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Raghavan V, Sobczyk O, Sayin ES, Poublanc J, Skanda A, Duffin J, Venkatraghavan L, Fisher JA, Mikulis DJ. Assessment of Cerebrovascular Reactivity Using CO 2-BOLD MRI: A 15-Year, Single Center Experience. J Magn Reson Imaging 2024; 60:954-961. [PMID: 38135486 DOI: 10.1002/jmri.29176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Cerebrovascular reactivity (CVR) is a measure of the change in cerebral blood flow (CBF) in response to a vasoactive challenge. It is a useful indicator of the brain's vascular health. PURPOSE To evaluate the factors that influence successful and unsuccessful CVR examinations using precise arterial and end-tidal partial pressure of CO2 control during blood oxygen level-dependent (BOLD) MRI. STUDY TYPE Retrospective. SUBJECTS Patients that underwent a CVR between October 2005 and May 2021 were studied (total of 1162 CVR examinations). The mean (±SD) age was 46.1 (±18.8) years, and 352 patients (43%) were female. FIELD STRENGTH/SEQUENCE 3 T; T1-weighted images, T2*-weighed two-dimensional gradient-echo sequence with standard echo-planar readout. ASSESSMENT Measurements were obtained following precise hypercapnic stimuli using BOLD MRI as a surrogate of CBF. Successful CVR examinations were defined as those where: 1) patients were able to complete CVR testing, and 2) a clinically useful CVR map was generated. Unsuccessful examinations were defined as those where patients were not able to complete the CVR examination or the CVR maps were judged to be unreliable due to, for example, excessive head motion, and poor PETCO2 targeting. STATISTICAL ANALYSIS Successful and unsuccessful CVR examinations between hypercapnic stimuli, and between different patterns of stimulus were compared with Chi-Square tests. Interobserver variability was determined by using the intraclass correlation coefficient (P < 0.05 is significant). RESULTS In total 1115 CVR tests in 662 patients were included in the final analysis. The success rate of generating CVR maps was 90.8% (1012 of 1115). Among the different hypercapnic stimuli, those containing a step plus a ramp protocol was the most successful (95.18%). Among the unsuccessful examinations (9.23%), most were patient related (89.3%), the most common of which was difficulty breathing. DATA CONCLUSION CO2-BOLD MRI CVR studies are well tolerated with a high success rate. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Vishvak Raghavan
- School of Computer Science, McGill University, Montreal, Quebec, Canada
| | - Olivia Sobczyk
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada
| | - Ece Su Sayin
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada
| | - Abby Skanda
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Lashmi Venkatraghavan
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Joseph A Fisher
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada
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Garbani Nerini L, Bellomo J, Höbner LM, Stumpo V, Colombo E, van Niftrik CHB, Schubert T, Kulcsár Z, Wegener S, Luft A, Regli L, Fierstra J, Sebök M, Esposito G. BOLD Cerebrovascular Reactivity and NOVA Quantitative MR Angiography in Adult Patients with Moyamoya Vasculopathy Undergoing Cerebral Bypass Surgery. Brain Sci 2024; 14:762. [PMID: 39199456 PMCID: PMC11353214 DOI: 10.3390/brainsci14080762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/21/2024] [Accepted: 07/25/2024] [Indexed: 09/01/2024] Open
Abstract
Revascularization surgery for the symptomatic hemisphere with hemodynamic impairment is effective for Moyamoya vasculopathy patients. However, careful patient selection is crucial and ideally supported by advanced quantitative hemodynamic imaging. Recently, blood oxygenation level-dependent cerebrovascular reactivity (BOLD-CVR) and quantitative magnetic resonance angiography with non-invasive optimal vessel analysis (qMRA-NOVA) have gained prominence in assessing these patients. This study aims to present the results of BOLD-CVR and qMRA-NOVA imaging along with the changes in cerebral hemodynamics and flow status following flow augmentation with superficial temporal artery-middle cerebral artery (STA-MCA) bypass in our Moyamoya vasculopathy patient cohort. Symptomatic patients with Moyamoya vasculopathy treated at the Clinical Neuroscience Center of the University Hospital Zurich who underwent hemodynamic and flow imaging (BOLD-CVR and qMRA-NOVA) before and after bypass were included in the analysis. Reduced hemispheric volume flow rates, as well as impaired BOLD-CVR, were measured in all 12 patients with Moyamoya vasculopathy before STA-MCA bypass surgery. Following the surgical procedure, post-operative BOLD-CVR demonstrated a non-significant increase in BOLD-CVR values within the revascularized, symptomatic middle cerebral artery territory and cerebral hemisphere. The results of the statistical tests should be viewed as indicative due to the small sample size. Additionally, post-operative qMRA-NOVA revealed a significant improvement in the hemispheric volume flow rate of the affected hemisphere due to the additional bypass flow rate. Our findings affirm the presence of hemodynamic and flow impairments in the symptomatic hemisphere of the Moyamoya vasculopathy patients. Bypass surgery proves effective in improving both BOLD-CVR impairment and the hemispheric volume flow rate in our patient cohort.
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Affiliation(s)
- Loris Garbani Nerini
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
- University of Zürich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Jacopo Bellomo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Lara Maria Höbner
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Vittorio Stumpo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Elisa Colombo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Tilman Schubert
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
- Department of Neuroradiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Zsolt Kulcsár
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
- Department of Neuroradiology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Andreas Luft
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (L.G.N.); (J.B.); (L.M.H.); (V.S.); (E.C.); (C.H.B.v.N.); (L.R.); (J.F.); (G.E.)
- Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (T.S.); (Z.K.); (S.W.); (A.L.)
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Duffin J, Sayin ES, Sobczyk O, Poublanc J, Mikulis DJ, Fisher JA. Cerebral perfusion metrics calculated directly from a hypoxia-induced step change in deoxyhemoglobin. Sci Rep 2024; 14:17121. [PMID: 39054379 PMCID: PMC11272773 DOI: 10.1038/s41598-024-68047-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 07/18/2024] [Indexed: 07/27/2024] Open
Abstract
Resting cerebral perfusion metrics can be calculated from the MRI ΔR2* signal during the first passage of an intravascular bolus of a Gadolinium-based contrast agent (GBCA), or more recently, a transient hypoxia-induced change in the concentration of deoxyhemoglobin ([dOHb]). Conventional analysis follows a proxy process that includes deconvolution of an arterial input function (AIF) in a tracer kinetic model. We hypothesized that the step reduction in magnetic susceptibility accompanying a step decrease in [dOHb] that occurs when a single breath of oxygen terminates a brief episode of lung hypoxia permits direct calculation of relative perfusion metrics. The time course of the ΔR2* signal response enables both the discrimination of blood arrival times and the time course of voxel filling. We calculated the perfusion metrics implied by this step signal change in seven healthy volunteers and compared them to those from conventional analyses of GBCA and dOHb using their AIF and indicator dilution theory. Voxel-wise maps of relative cerebral blood flow and relative cerebral blood volume had a high spatial and magnitude congruence for all three analyses (r > 0.9) and were similar in appearance to published maps. The mean (SD) transit times (s) in grey and white matter respectively for the step response (7.4 (1.1), 8.05 (1.71)) were greater than those for GBCA (2.6 (0.45), 3.54 (0.83)) attributable to the nature of their respective calculation models. In conclusion we believe these calculations of perfusion metrics derived directly from ΔR2* have superior merit to calculations via AIF by virtue of being calculated from a direct signal rather than through a proxy model which encompasses errors inherent in designating an AIF and performing deconvolution calculations.
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Affiliation(s)
- James Duffin
- Department of Physiology, University of Toronto, Toronto, ON, Canada.
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Canada.
| | - Ece Su Sayin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Olivia Sobczyk
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Canada
| | - Joseph A Fisher
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Canada
- Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada
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Plitman E, Venkatraghavan L, Agrawal S, Raghavan V, Chowdhury T, Sobczyk O, Sayin ES, Poublanc J, Duffin J, Mikulis D, Fisher J. Variability of Resting Carbon Dioxide Tension in Patients with Intracranial Steno-occlusive Disease. Asian J Neurosurg 2024; 19:235-241. [PMID: 38974441 PMCID: PMC11226286 DOI: 10.1055/s-0044-1786699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Introduction Controlling the partial pressure of carbon dioxide (PaCO 2 ) is an important consideration in patients with intracranial steno-occlusive disease to avoid reductions in critical perfusion from vasoconstriction due to hypocapnia, or reductions in blood flow due to steal physiology during hypercapnia. However, the normal range for resting PCO 2 in this patient population is not known. Therefore, we investigated the variability in resting end-tidal PCO 2 (P ET CO 2 ) in patients with intracranial steno-occlusive disease and the impact of revascularization on resting P ET CO 2 in these patients. Setting and Design Tertiary care center, retrospective chart review Materials and Methods We collected resting P ET CO 2 values in adult patients with intracranial steno-occlusive disease who presented to our institution between January 2010 and June 2021. We also explored postrevascularization changes in resting P ET CO 2 in a subset of patients. Results Two hundred and twenty-seven patients were included [moyamoya vasculopathy ( n = 98) and intracranial atherosclerotic disease ( n = 129)]. In the whole cohort, mean ± standard deviation resting P ET CO 2 was 37.8 ± 3.9 mm Hg (range: 26-47). In patients with moyamoya vasculopathy and intracranial atherosclerotic disease, resting P ET CO 2 was 38.4 ± 3.6 mm Hg (range: 28-47) and 37.4 ± 4.1 mm Hg (range: 26-46), respectively. A trend was identified suggesting increasing resting P ET CO 2 after revascularization in patients with low preoperative resting P ET CO 2 (<38 mm Hg) and decreasing resting P ET CO 2 after revascularization in patients with high preoperative resting P ET CO 2 (>38 mm Hg). Conclusion This study demonstrates that resting P ET CO 2 in patients with intracranial steno-occlusive disease is highly variable. In some patients, there was a change in resting P ET CO 2 after a revascularization procedure.
