Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2026
How vascular territories change in intracranial atherosclerosis - a CT perfusion flow territory mapping study.
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Pavlin-Premrl Davor, Thijs Vincent, Mitchell Peter J, Yassi Nawaf, Parsons Mark, Christensen Søren, Boopathy Sethu Raman, Nemes Andras, Mohammadzadeh Milad, Monajemi Sadaf, Churilov Leonid, Yeo Leonard, Campbell Bruce Cv
Аннотация
BACKGROUND: Intracranial atherosclerosis is common and has a high recurrence rate. It has been theorized that vascular territory volumes change in ICAD due to collateral activation, but this has not been demonstrated. CT perfusion territory flow mapping is a recently developed technique that uses the collision of wavefronts from perfusion data of different territories to calculate territory volumes. We aimed to investigate how territory volumes change in ICAD.
METHODS: This was a multi-centre international case-control study where we measured arterial territory volumes in 72 patients with ICAD, as well as 49 controls using CT perfusion-based flow territory mapping. ICAD-affected and ICAD-adjacent territory volumes were compared to their homologous pairs and to control patient territories. Correlation between territory volumes and percentage vessel stenosis was tested.
RESULTS: The territory volumes in the ICAD-affected regions were significantly smaller (p<0.001) and adjacent territories significantly larger (p<0.001) than homologous contralateral territories. ICAD-affected territory volume ratios were also significantly smaller than control territory ratios, median 0.84 (IQR 0.63-0.99) vs 0.97 (IQR 0.87-1.09), p<0.001. For the largest group (MCA affected territories), the median of the ICAD affected sides was 232.3mls (IQR 162.4-275.9mls) and the median of the unaffected sides was 270.1mls (IQR 241.0-303.7mls). Adjacent territory ratios were significantly larger than control territory ratios 1.19 (IQR 0.95-1.55) vs 0.97 (IQR 0.87-1.09), p<0.001.
CONCLUSIONS: This study demonstrates that the presence of ICAD is associated with reduction in volume of the affected arterial territory with increases in the adjacent territory volumes.
METHODS: This was a multi-centre international case-control study where we measured arterial territory volumes in 72 patients with ICAD, as well as 49 controls using CT perfusion-based flow territory mapping. ICAD-affected and ICAD-adjacent territory volumes were compared to their homologous pairs and to control patient territories. Correlation between territory volumes and percentage vessel stenosis was tested.
RESULTS: The territory volumes in the ICAD-affected regions were significantly smaller (p<0.001) and adjacent territories significantly larger (p<0.001) than homologous contralateral territories. ICAD-affected territory volume ratios were also significantly smaller than control territory ratios, median 0.84 (IQR 0.63-0.99) vs 0.97 (IQR 0.87-1.09), p<0.001. For the largest group (MCA affected territories), the median of the ICAD affected sides was 232.3mls (IQR 162.4-275.9mls) and the median of the unaffected sides was 270.1mls (IQR 241.0-303.7mls). Adjacent territory ratios were significantly larger than control territory ratios 1.19 (IQR 0.95-1.55) vs 0.97 (IQR 0.87-1.09), p<0.001.
CONCLUSIONS: This study demonstrates that the presence of ICAD is associated with reduction in volume of the affected arterial territory with increases in the adjacent territory volumes.