{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,15]],"date-time":"2024-09-15T13:11:55Z","timestamp":1726405915291},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,4,2]],"date-time":"2019-04-02T00:00:00Z","timestamp":1554163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["5R01NS078828\u201002"],"award-info":[{"award-number":["5R01NS078828\u201002"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["14PRE20370055"],"award-info":[{"award-number":["14PRE20370055"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006098","name":"Radiological Society of North America","doi-asserted-by":"publisher","award":["RMS1402"],"award-info":[{"award-number":["RMS1402"]}],"id":[{"id":"10.13039\/100006098","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Magnetic Resonance Imaging"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Stroke risk stratification in patients with symptomatic intracranial atherosclerotic arterial disease (ICAD) remains an important clinical objective owing to the high 14\u201319% recurrent stroke rate in these patients on standard\u2010of\u2010care medical management. There thus remains a need for hemodynamic markers that may allow for the selection of personalized therapies for high\u2010risk symptomatic patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To determine if shifting of cerebral blood flow (CBF) territories in response to changes in cerebral perfusion pressure (CPP) may provide a marker for stroke risk in ICAD patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Type<\/jats:title><jats:p>Prospective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Twenty ICAD patients who experienced a stroke within 45 days of study enrollment and 10 healthy controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Sequence<\/jats:title><jats:p>3.0T MRI including anatomical imaging (T<jats:sub>1<\/jats:sub>\u2010weighted, T<jats:sub>2<\/jats:sub>\u2010weighted\/FLAIR), 3D MR angiography, and normocapnic and hypercapnic vessel\u2010encoded CBF\u2010weighted arterial spin labeling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Assessment<\/jats:title><jats:p>Patients were scanned within 45 days of overt stroke and monitored (duration = 13.2 \u00b1 4.4 months) for the endpoint of non\u2010cardioembolic stroke or transient ischemic attack. Flow territory shifting (shifting index) was calculated from the first scan by determining whether a voxel shifted from its primary arterial source from normocapnia to hypercapnia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Statistical Tests<\/jats:title><jats:p>A Mann\u2013Whitney<jats:italic>U<\/jats:italic>\u2010test (significance:<jats:italic>P<\/jats:italic>&lt; 0.05) was performed to determine whether patients meeting the endpoint had greater shifting indices relative to controls or patients not meeting the endpoint.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Shifting indices (mean \u00b1 standard error) were significantly higher in patients meeting endpoint criteria relative to controls (<jats:italic>P<\/jats:italic>= 0.0057; adjusted<jats:italic>P<\/jats:italic>= 0.036) and patients not meeting endpoint criteria (<jats:italic>P<\/jats:italic>= 0.0047; adjusted<jats:italic>P<\/jats:italic>= 0.036).<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Conclusion<\/jats:title><jats:p>Flow territory shifting may provide a marker of recurrent stroke risk in symptomatic ICAD patients on standard\u2010of\u2010care medical management therapies.<\/jats:p><jats:p><jats:bold>Level of Evidence:<\/jats:bold>1<\/jats:p><jats:p><jats:bold>Technical Efficacy:<\/jats:bold>Stage 2<\/jats:p><jats:p>J. Magn. Reson. Imaging 2019;50:1441\u20131451.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jmri.26737","type":"journal-article","created":{"date-parts":[[2019,4,2]],"date-time":"2019-04-02T07:53:17Z","timestamp":1554191597000},"page":"1441-1451","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cerebral blood flow territory instability in patients with atherosclerotic intracranial stenosis"],"prefix":"10.1002","volume":"50","author":[{"given":"Daniel F.","family":"Arteaga","sequence":"first","affiliation":[{"name":"Department of Neurology University of Virginia Charlottesville Virginia USA"},{"name":"Department of Radiology Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan K.","family":"Strother","sequence":"additional","affiliation":[{"name":"Department of Radiology Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos C.","family":"Faraco","sequence":"additional","affiliation":[{"name":"Department of Radiology Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. 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