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Affiliation(s)
- Eric Plitman
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lashmi Venkatraghavan
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sanket Agrawal
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Vishvak Raghavan
- Department of Computer Science, Faculty of Science, McGill University, Montreal, Quebec, Canada
| | - Tumul Chowdhury
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Olivia Sobczyk
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ece Su Sayin
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - David Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Joseph Fisher
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Magnusson G, Engström M, Georgiopoulos C, Cedersund G, Tobieson L, Tisell A. High inspired CO 2 target accuracy in mechanical ventilation and spontaneous breathing using the Additional CO 2 method. Front Med (Lausanne) 2024; 11:1352012. [PMID: 38841571 PMCID: PMC11150593 DOI: 10.3389/fmed.2024.1352012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/16/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Cerebrovascular reactivity imaging (CVR) is a diagnostic method for assessment of alterations in cerebral blood flow in response to a controlled vascular stimulus. The principal utility is the capacity to evaluate the cerebrovascular reserve, thereby elucidating autoregulatory functioning. In CVR, CO2 gas challenge is the most prevalent method, which elicits a vascular response by alterations in inspired CO2 concentrations. While several systems have been proposed in the literature, only a limited number have been devised to operate in tandem with mechanical ventilation, thus constraining the majority CVR investigations to spontaneously breathing individuals. Methods We have developed a new method, denoted Additional CO2, designed to enable CO2 challenge in ventilators. The central idea is the introduction of an additional flow of highly concentrated CO2 into the respiratory circuit, as opposed to administration of the entire gas mixture from a reservoir. By monitoring the main respiratory gas flow emanating from the ventilator, the CO2 concentration in the inspired gas can be manipulated by adjusting the proportion of additional CO2. We evaluated the efficacy of this approach in (1) a ventilator coupled with a test lung and (2) in spontaneously breathing healthy subjects. The method was evaluated by assessment of the precision in attaining target inspired CO2 levels and examination of its performance within a magnetic resonance imaging environment. Results and discussion Our investigations revealed that the Additional CO2 method consistently achieved a high degree of accuracy in reaching target inspired CO2 levels in both mechanical ventilation and spontaneous breathing. We anticipate that these findings will lay the groundwork for a broader implementation of CVR assessments in mechanically ventilated patients.
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Affiliation(s)
- Gustav Magnusson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Maria Engström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Charalampos Georgiopoulos
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Diagnostic Radiology, Department of Clinical Sciences, Medical Faculty, Lund University, Lund, Sweden
| | - Gunnar Cedersund
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Lovisa Tobieson
- Department of Neurosurgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anders Tisell
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Vu C, Shen J, Gonzalez Zacarias C, Xu B, Baas K, Choi S, Nederveen A, Wood JC. Contrast-free dynamic susceptibility contrast using sinusoidal and bolus oxygenation challenges. NMR IN BIOMEDICINE 2024; 37:e5111. [PMID: 38297919 PMCID: PMC10987281 DOI: 10.1002/nbm.5111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/10/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024]
Abstract
Deoxygenation-based dynamic susceptibility contrast (dDSC) MRI uses respiratory challenges as a source of endogenous contrast as an alternative to gadolinium injection. These gas challenges induce T2*-weighted MRI signal losses, after which tracer kinetics modeling was applied to calculate cerebral perfusion. This work compares three gas challenges, desaturation (transient hypoxia), resaturation (transient normoxia), and SineO2 (sinusoidal modulation of end-tidal oxygen pressures) in a cohort of 10 healthy volunteers (age 37 ± 11 years; 60% female). Perfusion estimates consisted of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). Calculations were computed using a traditional tracer kinetics model in the time domain for desaturation and resaturation and in the frequency domain for SineO2. High correlations and limits of agreement were observed among the three deoxygenation-based paradigms for CBV, although MTT and CBF estimates varied with the hypoxic stimulus. Cross-modality correlation with gadolinium DSC was lower, particularly for MTT, but on a par with agreement between the other perfusion references. Overall, this work demonstrated the feasibility and reliability of oxygen respiratory challenges to measure brain perfusion. Additional work is needed to assess the utility of dDSC in the diagnostic evaluation of various pathologies such as ischemic strokes, brain tumors, and neurodegenerative diseases.
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Affiliation(s)
- Chau Vu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Jian Shen
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Clio Gonzalez Zacarias
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
| | - Botian Xu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Koen Baas
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
| | - Aart Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - John C. Wood
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
- Division of Cardiology, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
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Stumpo V, Sayin ES, Bellomo J, Sobczyk O, van Niftrik CHB, Sebök M, Weller M, Regli L, Kulcsár Z, Pangalu A, Bink A, Duffin J, Mikulis DD, Fisher JA, Fierstra J. Transient deoxyhemoglobin formation as a contrast for perfusion MRI studies in patients with brain tumors: a feasibility study. Front Physiol 2024; 15:1238533. [PMID: 38725571 PMCID: PMC11079274 DOI: 10.3389/fphys.2024.1238533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
Background: Transient hypoxia-induced deoxyhemoglobin (dOHb) has recently been shown to represent a comparable contrast to gadolinium-based contrast agents for generating resting perfusion measures in healthy subjects. Here, we investigate the feasibility of translating this non-invasive approach to patients with brain tumors. Methods: A computer-controlled gas blender was used to induce transient precise isocapnic lung hypoxia and thereby transient arterial dOHb during echo-planar-imaging acquisition in a cohort of patients with different types of brain tumors (n = 9). We calculated relative cerebral blood volume (rCBV), cerebral blood flow (rCBF), and mean transit time (MTT) using a standard model-based analysis. The transient hypoxia induced-dOHb MRI perfusion maps were compared to available clinical DSC-MRI. Results: Transient hypoxia induced-dOHb based maps of resting perfusion displayed perfusion patterns consistent with underlying tumor histology and showed high spatial coherence to gadolinium-based DSC MR perfusion maps. Conclusion: Non-invasive transient hypoxia induced-dOHb was well-tolerated in patients with different types of brain tumors, and the generated rCBV, rCBF and MTT maps appear in good agreement with perfusion maps generated with gadolinium-based DSC MR perfusion.
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Affiliation(s)
- Vittorio Stumpo
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ece Su Sayin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
| | - Jacopo Bellomo
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Olivia Sobczyk
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Martina Sebök
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Zsolt Kulcsár
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Athina Pangalu
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Bink
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
| | - David D. Mikulis
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Joseph A. Fisher
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
| | - Jorn Fierstra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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van Niftrik CHB, Sebök M, Germans MR, Halter M, Pokorny T, Stumpo V, Bellomo J, Piccirelli M, Pangalu A, Katan M, Wegener S, Tymianski M, Kulcsár Z, Luft AR, Fisher JA, Mikulis DJ, Regli L, Fierstra J. Increased Risk of Recurrent Stroke in Symptomatic Large Vessel Disease With Impaired BOLD Cerebrovascular Reactivity. Stroke 2024; 55:613-621. [PMID: 38328926 DOI: 10.1161/strokeaha.123.044259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Impaired cerebrovascular reactivity (CVR) has been correlated with recurrent ischemic stroke. However, for clinical purposes, most CVR techniques are rather complex, time-consuming, and lack validation for quantitative measurements. The recent adaptation of a standardized hypercapnic stimulus in combination with a blood-oxygenation-level-dependent (BOLD) magnetic resonance imaging signal as a surrogate for cerebral blood flow offers a potential universally comparable CVR assessment. We investigated the association between impaired BOLD-CVR and risk for recurrent ischemic events. METHODS We conducted a retrospective analysis of patients with symptomatic cerebrovascular large vessel disease who had undergone a prospective hypercapnic-challenged BOLD-CVR protocol at a single tertiary stroke referral center between June 2014 and April 2020. These patients were followed up for recurrent acute ischemic events for up to 3 years. BOLD-CVR (%BOLD signal change per mm Hg CO2) was calculated on a voxel-by-voxel basis. Impaired BOLD-CVR of the affected (ipsilateral to the vascular pathology) hemisphere was defined as an average BOLD-CVR, falling 2 SD below the mean BOLD-CVR of the right hemisphere in a healthy age-matched reference cohort (n=20). Using a multivariate Cox proportional hazards model, the association between impaired BOLD-CVR and ischemic stroke recurrence was assessed and Kaplan-Meier survival curves to visualize the acute ischemic stroke event rate. RESULTS Of 130 eligible patients, 28 experienced recurrent strokes (median, 85 days, interquartile range, 5-166 days). Risk factors associated with an increased recurrent stroke rate included impaired BOLD-CVR, a history of atrial fibrillation, and heart insufficiency. After adjusting for sex, age group, and atrial fibrillation, impaired BOLD-CVR exhibited a hazard ratio of 10.73 (95% CI, 4.14-27.81; P<0.001) for recurrent ischemic stroke. CONCLUSIONS Among patients with symptomatic cerebrovascular large vessel disease, those exhibiting impaired BOLD-CVR in the affected hemisphere had a 10.7-fold higher risk of recurrent ischemic stroke events compared with individuals with nonimpaired BOLD-CVR.
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Affiliation(s)
- Christiaan H B van Niftrik
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Martina Sebök
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Menno R Germans
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Matthias Halter
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Thomas Pokorny
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Vittorio Stumpo
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Jacopo Bellomo
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Marco Piccirelli
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (M.P., A.P., Z.K.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Athina Pangalu
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (M.P., A.P., Z.K.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Mira Katan
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Michael Tymianski
- Division of Neurosurgery, Toronto Western Hospital (M.T., J.F.), University of Toronto, ON, Canada
| | - Zsolt Kulcsár
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (M.P., A.P., Z.K.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Andreas R Luft
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Joseph A Fisher
- Institute of Medical Science (J.A.F.), University of Toronto, ON, Canada
- Department of Anesthesia and Pain Management (J.A.F.), University Health Network, Toronto, ON, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and Functional Neuroimaging Laboratory (D.J.M.), University Health Network, Toronto, ON, Canada
| | - Luca Regli
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Division of Neurosurgery, Toronto Western Hospital (M.T., J.F.), University of Toronto, ON, Canada
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9
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Mikulis DJ. Cerebrovascular Reserve Imaging: Problems and Solutions. Magn Reson Imaging Clin N Am 2024; 32:93-109. [PMID: 38007286 DOI: 10.1016/j.mric.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
The current standard of practice for assessing patients with cerebrovascular steno-occlusive disease is based on measuring resting blood flow metrics using MR imaging and CT perfusion imaging. However, the reliability of these methods decreases as the degree and number of stenoses increase. The reason for this is that measures of adequate baseline blood flow in highly collateralized circulations do not account for possible shortfalls in recruitable blood flow or increased metabolic demand. The following offers a clinically tested solution for this purpose using cerebrovascular reactivity methodology that applies a quantifiable vasodilatory stimulus improving reproducibility and repeatability essential for optimizing patient management.
