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Research ArticleNEUROVASCULAR/STROKE IMAGING

Correlation between P2-PCA Volume Flow Rate and BOLD Cerebrovascular Reactivity in Patients with Symptomatic Carotid Artery Occlusion

Amely Walser, Jorn Fierstra, Lara Maria Höbner, Jacopo Bellomo, Tilman Schubert, Menno Germans, Vittorio Stumpo, Christiaan Hendrik Bas van Niftrik, Susanne Wegener, Andreas R. Luft, Zsolt Kulcsár, Luca Regli, Giuseppe Esposito and Martina Sebök
American Journal of Neuroradiology June 2025, DOI: https://doi.org/10.3174/ajnr.A8626
Amely Walser
aFrom the Department of Neurosurgery (G.E., M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
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Jorn Fierstra
aFrom the Department of Neurosurgery (G.E., M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
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  • ORCID record for Jorn Fierstra
Lara Maria Höbner
aFrom the Department of Neurosurgery (G.E., M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
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Jacopo Bellomo
aFrom the Department of Neurosurgery (G.E., M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
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Tilman Schubert
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
cDepartment of Neuroradiology (T.S., Z.K.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Menno Germans
aFrom the Department of Neurosurgery (G.E., M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
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Vittorio Stumpo
aFrom the Department of Neurosurgery (G.E., M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
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Christiaan Hendrik Bas van Niftrik
aFrom the Department of Neurosurgery (G.E., M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
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Susanne Wegener
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
dDepartment of Neurology (S.W., A.R.L.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Andreas R. Luft
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
dDepartment of Neurology (S.W., A.R.L.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
eCereneo Center for Neurology and Rehabilitation (A.R.L.), Vitznau, Switzerland
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Zsolt Kulcsár
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
cDepartment of Neuroradiology (T.S., Z.K.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Luca Regli
aFrom the Department of Neurosurgery (G.E., M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
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Giuseppe Esposito
aFrom the Department of Neurosurgery (G.E., M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Martina Sebök
aFrom the Department of Neurosurgery (G.E., M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
bClinical Neuroscience Center (M.S., A.W., J.F., L.M.H., J.B., M.G., V.S., C.H.B.v.N., L.R., T.S., S.W., A.R.L., Z.K.), University Hospital Zurich, Zurich, Switzerland
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  • FIG 1.
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    FIG 1.

    Correlation analysis between NOVA-qMRA-derived P2-VFR and BOLD-CVR of the MCA territory. Linear mixed-effects model. A moderate correlation is seen with r = 0.44, R2 = 0.2, and P < .001. The adjusted R2 value of 0.20 means that 20% of the variance of the P2-VFR can be explained by the BOLD-CVR of the MCA territory. The affected side refers to ipsilateral to ICA stenosis.

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    FIG 2.

    Correlation analysis between NOVA-qMRA-derived P2-VFR and hemispheric BOLD-CVR. At the top, the linear mixed-effects model considering both hemispheres is shown. This shows a moderate correlation with r = 0.39, R2 = 0.15, and P < .001. The adjusted R2 value of 0.15 means that 15% of the variance of the P2-VFR can be explained by the BOLD-CVR of the MCA territory. The affected side refers to ipsilateral to ICA stenosis.

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    FIG 3.

    An illustrative case of a patient presenting with symptomatic ICA occlusion. The BOLD-CVR map shows severely impaired BOLD-CVR in the left ACA and MCA territory, including negative CVR-values indicating the steal phenomenon. The NOVA-qMRA report shows that the P2 flow is nearly double the amount on the affected left side than on the unaffected right side.

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    Table 1:

    Patient characteristics

    Baseline Characteristicsn = 37
    Age (mean ± SD), y (range)64 ± 11 (37–82)
    Male, n (%)28 (76)
    Smoking, n (%)21 (57)
    Hypertension, n (%)21 (57)
    Dyslipidemia, n (%)22 (59)
    Diabetes mellitus9 (24)
    Coronary artery disease, n (%)6 (16)
    Peripheral arterial occlusive disease, n (%)3 (8.1)
    Atrial fibrillation, n (%)6 (16)
    Event classification, n (%)
    • Ischemic stroke, n (%)

    34 (92)
    • Transient ischemic attack, n (%)

    2 (5.4)
    • Retinal artery occlusion, n (%)

    1 (2.7)
    Degree of contralateral stenosis, n (%)
    • No contralateral stenosis

    19 (51)
    • Low (<50%), n (%)

    9 (24)
    • Moderate (50%–69%), n (%)

    8 (22)
    • High (≥70%), n (%)

    1 (2.7)
    • View popup
    Table 2:

    Summary BOLD-CVR values

    BOLD-CVR ValuesMean ± SD
    (%BOLD signal change/mm Hg CO2)
    BOLD-CVR whole brain0.09 ± 0.09
    BOLD-CVR gray matter0.11 ± 0.09
    BOLD-CVR white matter0.05 ± 0.08
    BOLD-CVR ipsilateral hemisphere0.07 ± 0.10
    BOLD-CVR contralateral hemisphere0.12 ± 0.07
    BOLD-CVR ipsilateral MCA territory0.07 ± 0.10
    BOLD-CVR contralateral MCA territory0.12 ± 0.07
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Amely Walser, Jorn Fierstra, Lara Maria Höbner, Jacopo Bellomo, Tilman Schubert, Menno Germans, Vittorio Stumpo, Christiaan Hendrik Bas van Niftrik, Susanne Wegener, Andreas R. Luft, Zsolt Kulcsár, Luca Regli, Giuseppe Esposito, Martina Sebök
Correlation between P2-PCA Volume Flow Rate and BOLD Cerebrovascular Reactivity in Patients with Symptomatic Carotid Artery Occlusion
American Journal of Neuroradiology Jun 2025, DOI: 10.3174/ajnr.A8626

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P2-PCA VFR and BOLD-CVR in ICA Occlusion
Amely Walser, Jorn Fierstra, Lara Maria Höbner, Jacopo Bellomo, Tilman Schubert, Menno Germans, Vittorio Stumpo, Christiaan Hendrik Bas van Niftrik, Susanne Wegener, Andreas R. Luft, Zsolt Kulcsár, Luca Regli, Giuseppe Esposito, Martina Sebök
American Journal of Neuroradiology Jun 2025, DOI: 10.3174/ajnr.A8626
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