Abstract
Background and Purpose: The purpose of this study was to explore the changes of iron level using quantitative susceptibility mapping (QSM) in the bilateral basal ganglia region in middle cerebral artery occlusion (MCAO) patients with long-term ischemia.Methods: Twenty-seven healthy controls and nine patients with MCAO were recruited, and their QSM images were obtained. The bilateral caudate nucleus (Cd), putamen (Pt), and globus pallidus (Gp) were selected as the regions of interest (ROIs). Susceptibility values of bilateral ROIs were calculated and compared between the affected side and unaffected side in patients with MCAO and between patients with MCAO and healthy controls. In addition, receiver operating characteristic (ROC) curves were performed to evaluate the diagnostic capability of susceptibility values in differentiating healthy controls and patients with MCAO by the area under the curve (AUC).Results: The susceptibility values of bilateral Cd were asymmetric in healthy controls; however, this asymmetry disappeared in patients with MCAO. In addition, compared with healthy controls, the average susceptibility values of the bilateral Pt in patients with MCAO were increased (P < 0.05), and the average susceptibility value of the bilateral Gp was decreased (P < 0.05). ROC curves showed that the susceptibility values of the Pt and Gp had a larger AUC (AUC = 0.700 and 0.889, respectively).Conclusion: As measured by QSM, the iron levels of the bilateral basal ganglia region were significantly changed in patients with MCAO. Iron dyshomeostasis in the basal ganglia region might be involved in the pathophysiological process of middle cerebral artery stenosis and occlusion. These findings may provide a novel insight to profoundly address the pathophysiological mechanisms of MCAO.
Highlights
It is well-established that stroke has been one of the most common cerebrovascular diseases that could generate neuronal deaths and subsequent disability and mortality
The interobserver variability was assessed by intraclass correlation coefficient (ICC), and a good agreement was acquired between two radiologists for the susceptibility values (Table 3)
The results showed that the susceptibility values of bilateral caudate nucleus (Cd) were asymmetric in healthy controls; the asymmetry disappeared in patients with middle cerebral artery occlusion (MCAO)
Summary
It is well-established that stroke has been one of the most common cerebrovascular diseases that could generate neuronal deaths and subsequent disability and mortality. Middle cerebral artery stenosis and occlusion is the most frequent ischemic subtype in clinical practice and the most widely selected experimental model to elucidate the pathophysiology of cerebrovascular ischemic lesions. Mainly stored in the form of ferritin or hemosiderin in brain tissue, is indispensable to the maintenance of normal brain function as it is an important cofactor for various enzymes involved in neurotransmitter synthesis, oxygen transport, electron transfer, and myelin generation (Connor et al, 2001; Munoz and Humeres, 2012). The purpose of this study was to explore the changes of iron level using quantitative susceptibility mapping (QSM) in the bilateral basal ganglia region in middle cerebral artery occlusion (MCAO) patients with long-term ischemia
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