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Affiliation(s)
- David J Mikulis
- The Krembil Brain Institute, Institute of Medcial Science, Department of Medical Imaging, The University of Toronto, The University Health Network, The Toronto Western Hospital, 399 Bathurst Street, Room 3MC-431, Toronto, ON M5T 2S8, Canada.
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10
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Sebök M, Höbner LM, Fierstra J, Schubert T, Wegener S, Kulcsár Z, Luft AR, Regli L, Esposito G. Flow-augmentation STA-MCA bypass for acute and subacute ischemic stroke due to internal carotid artery occlusion and the role of advanced neuroimaging with hemodynamic and flow-measurement in the decision-making: preliminary data. Quant Imaging Med Surg 2024; 14:777-788. [PMID: 38223058 PMCID: PMC10784084 DOI: 10.21037/qims-23-876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/30/2023] [Indexed: 01/16/2024]
Abstract
Background A major clinical challenge is the adequate identification of patients with acute (<1 week) and subacute (1-6 weeks) ischemic stroke due to internal carotid artery (ICA) occlusion who could benefit from a surgical revascularization after a failure of endovascular and/or medical treatment. Recently, two novel quantitative imaging modalities have been introduced: (I) quantitative magnetic resonance angiography (qMRA) with non-invasive optimal vessel analysis (NOVA) for quantification of blood flow in major cerebral arteries (in mL/min), and (II) blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging to assess cerebrovascular reactivity (CVR). The aim of this study is to present our cohort of patients who underwent surgical revascularization in the acute and subacute phase of ischemic stroke as well as to demonstrate the importance of hemodynamic and flow assessment for the decision-making regarding surgical revascularization in patients with acute and subacute stroke and ICA-occlusion. Methods Symptomatic patients with acute and subacute ischemic stroke because of persistent ICA-occlusion despite optimal medical/endovascular recanalization therapy who were treated at the Neuroscience Clinical Center of the University Hospital Zurich underwent both BOLD-CVR and qMRA-NOVA to study the hemodynamic and collateral vessel status. Patients selected for surgical revascularization according to our previously published flowchart were included in this prospective cohort study. Repeated NOVA and BOLD-CVR investigations were done after bypass surgery as follow up as well as clinical follow up. Continuous BOLD-CVR and qMRA-NOVA variables were compared using paired Student t-test. Results Between May 2019 and September 2022, superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery was performed in 12 patients with acute and subacute stroke because of ICA-occlusion despite of optimal endovascular and/or medical treatment prior to the surgery. Impaired BOLD-CVR in the occluded vascular territory [MCA territory: ipsilateral vs. contralateral: -0.03±0.07 vs. 0.11±0.07 %BOLD/mmHgCO2, P<0.001] as well as reduced hemispheric flow with qMRA-NOVA (ipsilateral vs. contralateral: 228.00±54.62 vs. 384.50±70.99 mL/min, P=0.01) were measured indicating insufficient collateralization. Post-operative qMRA-NOVA showed improved hemispheric flow (via bypass) (pre-bypass vs. post-bypass: 236.60±76.45 vs. 334.20±131.33 mL/min, P=0.02) and the 3-month-follow-up with BOLD-CVR showed improved cerebral hemodynamics (MCA territory: pre-bypass vs. post-bypass: -0.01±0.05 vs. 0.06±0.03 %BOLD/mmHgCO2, P=0.02) in all patients studied. Conclusions Quantitative assessment with BOLD-CVR and qMRA-NOVA allows us to evaluate the pre- and post-operative cerebral hemodynamics and collateral vessel status in patients with acute/subacute stroke due to ICA occlusion who may benefit from surgical revascularization after failure of endovascular/medical treatment.
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Affiliation(s)
- Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Lara Maria Höbner
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Tilman Schubert
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Zsolt Kulcsár
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas R. Luft
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
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11
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Farra SD, Jacobs I. Arterial desaturation rate does not influence self-selected knee extension force but alters ventilatory response to progressive hypoxia: A pilot study. Physiol Rep 2024; 12:e15892. [PMID: 38172088 PMCID: PMC10764295 DOI: 10.14814/phy2.15892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
The absolute magnitude and rate of arterial desaturation each independently impair whole-body aerobic exercise. This study examined potential mechanisms underlying the rate-dependent relationship. Utilizing an exercise protocol involving unilateral, intermittent, isometric knee extensions (UIIKE), we provided sufficient reperfusion time between contractions to reduce the accumulation of intramuscular metabolic by-products that typically stimulate muscle afferents. The objective was to create a milieu conducive to accentuating any influence of arterial desaturation rate on muscular fatigue. Eight participants completed four UIIKE sessions, performing one 3 s contraction every 30s at a perceived intensity of 50% MVC for 25 min. Participants voluntarily adjusted their force generation to maintain perceptual effort at 50% MVC without feedback. Reductions in inspired oxygen fraction (FI O2 ) decreased arterial saturation from >98% to 70% with varying rates in three trials: FAST (5.3 ± 1.3 min), MED (11.8 ± 2.7 min), and SLOW (19.9 ± 3.7 min). FI O2 remained at 0.21 during the control trial. Force generation and muscle activation remained at baseline levels throughout UIIKE trials, unaffected by the magnitude or rate of desaturation. Minute ventilation increased with hypoxia (p < 0.05), and faster desaturation rates magnified this response. These findings demonstrate that arterial desaturation magnitude and rate independently affect ventilation, but do not influence fatigue development during UIIKE.
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Affiliation(s)
- Saro D. Farra
- Faculty of Kinesiology & Physical EducationUniversity of TorontoTorontoOntarioCanada
| | - Ira Jacobs
- Faculty of Kinesiology & Physical EducationUniversity of TorontoTorontoOntarioCanada
- Tanenbaum Institute for Science in Sport, University of TorontoTorontoOntarioCanada
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12
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Johnson BJ, Lipford ME, Barcus RA, Olson JD, Schaaf GW, Andrews RN, Kim J, Dugan GO, Deycmar S, Reed CA, Whitlow CT, Cline JM. Assessing cerebrovascular reactivity (CVR) in rhesus macaques (Macaca mulatta) using a hypercapnic challenge and pseudo-continuous arterial spin labeling (pCASL). Neuroimage 2024; 285:120491. [PMID: 38070839 PMCID: PMC10842457 DOI: 10.1016/j.neuroimage.2023.120491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024] Open
Abstract
Cerebrovascular reactivity (CVR) is a measure of cerebral small vessels' ability to respond to changes in metabolic demand and can be quantified using magnetic resonance imaging (MRI) coupled with a vasoactive stimulus. Reduced CVR occurs with neurodegeneration and is associated with cognitive decline. While commonly measured in humans, few studies have evaluated CVR in animal models. Herein, we describe methods to induce hypercapnia in rhesus macaques (Macaca mulatta) under gas anesthesia to measure cerebral blood flow (CBF) and CVR using pseudo-continuous arterial spin labeling (pCASL). Fifteen (13 M, 2 F) adult rhesus macaques underwent pCASL imaging that included a baseline segment (100% O2) followed by a hypercapnic challenge (isoflurane anesthesia with 5% CO2, 95% O2 mixed gas). Relative hypercapnia was defined as an end-tidal CO2 (ETCO2) ≥5 mmHg above baseline ETCO2. The mean ETCO2 during the baseline segment of the pCASL sequence was 34 mmHg (range: 23-48 mmHg). During this segment, mean whole-brain CBF was 51.48 ml/100g/min (range: 21.47-77.23 ml/100g/min). Significant increases (p<0.0001) in ETCO2 were seen upon inspiration of the mixed gas (5% CO2, 95% O2). The mean increase in ETCO2 was 8.5 mmHg and corresponded with a mean increase in CBF of 37.1% (p<0.0001). The mean CVR measured was 4.3%/mmHg. No anesthetic complications occurred as a result of the CO2 challenge. Our methods were effective at inducing a state of relative hypercapnia that corresponds with a detectable increase in whole brain CBF using pCASL MRI. Using these methods, a CO2 challenge can be performed in conjunction with pCASL imaging to evaluate CBF and CVR in rhesus macaques. The measured CVR in rhesus macaques is comparable to human CVR highlighting the translational utility of rhesus macaques in neuroscience research. These methods present a feasible means to measure CVR in comparative models of neurodegeneration and cerebrovascular dysfunction.
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Affiliation(s)
- Brendan J Johnson
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States.
| | - Megan E Lipford
- Department of Radiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States; Department of Biomedical Engineering, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Richard A Barcus
- Department of Radiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - John D Olson
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - George W Schaaf
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Rachel N Andrews
- Department of Radiation Oncology, Section on Radiation Biology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Jeongchul Kim
- Department of Radiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Greg O Dugan
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Simon Deycmar
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Colin A Reed
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Christopher T Whitlow
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States; Department of Radiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States; Department of Biomedical Engineering, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States; Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - J Mark Cline
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States; Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States; Department of Radiation Oncology, Section on Radiation Biology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
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13
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Venkatraghavan L, Rosen C, McKetton L, Poublanc J, Sobczyk O, Duffin J, Tymianski M, Fisher JA, Mikulis DJ. Brain Stress Test for Assessing Risk for Hemodynamic Stroke. Can J Neurol Sci 2024; 51:57-63. [PMID: 36624923 DOI: 10.1017/cjn.2023.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In patients with intracranial steno-occlusive disease (SOD), the risk of hemodynamic stroke depends on the poststenotic vasodilatory reserve. Cerebrovascular reactivity (CVR) is a test for vasodilatory reserve. We tested for vasodilatory reserve by using PETCO2 as the stressor, and Blood Oxygen Level Dependent (BOLD) MRI as a surrogate of blood flow. We correlate the CVR to the incidence of stroke after a 1-year follow-up in patients with symptomatic intracranial SOD. METHODS In this retrospective study, 100 consecutive patients with symptomatic intracranial SOD that had undergone CVR testing were identified. CVR was measured as % BOLD MR signal intensity/mmHg PETCO2. All patients with normal CVR were treated with optimal medical therapy; those with abnormal CVR were offered revascularization where feasible. We determined the incidence of stroke at 1 year. RESULTS 83 patients were included in the study. CVR was normal in 14 patients and impaired in 69 patients ipsilateral to the lesion. Of these, 53 underwent surgical revascularization. CVR and symptoms improved in 86% of the latter. The overall incidence of stroke was 4.8 % (4/83). All strokes occurred in patients with impaired CVR (4/69; 2/53 in the surgical group, all in the nonrevascularized hemisphere), and none in patients with normal CVR (0/14). CONCLUSION Our study confirms that CO2-BOLD MRI CVR can be used as a brain stress test for the assessment of cerebrovascular reserve. Impaired CVR is associated with a higher incidence of stroke and normal CVR despite significant stenosis is associated with a low risk for stroke.
