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22. European Stroke Conference Vascular imaging (PO 191 - 220) 384 © 2013 S. Karger AG, Basel Scientific Programme 192 Vascular imaging Unruptured intracranial aneurysm pulsation imaged with 7.0 Tesla MRI. R. Kleinloog1, J.J. Zwanenburg2, Y.M. Ruigrok3, P.R. Luijten4, F. Visser5, L. Regli6, G.J. Rinkel7, B.H. Verweij8 Utrecht Stroke Centre, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, THE NETHERLANDS1, Depart-ment of Radiology, University Medical Centre Utrecht, Utrecht, THE NETHERLANDS2, Utrecht Stroke Centre, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neurosci-ence, University Medical Centre Utrecht, Utrecht, THE NETHERLANDS3, Department of Radiol-ogy, University Medical Centre Utrecht, Utrecht, THE NETHERLANDS4, Philips Healthcare, Best, THE NETHERLANDS5, Department of Neurosurgery, University Hospital Zürich, Zürich, SWIT-ZERLAND6, Utrecht Stroke Centre, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, THE NETHERLANDS7, Utrecht Stroke Centre, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, THE NETHERLANDS8 Background: Risk prediction of rupture of intracranial aneurysms is poor. Therefore markers of rup-ture are needed. Interesting markers could be those reflecting wall properties, such as pulsation of the aneurysm, defined as change in total volume during the cardiac cycle. However, the resolution of currently available imaging methods is insufficient to image changes in volume of small lesions such as aneurysms. Since 7.0 Tesla (7T) MRI enables imaging with a higher resolution, we evaluat-ed whether 7T MRI can be used to image pulsation. Methods: Nine patients with ten unruptured intracranial aneurysms underwent 7T MRI with a 32 channel receive head-coil using a Turbo Field Echo (TFE) sequence with cardiac triggering (resolu-tion: 0.6x0.6x0.6mm3, acquired temporal resolution: 90 ms, interpolated to 15 cardiac phases). An-eurysm volume was measured per phase using ANALYZE 11.0 software. The percentage increase in volume between the phase with the largest volume and the phase with the smallest volume was calculated: ((maximum volume - minimum volume) / minimum volume) x 100%. Volume measure-ments were repeated for one randomly selected cardiac phase for each aneurysm and an intraclass correlation coefficient (ICC) with 95% confidence interval (CI) was calculated. Patient and aneu-rysm characteristics were collected. Results: The mean age of the patients was 60 years (SD 8 years) and 7 were female. Aneurysms were located on the middle cerebral artery (4), anterior cerebral artery (4), basilar artery (1) and pos-terior inferior cerebellar artery (1). Mean aneurysm size was 9mm (range 2-19mm; SD 4.5mm). The mean increase in volume was 8.7% (SD 7.5%, range 2.7–28%). The ICC was 0.995 (95%CI:0.968– 0.999). Conclusion: Pulsation of intracranial aneurysm volume can be imaged with 7T MRI and the volume analysis is highly reproducible. The absolute and proportional volume changes differ between aneu-rysms. 191 Vascular imaging Migraine is associated with an incomplete circle of Willis B. Cucchiara1, R.L. Wolf2, L. Nagae3, Q. Zhang4, R. Datta5, S.E. Kasner6, G.K. Aguirre7, J.A. De-tre8 University of Pennsylvania, Philadelphia, USA1, University of Pennsylvania, Philadelphia, USA2, Children’s Hospital of Philadelphia, Philadelphia, USA3, Tianjin Medical University, Tianjin, CHI-NA4, University of Pennsylvania, Philadelphia, USA5, University of Pennsylvania, Philadelphia, USA6, University of Pennsylvania, Philadelphia, USA7, University of Pennsylvania, Philadelphia, USA8 Background: Anatomical variations in the circle of Willis are common and may alter cerebral blood flow (CBF) regulation. Cortical spreading depression is thought to play a critical role in migraine and can be triggered by alterations in CBF. It is not known whether variations in the structure of the circle of Willis might contribute to migraine susceptibility. Methods: We performed the Anatomy and Cerebral Hemodynamic Evaluation of Migraine (ACHE-M) study, a prospective, observational, case-control study. Migraine with aura (MWA), migraine without aura (MwoA), and control subjects between the age of 25-50 were enrolled in a 1:1:1 ratio. 3T MRA was performed to examine circle of Willis anatomy and arterial spin labeled perfusion MRI to measure regional CBF. Two blinded raters used a standardized template rating system to categorize circle of Willis variants. The primary pre-specified outcome measure was the frequency of an incomplete circle of Willis. The association between circle of Willis variations and regional CBF was also ana-lyzed. Results: 170 subjects were enrolled (53 control, 56 MWA, 61 MwoA). An incomplete circle of Willis was significantly more common in the MWA compared to control group (73% vs. 51%, p=0.02), with a similar trend for the MwoA group (67% vs. 51%, p=0.08). Using a quantitative score of the burden of circle of Willis variants, MWA subjects had a higher burden of variants than controls (p=0.02). Regional CBF in PCA territory was significantly lower in subjects with an incomplete posterior cir-cle (53.3 vs. 58.4 ml/100 grams/min, p=0.02). Compared to those with a complete circle, subjects with an incomplete circle had greater asymmetry in hemispheric cerebral blood flow (p=0.05). Conclusions: An incomplete circle of Willis is more common in migraine subjects than controls, and is associated with alterations in CBF.


Karger_ESC London_2013
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