrankungen und die Therapieindikation. Ziel dieser Studie ist es, die Übereinstimmung von Blutflussvolumenmessungen zwischen Duplex-Sonografie und quantitativer Magnetresonanzangiografie (qMRA) in zervikalen und intrakraniellen Arterien zu beurteilen.

Material und Methoden Bei konsekutiven Patienten mit Verdacht auf zerebrale Gefäßpathologie wurden eine qMRA und Duplex-Sonografie der zervikalen und intrakraniellen Arterien mit Blutflussvolumenmessung mit 2 verschiedenen Ultraschallgeräten in der bilateralen A. carotis communis (CCA), A. carotis interna (ICA) und externa, A. vertebralis und A. basilaris und in der A. cerebri media, anterior und posterior und in der A. communicans posterior durchgeführt. Zehn Patienten wurden 2-mal untersucht. Die Übereinstimmungen zwischen den Blutflussvolumenmessungen wurden mittels Spearman-Korrelationskoeffizient und Interklassen-Korrelationskoeffizient (ICC) bewertet.

Ergebnisse Insgesamt wurden 21 Probanden (15 Männer, Durchschnittsalter 56,3 ± 6,2 Jahre) in die Studie eingeschlossen. Die Übereinstimmung zwischen den Untersuchern der Duplex-Sonografie war ausgezeichnet (ICC = 0,972; p < 0,0001), ebenso die Übereinstimmung zwischen Untersuchern in der qMRA und der Duplex-Sonografie (ICC ˃ 0,990; p < 0,0001). Meistens wurden hohe Korrelationen zwischen qMRA und Duplex-Sonografie insbesondere für zervikale Arterien festgestellt, jedoch nur geringe bis mäßige Korrelationen für intrakranielle Arterien. Die mittleren Differenzen zwischen den Blutflussvolumenmessungen in der CCA und ihren Ästen betrugen 10,9 ± 8,1 % in der qMRA und 15,0 ± 11,9 % in der Duplex-Sonografie, im ICA-Siphon und seinen Ästen 13,5 ± 11,8 % (qMRA) und 35,4 ± 34,2 % (Duplex) und in beiden A. vertebralis und A. basilaris 24,1 ± 19,7 % (qMRA) und 44,9 ± 44,0 % (Duplex).

Schlussfolgerung Sowohl die Duplex-Sonografie als auch die qMRA erlauben eine gut reproduzierbare Messung des Blutflussvolumens in zervikalen und intrakraniellen Arterien in der klinischen Routinepraxis.

Key words

magnetic resonance - duplex sonography - blood flow volume - cervical arteries - brain arteries

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