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Affiliation(s)
| | - Casey Rosen
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Larissa McKetton
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Julien Poublanc
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Olivia Sobczyk
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - James Duffin
- Department of Physiology, The University of Toronto, Toronto, ON, Canada
| | - Michael Tymianski
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Joseph A Fisher
- Department of Anaesthesia, University Health Network, Toronto, ON, Canada
| | - David J Mikulis
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
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14
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Sayin ES, Duffin J, Stumpo V, Bellomo J, Piccirelli M, Poublanc J, Wijeya V, Para A, Pangalu A, Bink A, Nemeth B, Kulcsar Z, Mikulis DJ, Fisher JA, Sobczyk O, Fierstra J. Assessing Perfusion in Steno-Occlusive Cerebrovascular Disease Using Transient Hypoxia-Induced Deoxyhemoglobin as a Dynamic Susceptibility Contrast Agent. AJNR Am J Neuroradiol 2023; 45:37-43. [PMID: 38164571 PMCID: PMC10756578 DOI: 10.3174/ajnr.a8068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND PURPOSE Resting brain tissue perfusion in cerebral steno-occlusive vascular disease can be assessed by MR imaging using gadolinium-based susceptibility contrast agents. Recently, transient hypoxia-induced deoxyhemoglobin has been investigated as a noninvasive MR imaging contrast agent. Here we present a comparison of resting perfusion metrics using transient hypoxia-induced deoxyhemoglobin and gadolinium-based contrast agents in patients with known cerebrovascular steno-occlusive disease. MATERIALS AND METHODS Twelve patients with steno-occlusive disease underwent DSC MR imaging using a standard bolus of gadolinium-based contrast agent compared with transient hypoxia-induced deoxyhemoglobin generated in the lungs using an automated gas blender. A conventional multi-slice 2D gradient echo sequence was used to acquire the perfusion data and analyzed using a standard tracer kinetic model. MTT, relative CBF, and relative CBV maps were generated and compared between contrast agents. RESULTS The spatial distributions of the perfusion metrics generated with both contrast agents were consistent. Perfusion metrics in GM and WM were not statistically different except for WM MTT. CONCLUSIONS Cerebral perfusion metrics generated with noninvasive transient hypoxia-induced changes in deoxyhemoglobin are very similar to those generated using a gadolinium-based contrast agent in patients with cerebrovascular steno-occlusive disease.
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Affiliation(s)
- Ece Su Sayin
- From the Department of Physiology (E.S.S., J.D., J.A.F.), University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab (E.S.S., J.P., V.W., A. Para, D.J.M., O.S.), University Health Network, Toronto, Ontario, Canada
| | - James Duffin
- From the Department of Physiology (E.S.S., J.D., J.A.F.), University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management (J.D., J.A.F.), University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Vittorio Stumpo
- Department of Neurosurgery (V.S., J.B. J.F.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jacopo Bellomo
- Department of Neurosurgery (V.S., J.B. J.F.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Piccirelli
- Department of Neuroradiology and Clinical Neuroscience Center (M.P., A. Pangalu, A.B., B.N., Z.K.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab (E.S.S., J.P., V.W., A. Para, D.J.M., O.S.), University Health Network, Toronto, Ontario, Canada
| | - Vepeson Wijeya
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab (E.S.S., J.P., V.W., A. Para, D.J.M., O.S.), University Health Network, Toronto, Ontario, Canada
| | - Andrea Para
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab (E.S.S., J.P., V.W., A. Para, D.J.M., O.S.), University Health Network, Toronto, Ontario, Canada
| | - Athina Pangalu
- Department of Neuroradiology and Clinical Neuroscience Center (M.P., A. Pangalu, A.B., B.N., Z.K.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Bink
- Department of Neuroradiology and Clinical Neuroscience Center (M.P., A. Pangalu, A.B., B.N., Z.K.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bence Nemeth
- Department of Neuroradiology and Clinical Neuroscience Center (M.P., A. Pangalu, A.B., B.N., Z.K.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology and Clinical Neuroscience Center (M.P., A. Pangalu, A.B., B.N., Z.K.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David J Mikulis
- Department of Medical Biophysics (D.J.M.), University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab (E.S.S., J.P., V.W., A. Para, D.J.M., O.S.), University Health Network, Toronto, Ontario, Canada
| | - Joseph A Fisher
- From the Department of Physiology (E.S.S., J.D., J.A.F.), University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management (J.D., J.A.F.), University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Olivia Sobczyk
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab (E.S.S., J.P., V.W., A. Para, D.J.M., O.S.), University Health Network, Toronto, Ontario, Canada
| | - Jorn Fierstra
- Department of Neurosurgery (V.S., J.B. J.F.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Sebök M, van der Wouden F, Mader C, Pangalu A, Treyer V, Fisher JA, Mikulis DJ, Hüllner M, Regli L, Fierstra J, van Niftrik CHB. Hemodynamic Failure Staging With Blood Oxygenation Level-Dependent Cerebrovascular Reactivity and Acetazolamide-Challenged ( 15O-)H 2O-Positron Emission Tomography Across Individual Cerebrovascular Territories. J Am Heart Assoc 2023; 12:e029491. [PMID: 38084716 PMCID: PMC10863778 DOI: 10.1161/jaha.123.029491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/11/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Staging of hemodynamic failure (HF) in symptomatic patients with cerebrovascular steno-occlusive disease is required to assess the risk of ischemic stroke. Since the gold standard positron emission tomography-based perfusion reserve is unsuitable as a routine clinical imaging tool, blood oxygenation level-dependent cerebrovascular reactivity (BOLD-CVR) with CO2 is a promising surrogate imaging approach. We investigated the accuracy of standardized BOLD-CVR to classify the extent of HF. METHODS AND RESULTS Patients with symptomatic unilateral cerebrovascular steno-occlusive disease, who underwent both an acetazolamide challenge (15O-)H2O-positron emission tomography and BOLD-CVR examination, were included. HF staging of vascular territories was assessed using qualitative inspection of the positron emission tomography perfusion reserve images. The optimum BOLD-CVR cutoff points between HF stages 0-1-2 were determined by comparing the quantitative BOLD-CVR data to the qualitative (15O-)H2O-positron emission tomography classification using the 3-dimensional accuracy index to the randomly assigned training and test data sets with the following determination of a single cutoff for clinical application. In the 2-case scenario, classifying data points as HF 0 or 1-2 and HF 0-1 or 2, BOLD-CVR showed an accuracy of >0.7 for all vascular territories for HF 1 and HF 2 cutoff points. In particular, the middle cerebral artery territory had an accuracy of 0.79 for HF 1 and 0.83 for HF 2, whereas the anterior cerebral artery had an accuracy of 0.78 for HF 1 and 0.82 for HF 2. CONCLUSIONS Standardized and clinically accessible BOLD-CVR examinations harbor sufficient data to provide specific cerebrovascular reactivity cutoff points for HF staging across individual vascular territories in symptomatic patients with unilateral cerebrovascular steno-occlusive disease.
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Affiliation(s)
- Martina Sebök
- Department of NeurosurgeryUniversity Hospital Zurich, University of ZurichSwitzerland
- Clinical Neuroscience CenterUniversity Hospital Zurich, University of ZurichSwitzerland
| | | | - Cäcilia Mader
- Department of Nuclear MedicineUniversity Hospital Zurich, University of ZurichSwitzerland
| | - Athina Pangalu
- Clinical Neuroscience CenterUniversity Hospital Zurich, University of ZurichSwitzerland
- Department of NeuroradiologyUniversity Hospital Zurich, University of ZurichSwitzerland
| | - Valerie Treyer
- Department of Nuclear MedicineUniversity Hospital Zurich, University of ZurichSwitzerland
| | - Joseph Arnold Fisher
- Department of Anesthesia and Pain ManagementUniversity Health NetworkTorontoOntarioCanada
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
| | - David John Mikulis
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
- Joint Department of Medical Imaging and the Functional Neuroimaging LaboratoryUniversity Health NetworkTorontoOntarioCanada
| | - Martin Hüllner
- Department of Nuclear MedicineUniversity Hospital Zurich, University of ZurichSwitzerland
| | - Luca Regli
- Department of NeurosurgeryUniversity Hospital Zurich, University of ZurichSwitzerland
- Clinical Neuroscience CenterUniversity Hospital Zurich, University of ZurichSwitzerland
| | - Jorn Fierstra
- Department of NeurosurgeryUniversity Hospital Zurich, University of ZurichSwitzerland
- Clinical Neuroscience CenterUniversity Hospital Zurich, University of ZurichSwitzerland
| | - Christiaan Hendrik Bas van Niftrik
- Department of NeurosurgeryUniversity Hospital Zurich, University of ZurichSwitzerland
- Clinical Neuroscience CenterUniversity Hospital Zurich, University of ZurichSwitzerland
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16
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Sayin ES, Duffin J, Poublanc J, Venkatraghavan L, Mikulis DJ, Fisher JA, Sobczyk O. Determining the effects of elevated partial pressure of oxygen on hypercapnia-induced cerebrovascular reactivity. J Cereb Blood Flow Metab 2023; 43:2085-2095. [PMID: 37632334 PMCID: PMC10925865 DOI: 10.1177/0271678x231197000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/28/2023]
Abstract
Evaluation of cerebrovascular reactivity (CVR) to hypo- and hypercapnia is a valuable test for the assessment of vasodilatory reserve. While hypercapnia-induced CVR testing is usually performed at normoxia, mild hyperoxia may increase tolerability of hypercapnia by reducing the ventilatory distress. However, the effects of mild hyperoxia on CVR was unknown. We therefore recruited 21 patients with a range of steno-occlusive diseases and 12 healthy participants who underwent a standardized 13-minute step plus ramp CVR test with a carbon dioxide gas challenge at the subject's resting end-tidal partial pressure of oxygen or at mild hyperoxia (PetO2 = 150 mmHg) depending on to which group they were assigned. In 11 patients, the second CVR test was at normoxia to examine test-retest differences. CVR was defined as % Δ Signal/ΔPetCO2. We found that there was no significant difference between CVR test results conducted at normoxia and at mild hyperoxia for participants in Groups 1 and 2 for the step and ramp portion. We also found no difference between test and retest CVR at normoxia for patients with cerebrovascular pathology (Group 3) for step and ramp portion. We concluded normoxic CVR is repeatable, and that mild hyperoxia does not affect CVR.
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Affiliation(s)
- Ece Su Sayin
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
| | - Lashmikumar Venkatraghavan
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David John Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
| | - Joseph Arnold Fisher
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Olivia Sobczyk
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
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17
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van Niftrik CHB, Hiller A, Sebök M, Halter M, Duffin J, Fisher JA, Mikulis DJ, Regli L, Piccirelli M, Fierstra J. Heterogeneous motor BOLD-fMRI responses in brain areas exhibiting negative BOLD cerebrovascular reactivity indicate that steal phenomenon does not always result from exhausted cerebrovascular reserve capacity. Magn Reson Imaging 2023; 103:124-130. [PMID: 37481092 DOI: 10.1016/j.mri.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Brain areas exhibiting negative blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) responses to carbon dioxide (CO2) are thought to suffer from a completely exhausted autoregulatory cerebrovascular reserve capacity and exhibit vascular steal phenomenon. If this assumption is correct, the presence of vascular steal phenomenon should subsequently result in an equal negative fMRI signal response during a motor-task based BOLD-fMRI study (increase in metabolism without an increase in cerebral blood flow due to exhausted reserve capacity) in otherwise functional brain tissue. To investigate this premise, the aim of this study was to further investigate motor-task based BOLD-fMRI signal responses in brain areas exhibiting negative BOLD-CVR. MATERIAL AND METHODS Seventy-one datasets of patients with cerebrovascular steno-occlusive disease without motor defects, who underwent a CO2-calibrated motor task-based BOLD-fMRI study with a fingertapping paradigm and a subsequent BOLD-CVR study with a precisely controlled CO2-challenge during the same MRI examination, were included. We compared BOLD-fMRI signal responses in the bilateral pre- and postcentral gyri - i.e. Region of Interest (ROI) with the corresponding BOLD-CVR in this ROI. The ROI was determined using a second level group analysis of the BOLD-fMRI task study of 42 healthy individuals undergoing the same study protocol. RESULTS An overall decrease in BOLD-CVR was associated with a decrease in BOLD-fMRI signal response within the ROI. For patients exhibiting negative BOLD-CVR, we found both positive and negative motor-task based BOLD-fMRI signal responses. CONCLUSION We show that the presence of negative BOLD-CVR responses to CO2 is associated with heterogeneous motor task-based BOLD-fMRI signal responses, where some patients show -more presumed- negative BOLD-fMRI signal responses, while other patient showed positive BOLD-fMRI signal responses. This finding may indicate that the autoregulatory vasodilatory reserve capacity does not always need to be completely exhausted for vascular steal phenomenon to occur.
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Affiliation(s)
- Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, Switzerland.
| | - Aimée Hiller
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Abdominal and Transplant Surgery, University Hospital Zurich, University of Zurich. Switzerland
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, Switzerland
| | - Matthias Halter
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, Switzerland
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Joseph A Fisher
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, Switzerland
| | - Marco Piccirelli
- Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neuroradiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, Switzerland
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18
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Bellomo J, Sebök M, Stumpo V, van Niftrik CHB, Meisterhans D, Piccirelli M, Michels L, Reolon B, Esposito G, Schubert T, Kulcsar Z, Luft AR, Wegener S, Regli L, Fierstra J. Blood Oxygenation Level-Dependent Cerebrovascular Reactivity-Derived Steal Phenomenon May Indicate Tissue Reperfusion Failure After Successful Endovascular Thrombectomy. Transl Stroke Res 2023:10.1007/s12975-023-01203-y. [PMID: 37880561 DOI: 10.1007/s12975-023-01203-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/25/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
In acute ischemic stroke due to large-vessel occlusion (LVO), the clinical outcome after endovascular thrombectomy (EVT) is influenced by the extent of autoregulatory hemodynamic impairment, which can be derived from blood oxygenation level-dependent cerebrovascular reactivity (BOLD-CVR). BOLD-CVR imaging identifies brain areas influenced by hemodynamic steal. We sought to investigate the presence of steal phenomenon and its relationship to DWI lesions and clinical deficit in the acute phase of ischemic stroke following successful vessel recanalization.From the prospective longitudinal IMPreST (Interplay of Microcirculation and Plasticity after ischemic Stroke) cohort study, patients with acute ischemic unilateral LVO stroke of the anterior circulation with successful endovascular thrombectomy (EVT; mTICI scale ≥ 2b) and subsequent BOLD-CVR examination were included for this analysis. We analyzed the spatial correlation between brain areas exhibiting BOLD-CVR-associated steal phenomenon and DWI infarct lesion as well as the relationship between steal phenomenon and NIHSS score at hospital discharge.Included patients (n = 21) exhibited steal phenomenon to different extents, whereas there was only a partial spatial overlap with the DWI lesion (median 19%; IQR, 8-59). The volume of steal phenomenon outside the DWI lesion showed a positive correlation with overall DWI lesion volume and was a significant predictor for the NIHSS score at hospital discharge.Patients with acute ischemic unilateral LVO stroke exhibited hemodynamic steal identified by BOLD-CVR after successful EVT. Steal volume was associated with DWI infarct lesion size and with poor clinical outcome at hospital discharge. BOLD-CVR may further aid in better understanding persisting hemodynamic impairment following reperfusion therapy.
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Affiliation(s)
- Jacopo Bellomo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland.
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland.
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Vittorio Stumpo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Christiaan H B van Niftrik
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Darja Meisterhans
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Marco Piccirelli
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Lars Michels
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Beno Reolon
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Tilman Schubert
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas R Luft
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
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19
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Agarwal S, Welker KM, Black DF, Little JT, DeLone DR, Messina SA, Passe TJ, Bettegowda C, Pillai JJ. Detection and Mitigation of Neurovascular Uncoupling in Brain Gliomas. Cancers (Basel) 2023; 15:4473. [PMID: 37760443 PMCID: PMC10527022 DOI: 10.3390/cancers15184473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Functional magnetic resonance imaging (fMRI) with blood oxygen level-dependent (BOLD) technique is useful for preoperative mapping of brain functional networks in tumor patients, providing reliable in vivo detection of eloquent cortex to help reduce the risk of postsurgical morbidity. BOLD task-based fMRI (tb-fMRI) is the most often used noninvasive method that can reliably map cortical networks, including those associated with sensorimotor, language, and visual functions. BOLD resting-state fMRI (rs-fMRI) is emerging as a promising ancillary tool for visualization of diverse functional networks. Although fMRI is a powerful tool that can be used as an adjunct for brain tumor surgery planning, it has some constraints that should be taken into consideration for proper clinical interpretation. BOLD fMRI interpretation may be limited by neurovascular uncoupling (NVU) induced by brain tumors. Cerebrovascular reactivity (CVR) mapping obtained using breath-hold methods is an effective method for evaluating NVU potential.
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Affiliation(s)
- Shruti Agarwal
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Kirk M. Welker
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
| | - David F. Black
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
| | - Jason T. Little
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
| | - David R. DeLone
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
| | - Steven A. Messina
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
| | - Theodore J. Passe
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Jay J. Pillai
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
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20
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Dasari Y, Duffin J, Sayin ES, Levine HT, Poublanc J, Para AE, Mikulis DJ, Fisher JA, Sobczyk O, Khamesee MB. Convolutional Neural Networks to Assess Steno-Occlusive Disease Using Cerebrovascular Reactivity. Healthcare (Basel) 2023; 11:2231. [PMID: 37628429 PMCID: PMC10454585 DOI: 10.3390/healthcare11162231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Cerebrovascular Reactivity (CVR) is a provocative test used with Blood oxygenation level-dependent (BOLD) Magnetic Resonance Imaging (MRI) studies, where a vasoactive stimulus is applied and the corresponding changes in the cerebral blood flow (CBF) are measured. The most common clinical application is the assessment of cerebral perfusion insufficiency in patients with steno-occlusive disease (SOD). Globally, millions of people suffer from cerebrovascular diseases, and SOD is the most common cause of ischemic stroke. Therefore, CVR analyses can play a vital role in early diagnosis and guiding clinical treatment. This study develops a convolutional neural network (CNN)-based clinical decision support system to facilitate the screening of SOD patients by discriminating between healthy and unhealthy CVR maps. The networks were trained on a confidential CVR dataset with two classes: 68 healthy control subjects, and 163 SOD patients. This original dataset was distributed in a ratio of 80%-10%-10% for training, validation, and testing, respectively, and image augmentations were applied to the training and validation sets. Additionally, some popular pre-trained networks were imported and customized for the objective classification task to conduct transfer learning experiments. Results indicate that a customized CNN with a double-stacked convolution layer architecture produces the best results, consistent with expert clinical readings.
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Affiliation(s)
- Yashesh Dasari
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Ece Su Sayin
- Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Harrison T. Levine
- Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Andrea E. Para
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON M5G 2C4, Canada
| | - David J. Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON M5G 2C4, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Joseph A. Fisher
- Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON M5G 2C4, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Olivia Sobczyk
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON M5G 2C4, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Mir Behrad Khamesee
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
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21
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Pinto J, Blockley NP, Harkin JW, Bulte DP. Modelling spatiotemporal dynamics of cerebral blood flow using multiple-timepoint arterial spin labelling MRI. Front Physiol 2023; 14:1142359. [PMID: 37304817 PMCID: PMC10250662 DOI: 10.3389/fphys.2023.1142359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/14/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction: Cerebral blood flow (CBF) is an important physiological parameter that can be quantified non-invasively using arterial spin labelling (ASL) imaging. Although most ASL studies are based on single-timepoint strategies, multi-timepoint approaches (multiple-PLD) in combination with appropriate model fitting strategies may be beneficial not only to improve CBF quantification but also to retrieve other physiological information of interest. Methods: In this work, we tested several kinetic models for the fitting of multiple-PLD pCASL data in a group of 10 healthy subjects. In particular, we extended the standard kinetic model by incorporating dispersion effects and the macrovascular contribution and assessed their individual and combined effect on CBF quantification. These assessments were performed using two pseudo-continuous ASL (pCASL) datasets acquired in the same subjects but during two conditions mimicking different CBF dynamics: normocapnia and hypercapnia (achieved through a CO2 stimulus). Results: All kinetic models quantified and highlighted the different CBF spatiotemporal dynamics between the two conditions. Hypercapnia led to an increase in CBF whilst decreasing arterial transit time (ATT) and arterial blood volume (aBV). When comparing the different kinetic models, the incorporation of dispersion effects yielded a significant decrease in CBF (∼10-22%) and ATT (∼17-26%), whilst aBV (∼44-74%) increased, and this was observed in both conditions. The extended model that includes dispersion effects and the macrovascular component has been shown to provide the best fit to both datasets. Conclusion: Our results support the use of extended models that include the macrovascular component and dispersion effects when modelling multiple-PLD pCASL data.
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Affiliation(s)
- Joana Pinto
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Nicholas P. Blockley
- David Greenfield Human Physiology Unit, School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | | | - Daniel P. Bulte
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
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22
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Williams RJ, Specht JL, Mazerolle EL, Lebel RM, MacDonald ME, Pike GB. Correspondence between BOLD fMRI task response and cerebrovascular reactivity across the cerebral cortex. Front Physiol 2023; 14:1167148. [PMID: 37228813 PMCID: PMC10203231 DOI: 10.3389/fphys.2023.1167148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
BOLD sensitivity to baseline perfusion and blood volume is a well-acknowledged fMRI confound. Vascular correction techniques based on cerebrovascular reactivity (CVR) might reduce variance due to baseline cerebral blood volume, however this is predicated on an invariant linear relationship between CVR and BOLD signal magnitude. Cognitive paradigms have relatively low signal, high variance and involve spatially heterogenous cortical regions; it is therefore unclear whether the BOLD response magnitude to complex paradigms can be predicted by CVR. The feasibility of predicting BOLD signal magnitude from CVR was explored in the present work across two experiments using different CVR approaches. The first utilized a large database containing breath-hold BOLD responses and 3 different cognitive tasks. The second experiment, in an independent sample, calculated CVR using the delivery of a fixed concentration of carbon dioxide and a different cognitive task. An atlas-based regression approach was implemented for both experiments to evaluate the shared variance between task-invoked BOLD responses and CVR across the cerebral cortex. Both experiments found significant relationships between CVR and task-based BOLD magnitude, with activation in the right cuneus (R 2 = 0.64) and paracentral gyrus (R 2 = 0.71), and the left pars opercularis (R 2 = 0.67), superior frontal gyrus (R 2 = 0.62) and inferior parietal cortex (R 2 = 0.63) strongly predicted by CVR. The parietal regions bilaterally were highly consistent, with linear regressions significant in these regions for all four tasks. Group analyses showed that CVR correction increased BOLD sensitivity. Overall, this work suggests that BOLD signal response magnitudes to cognitive tasks are predicted by CVR across different regions of the cerebral cortex, providing support for the use of correction based on baseline vascular physiology.
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Affiliation(s)
- Rebecca J. Williams
- Faculty of Health, School of Human Services, Charles Darwin University, Darwin, NT, Australia
| | - Jacinta L. Specht
- Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Erin L. Mazerolle
- Departments of Psychology and Computer Science, St. Francis Xavier University, Antigonish, NS, Canada
| | - R. Marc Lebel
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- GE HealthCare, Calgary, AB, Canada
| | - M. Ethan MacDonald
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
- Department of Electrical and Software Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - G. Bruce Pike
- Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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23
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Sayin ES, Sobczyk O, Poublanc J, Mikulis DJ, Fisher JA, Duffin J. Transfer function analysis assesses resting cerebral perfusion metrics using hypoxia-induced deoxyhemoglobin as a contrast agent. Front Physiol 2023; 14:1167857. [PMID: 37250139 PMCID: PMC10213962 DOI: 10.3389/fphys.2023.1167857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/07/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction: Use of contrast in determining hemodynamic measures requires the deconvolution of an arterial input function (AIF) selected over a voxel in the middle cerebral artery to calculate voxel wise perfusion metrics. Transfer function analysis (TFA) offers an alternative analytic approach that does not require identifying an AIF. We hypothesised that TFA metrics Gain, Lag, and their ratio, Gain/Lag, correspond to conventional AIF resting perfusion metrics relative cerebral blood volume (rCBV), mean transit time (MTT) and relative cerebral blood flow (rCBF), respectively. Methods: 24 healthy participants (17 M) and 1 patient with steno-occlusive disease were recruited. We used non-invasive transient hypoxia-induced deoxyhemoglobin as an MRI contrast. TFA and conventional AIF analyses were used to calculate averages of whole brain and smaller regions of interest. Results: Maps of these average metrics had colour scales adjusted to enhance contrast and identify areas of high congruence. Regional gray matter/white matter (GM/WM) ratios for MTT and Lag, rCBF and Gain/Lag, and rCBV and Gain were compared. The GM/WM ratios were greater for TFA metrics compared to those from AIF analysis indicating an improved regional discrimination. Discussion: Resting perfusion measures generated by The BOLD analysis resulting from a transient hypoxia induced variations in deoxyhemoglobin analyzed by TFA are congruent with those analyzed by conventional AIF analysis.
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Affiliation(s)
- Ece Su Sayin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Departments of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Olivia Sobczyk
- Departments of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - David J. Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Joseph A. Fisher
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Departments of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Departments of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
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24
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Thomson BR, Richter H, Akeret K, Buzzi RM, Anagnostakou V, van Niftrik CHB, Schwendinger N, Kulcsar Z, Kronen PW, Regli L, Fierstra J, Schaer DJ, Hugelshofer M. Blood oxygenation-level dependent cerebrovascular reactivity imaging as strategy to monitor CSF-hemoglobin toxicity. J Stroke Cerebrovasc Dis 2023; 32:106985. [PMID: 36640721 DOI: 10.1016/j.jstrokecerebrovasdis.2023.106985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/27/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Cell-free hemoglobin in the cerebrospinal fluid (CSF-Hb) may be one of the main drivers of secondary brain injury after aneurysmal subarachnoid hemorrhage (aSAH). Haptoglobin scavenging of CSF-Hb has been shown to mitigate cerebrovascular disruption. Using digital subtraction angiography (DSA) and blood oxygenation-level dependent cerebrovascular reactivity imaging (BOLD-CVR) the aim was to assess the acute toxic effect of CSF-Hb on cerebral blood flow and autoregulation, as well as to test the protective effects of haptoglobin. METHODS DSA imaging was performed in eight anesthetized and ventilated sheep (mean weight: 80.4 kg) at baseline, 15, 30, 45 and 60 minutes after infusion of hemoglobin (Hb) or co-infusion with haptoglobin (Hb:Haptoglobin) into the left lateral ventricle. Additionally, 10 ventilated sheep (mean weight: 79.8 kg) underwent BOLD-CVR imaging to assess the cerebrovascular reserve capacity. RESULTS DSA imaging did not show a difference in mean transit time or cerebral blood flow. Whole-brain BOLD-CVR compared to baseline decreased more in the Hb group after 15 minutes (Hb vs Hb:Haptoglobin: -0.03 ± 0.01 vs -0.01 ± 0.02) and remained diminished compared to Hb:Haptoglobin group after 30 minutes (Hb vs Hb:Haptoglobin: -0.03 ± 0.01 vs 0.0 ± 0.01), 45 minutes (Hb vs Hb:Haptoglobin: -0.03 ± 0.01 vs 0.01 ± 0.02) and 60 minutes (Hb vs Hb:Haptoglobin: -0.03 ± 0.02 vs 0.01 ± 0.01). CONCLUSION It is demonstrated that CSF-Hb toxicity leads to rapid cerebrovascular reactivity impairment, which is blunted by haptoglobin co-infusion. BOLD-CVR may therefore be further evaluated as a monitoring strategy for CSF-Hb toxicity after aSAH.
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Affiliation(s)
- Bart R Thomson
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland; Division of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Henning Richter
- Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland; Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Kevin Akeret
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Raphael M Buzzi
- Division of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Vania Anagnostakou
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland; Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christiaan H B van Niftrik
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Nina Schwendinger
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland; Department of Neuroradiology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Peter W Kronen
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland; Veterinary Anaesthesia Services - International, Winterthur, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Dominik J Schaer
- Division of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Michael Hugelshofer
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland; Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland.
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25
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Vu C, Xu B, González-Zacarías C, Shen J, Baas KPA, Choi S, Nederveen AJ, Wood JC. Sinusoidal CO 2 respiratory challenge for concurrent perfusion and cerebrovascular reactivity MRI. Front Physiol 2023; 14:1102983. [PMID: 36846345 PMCID: PMC9948030 DOI: 10.3389/fphys.2023.1102983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction: Deoxygenation-based dynamic susceptibility contrast (dDSC) has previously leveraged respiratory challenges to modulate blood oxygen content as an endogenous source of contrast alternative to gadolinium injection in perfusion-weighted MRI. This work proposed the use of sinusoidal modulation of end-tidal CO2 pressures (SineCO 2 ), which has previously been used to measure cerebrovascular reactivity, to induce susceptibility-weighted gradient-echo signal loss to measure brain perfusion. Methods: SineCO 2 was performed in 10 healthy volunteers (age 37 ± 11, 60% female), and tracer kinetics model was applied in the frequency domain to calculate cerebral blood flow, cerebral blood volume, mean transit time, and temporal delay. These perfusion estimates were compared against reference techniques, including gadolinium-based DSC, arterial spin labeling, and phase contrast. Results: Our results showed regional agreement between SineCO 2 and the clinical comparators. SineCO 2 was able to generate robust CVR maps in conjunction to baseline perfusion estimates. Discussion: Overall, this work demonstrated feasibility of using sinusoidal CO2 respiratory paradigm to simultaneously acquire both cerebral perfusion and cerebrovascular reactivity maps in one imaging sequence.
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Affiliation(s)
- Chau Vu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
- Division of Cardiology, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Botian Xu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
- Division of Cardiology, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Clio González-Zacarías
- Division of Cardiology, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States
| | - Jian Shen
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
- Division of Cardiology, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Koen P. A. Baas
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Soyoung Choi
- Division of Cardiology, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - John C. Wood
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
- Division of Cardiology, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
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26
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Sayin ES, Schulman J, Poublanc J, Levine HT, Raghavan LV, Uludag K, Duffin J, Fisher JA, Mikulis DJ, Sobczyk O. Investigations of hypoxia-induced deoxyhemoglobin as a contrast agent for cerebral perfusion imaging. Hum Brain Mapp 2022; 44:1019-1029. [PMID: 36308389 PMCID: PMC9875930 DOI: 10.1002/hbm.26131] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/01/2022] [Accepted: 10/09/2022] [Indexed: 01/28/2023] Open
Abstract
The assessment of resting perfusion measures (mean transit time, cerebral blood flow, and cerebral blood volume) with magnetic resonance imaging currently requires the presence of a susceptibility contrast agent such as gadolinium. Here, we present an initial comparison between perfusion measures obtained using hypoxia-induced deoxyhemoglobin and gadolinium in healthy study participants. We hypothesize that resting cerebral perfusion measures obtained using precise changes of deoxyhemoglobin concentration will generate images comparable to those obtained using a clinical standard, gadolinium. Eight healthy study participants were recruited (6F; age 23-60). The study was performed using a 3-Tesla scanner with an eight-channel head coil. The experimental protocol consisted of a high-resolution T1-weighted scan followed by two BOLD sequence scans in which each participant underwent a controlled bolus of transient pulmonary hypoxia, and subsequently received an intravenous bolus of gadolinium. The resting perfusion measures calculated using hypoxia-induced deoxyhemoglobin and gadolinium yielded maps that looked spatially comparable. There was no statistical difference between methods in the average voxel-wise measures of mean transit time, relative cerebral blood flow and relative cerebral blood volume, in the gray matter or white matter within each participant. We conclude that perfusion measures generated with hypoxia-induced deoxyhemoglobin are spatially and quantitatively comparable to those generated from a gadolinium injection in the same healthy participant.
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Affiliation(s)
- Ece Su Sayin
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada,Department of Anaesthesia and Pain ManagementUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Jacob Schulman
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada,Techna Institute, University Health NetworkTorontoCanada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging LabUniversity Health NetworkTorontoOntarioCanada
| | - Harrison T. Levine
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada,Department of Anaesthesia and Pain ManagementUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Lakshmikumar Venkat Raghavan
- Department of Anaesthesia and Pain ManagementUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Kamil Uludag
- Techna Institute, University Health NetworkTorontoCanada,Joint Department of Medical Imaging and the Functional Neuroimaging LabUniversity Health NetworkTorontoOntarioCanada,Center for Neuroscience Imaging Research, Institute for Basic Science and Department of Biomedical EngineeringSungkyunkwan UniversitySuwonRepublic of Korea
| | - James Duffin
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada,Department of Anaesthesia and Pain ManagementUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Joseph A. Fisher
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada,Department of Anaesthesia and Pain ManagementUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - David J. Mikulis
- Techna Institute, University Health NetworkTorontoCanada,Joint Department of Medical Imaging and the Functional Neuroimaging LabUniversity Health NetworkTorontoOntarioCanada
| | - Olivia Sobczyk
- Department of Anaesthesia and Pain ManagementUniversity Health Network, University of TorontoTorontoOntarioCanada,Joint Department of Medical Imaging and the Functional Neuroimaging LabUniversity Health NetworkTorontoOntarioCanada
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27
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Sayin ES, Sobczyk O, Poublanc J, Mikulis DJ, Fisher JA, Kuo KHM, Duffin J. Assessment of cerebrovascular function in patients with sickle cell disease using transfer function analysis. Physiol Rep 2022; 10:e15472. [PMID: 36200271 PMCID: PMC9535348 DOI: 10.14814/phy2.15472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
In patients with sickle cell disease (SCD), the delivery of oxygen to the brain is compromised by anemia, abnormal rheology, and steno-occlusive vascular disease. Successful compensation depends on an increase in oxygen supply such as that provided by an increase in cerebral blood flow (CBF). We used magnetic resonance imaging to provide a high-resolution assessment of the ability of SCD patients to respond to a vasoactive stimulus in middle, anterior, and posterior cerebral artery territories for both white and gray matter. Cerebrovascular reactivity (CVR) was measured as the blood oxygen level dependent signal (a surrogate for CBF) response to an increase in the end tidal partial pressure of CO2 (PET CO2 ). The dynamic aspect of the response was measured as the time constant of the first order response kinetics (tau). To confirm and support these findings we used an alternative examination of the response, transfer function analysis (TFA), to measure the responsiveness (gain), the speed of response (phase), and the consistency of the response over time (coherence). We tested 34 patients with SCD and compared the results to those of 24 healthy controls participants. The results from a three-way ANOVA showed that patients with SCD have reduced CVR (p < 0.001) and lower coherence (p < 0.001) in gray matter and white matter and reduced gain in gray matter only (p < 0.001). In terms of the speed of the response to CO2 , tau (p < 0.001) and TFA phase (p < 0.001) were increased in SCD patients compared to healthy control subjects. These findings show that the cerebrovascular responsiveness to CO2 in patients with SCD is both decreased and slowed compared to healthy controls.
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Affiliation(s)
- Ece Su Sayin
- Department of PhysiologyUniversity of TorontoTorontoCanada
- Departments of Anaesthesia and Pain ManagementUniversity Health NetworkTorontoCanada
| | - Olivia Sobczyk
- Department of PhysiologyUniversity of TorontoTorontoCanada
- Departments of Anaesthesia and Pain ManagementUniversity Health NetworkTorontoCanada
- Joint Department of Medical Imaging and the Functional Neuroimaging LaboratoryUniversity Health NetworkTorontoCanada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging LaboratoryUniversity Health NetworkTorontoCanada
| | - David J. Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging LaboratoryUniversity Health NetworkTorontoCanada
- Institute of Medical SciencesUniversity of TorontoTorontoCanada
| | - Joseph A. Fisher
- Department of PhysiologyUniversity of TorontoTorontoCanada
- Departments of Anaesthesia and Pain ManagementUniversity Health NetworkTorontoCanada
| | - Kevin H. M. Kuo
- Division of Medical Oncology and Hematology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - James Duffin
- Department of PhysiologyUniversity of TorontoTorontoCanada
- Departments of Anaesthesia and Pain ManagementUniversity Health NetworkTorontoCanada
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28
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Sebök M, Esposito G, Niftrik CHBV, Fierstra J, Schubert T, Wegener S, Held J, Kulcsár Z, Luft AR, Regli L. Flow augmentation STA-MCA bypass evaluation for patients with acute stroke and unilateral large vessel occlusion: a proposal for an urgent bypass flowchart. J Neurosurg 2022; 137:1047-1055. [PMID: 34996035 DOI: 10.3171/2021.10.jns21986] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/25/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Endovascular recanalization trials have shown a positive impact on the preservation of ischemic penumbra in patients with acute large vessel occlusion (LVO). The concept of penumbra salvation can be extended to surgical revascularization with bypass in highly selected patients. For selecting these patients, the authors propose a flowchart based on multimodal MRI. METHODS All patients with acute stroke and persisting internal carotid artery (ICA) or M1 occlusion after intravenous lysis or mechanical thrombectomy undergo advanced neuroimaging in a time window of 72 hours after stroke onset including perfusion MRI, blood oxygenation level-dependent functional MRI to evaluate cerebrovascular reactivity (BOLD-CVR), and noninvasive optimal vessel analysis (NOVA) quantitative MRA to assess collateral circulation. RESULTS Symptomatic patients exhibiting persistent hemodynamic impairment and insufficient collateral circulation could benefit from bypass surgery. According to the flowchart, a bypass is considered for patients 1) with low or moderate neurological impairment (National Institutes of Health Stroke Scale score 1-15, modified Rankin Scale score ≤ 3), 2) without large or malignant stroke, 3) without intracranial hemorrhage, 4) with MR perfusion/diffusion mismatch > 120%, 5) with paradoxical BOLD-CVR in the occluded vascular territory, and 6) with insufficient collateral circulation. CONCLUSIONS The proposed flowchart is based on the patient's clinical condition and multimodal MR neuroimaging and aims to select patients with acute stroke due to LVO and persistent inadequate collateral flow, who could benefit from urgent bypass.
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Affiliation(s)
- Martina Sebök
- 1Departments of Neurosurgery
- 2Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Giuseppe Esposito
- 1Departments of Neurosurgery
- 2Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Jorn Fierstra
- 1Departments of Neurosurgery
- 2Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Tilman Schubert
- 2Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- 4Neuroradiology, University Hospital Zurich; and
| | - Susanne Wegener
- 2Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- 3Neurology, and
| | - Jeremia Held
- 2Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- 3Neurology, and
| | - Zsolt Kulcsár
- 2Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- 4Neuroradiology, University Hospital Zurich; and
| | - Andreas R Luft
- 2Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- 3Neurology, and
| | - Luca Regli
- 1Departments of Neurosurgery
- 2Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
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29
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Differential regional cerebrovascular reactivity to end-tidal gas combinations commonly seen during anaesthesia: A blood oxygenation level-dependent MRI observational study in awake adult subjects. Ugeskr Laeger 2022; 39:774-784. [PMID: 35852545 DOI: 10.1097/eja.0000000000001716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Regional cerebrovascular reactivity (rCVR) is highly variable in the human brain as measured by blood oxygenation level-dependent (BOLD) MRI to changes in both end-tidal CO 2 and O 2 . OBJECTIVES We examined awake participants under carefully controlled end-tidal gas concentrations to assess how regional CVR changes may present with end-tidal gas changes seen commonly with anaesthesia. DESIGN Observational study. SETTING Tertiary care centre, Winnipeg, Canada. The imaging for the study occurred in 2019. SUBJECTS Twelve healthy adult subjects. INTERVENTIONS Cerebral BOLD response was studied under two end-tidal gas paradigms. First end-tidal oxygen (ETO 2 ) maintained stable whereas ETCO 2 increased incrementally from hypocapnia to hypercapnia (CO 2 ramp); second ETCO 2 maintained stable whereas ETO 2 increased from normoxia to hyperoxia (O 2 ramp). BOLD images were modeled with end-tidal gas sequences split into two equal segments to examine regional CVR. MAIN OUTCOME MEASURES The voxel distribution comparing hypocapnia to mild hypercapnia and mild hyperoxia (mean F I O 2 = 0.3) to marked hyperoxia (mean F I O 2 = 0.7) were compared in a paired fashion ( P < 0.005 to reach threshold for voxel display). Additionally, type analysis was conducted on CO 2 ramp data. This stratifies the BOLD response to the CO 2 ramp into four categories of CVR slope based on segmentation (type A; +/+slope: normal response, type B +/-, type C -/-: intracranial steal, type D -/+.) Types B to D represent altered responses to the CO 2 stimulus. RESULTS Differential regional responsiveness was seen for both end-tidal gases. Hypocapnic regional CVR was more marked than hypercapnic CVR in 0.3% of voxels examined ( P < 0.005, paired comparison); the converse occurred in 2.3% of voxels. For O 2 , mild hyperoxia had more marked CVR in 0.2% of voxels compared with greater hyperoxia; the converse occurred in 0.5% of voxels. All subjects had altered regional CO 2 response based on Type Analysis ranging from 4 ± 2 to 7 ± 3% of voxels. CONCLUSION In awake subjects, regional differences and abnormalities in CVR were observed with changes in end-tidal gases common during the conduct of anaesthesia. On the basis of these findings, consideration could be given to minimising regional CVR fluctuations in patients-at-risk of neurological complications by tighter control of end-tidal gases near the individual's resting values.
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Forté S, Sobczyk O, Poublanc J, Duffin J, Hare GMT, Fisher JA, Mikulis D, Kuo KHM. Sickle cell cerebrovascular reactivity to a CO2 stimulus: Too little, too slow. Front Physiol 2022; 13:886807. [PMID: 36060689 PMCID: PMC9437621 DOI: 10.3389/fphys.2022.886807] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Despite increased cerebral blood flow (CBF), cerebral infarcts occur in patients with sickle cell disease (SCD). This suggests increased CBF does not meet metabolic demand possibly due to compromised cerebral vasodilatory response. Hypothesis: In adult SCD patients, cerebrovascular reactivity (CVR) and speed of vasodilatory response (tau) to a standardized vasodilatory stimulus, are reduced compared to normal subjects. Methods: Functional brain imaging performed as part of routine care in adult SCD patients without known large vessel cerebral vasculopathy was reviewed retrospectively. CVR was calculated as the change in CBF measured as the blood-oxygenation-level-dependent (BOLD)-magnetic resonance imaging signal, in response to a standard vasoactive stimulus of carbon dioxide (CO2). The tau corresponding to the best fit between the convolved end-tidal partial pressures of CO2 and BOLD signal was defined as the speed of vascular response. CVR and tau were normalized using a previously generated atlas of 42 healthy controls. Results: Fifteen patients were included. CVR was reduced in grey and white matter (mean Z-score for CVR −0.5 [−1.8 to 0.3] and −0.6 [−2.3 to 0.7], respectively). Tau Z-scores were lengthened in grey and white matter (+0.9 [−0.5 to 3.3] and +0.8 [−0.7 to 2.7], respectively). Hematocrit was the only significant independent predictor of CVR on multivariable regression. Conclusion: Both measures of cerebrovascular health (CVR and tau) in SCD patients were attenuated compared to normal controls. These findings show that CVR represents a promising tool to assess disease state, stroke risk, and therapeutic efficacy of treatments in SCD and merits further investigation.
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Affiliation(s)
- Stéphanie Forté
- Division of Medical Oncology and Hematology, Departement of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, ON, Canada
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Olivia Sobczyk
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
- Department of Anaesthesia and Pain Medicine, University Health Network, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - James Duffin
- The Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Gregory M. T. Hare
- The Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael’s Hospital, Toronto, ON, Canada
| | - Joseph Arnold Fisher
- Department of Anaesthesia and Pain Medicine, University Health Network, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - David Mikulis
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Kevin H. M. Kuo
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, ON, Canada
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- *Correspondence: Kevin H. M. Kuo,
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Clough RH, Minhas JS, Haunton VJ, Hanby MF, Robinson TG, Panerai RB. Dynamics of the cerebral autoregulatory response to paced hyperventilation assessed using sub-component and time-varying analyses. J Appl Physiol (1985) 2022; 133:311-319. [PMID: 35736950 DOI: 10.1152/japplphysiol.00100.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral blood flow (CBF) can be altered by a change in partial pressure of arterial CO2 (pCO2), being reduced during hyperventilation (HPV). Critical closing pressure (CrCP) and resistance area product (RAP) are parameters which can be studied to understand this change, but their dynamic response has not been investigated during paced HPV (PHPV). Seventy five participants had recordings at rest and during PHPV. Blood pressure (BP) (Finometer), bilateral CBF velocity (CBFV) (transcranial Doppler), end-tidal CO2 (capnography) and heart rate (HR) were recorded continuously. Subcomponent analysis (SCA) and time-varying CrCP, RAP and dynamic cerebral autoregulation (Autoregulation Index, ARI) were estimated comparing PHPV to poikilocapnia. PHPV caused a change in CBFV (p<0.01), EtCO2, (p<0.01), HR (p<0.001) and RAP (p<0.01). SCA demonstrated RAP was the main parameter explaining the changes in CBFV due to PHPV. The time-varying step responses for CBFV and RAP during PHPV demonstrated considerable non-stationarity compared to poikilocapnia (p<0.00001). Although time-varying ARI was temporarily depressed, after 60 s of PHPV it was significantly higher (6.81 ± 1.88) (p<0.0001) than in poikilocapnia (5.08 ± 1.86). The mean plateau of the RAP step response was -98.3 ± 58.8 % 60 s after the onset of PHPV but -71.7 ± 45.0 % for poikilocapnia (p=0.0026), with no corresponding changes in CrCP (p=0.6). Further work is needed to assess the role of sex and aging in our findings, and the potential for using RAP and CrCP to improve the sensitivity and specificity of CO2 reactivity studies in cerebrovascular conditions.
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Affiliation(s)
- Rebecca H Clough
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Jatinder S Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Victoria J Haunton
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Martha Frances Hanby
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Thompson G Robinson
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Ronney B Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
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Stickland RC, Zvolanek KM, Moia S, Caballero-Gaudes C, Bright MG. Lag-Optimized Blood Oxygenation Level Dependent Cerebrovascular Reactivity Estimates Derived From Breathing Task Data Have a Stronger Relationship With Baseline Cerebral Blood Flow. Front Neurosci 2022; 16:910025. [PMID: 35801183 PMCID: PMC9254683 DOI: 10.3389/fnins.2022.910025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Cerebrovascular reactivity (CVR), an important indicator of cerebrovascular health, is commonly studied with the Blood Oxygenation Level Dependent functional MRI (BOLD-fMRI) response to a vasoactive stimulus. Theoretical and empirical evidence suggests that baseline cerebral blood flow (CBF) modulates BOLD signal amplitude and may influence BOLD-CVR estimates. We address how acquisition and modeling choices affect the relationship between baseline cerebral blood flow (bCBF) and BOLD-CVR: whether BOLD-CVR is modeled with the inclusion of a breathing task, and whether BOLD-CVR amplitudes are optimized for hemodynamic lag effects. We assessed between-subject correlations of average GM values and within-subject spatial correlations across cortical regions. Our results suggest that a breathing task addition to a resting-state acquisition, alongside lag-optimization within BOLD-CVR modeling, can improve BOLD-CVR correlations with bCBF, both between- and within-subjects, likely because these CVR estimates are more physiologically accurate. We report positive correlations between bCBF and BOLD-CVR, both between- and within-subjects. The physiological explanation of this positive correlation is unclear; research with larger samples and tightly controlled vasoactive stimuli is needed. Insights into what drives variability in BOLD-CVR measurements and related measurements of cerebrovascular function are particularly relevant when interpreting results in populations with altered vascular and/or metabolic baselines or impaired cerebrovascular reserve.
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Affiliation(s)
- Rachael C. Stickland
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kristina M. Zvolanek
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Stefano Moia
- Basque Center on Cognition, Brain and Language, Donostia, Spain
- University of the Basque Country EHU/UPV, Donostia, Spain
| | | | - Molly G. Bright
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
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Sayin ES, Sobczyk O, Poublanc J, Mikulis DJ, Fisher JA, Kuo KHM, Duffin J. Assessing Cerebrovascular Resistance in Patients With Sickle Cell Disease. Front Physiol 2022; 13:847969. [PMID: 35422710 PMCID: PMC9002264 DOI: 10.3389/fphys.2022.847969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/08/2022] [Indexed: 02/05/2023] Open
Abstract
In patients with sickle cell disease (SCD) the delivery of oxygen to the brain is compromised by anemia, abnormal rheology, and steno-occlusive vascular disease. Meeting demands for oxygen delivery requires compensatory features of brain perfusion. The cerebral vasculature’s regulatory function and reserves can be assessed by observing the flow response to a vasoactive stimulus. In a traditional approach we measured voxel-wise change in Blood Oxygen-Level Dependent (BOLD) MRI signal as a surrogate of cerebral blood flow (CBF) in response to a linear progressive ramping of end-tidal partial pressure of carbon dioxide (PETCO2). Cerebrovascular reactivity (CVR) was defined as ΔBOLD/ΔPETCO2. We used a computer model to fit a virtual sigmoid resistance curve to the progressive CBF response to the stimulus, enabling the calculation of resistance parameters: amplitude, midpoint, range response, resistance sensitivity and vasodilatory reserve. The quality of the resistance sigmoid fit was expressed as the r2 of the fit. We tested 35 patients with SCD, as well as 24 healthy subjects to provide an indication of the normal ranges of the resistance parameters. We found that gray matter CVR and resistance amplitude, range, reserve, and sensitivity are reduced in patients with SCD compared to healthy controls, while resistance midpoint was increased. This study is the first to document resistance measures in adult patients with SCD. It is also the first to score these vascular resistance measures in comparison to the normal range. We anticipate these data will complement the current understanding of the cerebral vascular pathophysiology of SCD, identify paths for therapeutic interventions, and provide biomarkers for monitoring the progress of the disease.
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Affiliation(s)
- Ece Su Sayin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Olivia Sobczyk
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - David J. Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Joseph A. Fisher
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Kevin H. M. Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- *Correspondence: James Duffin,
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Hemodynamic Imaging in Cerebral Diffuse Glioma-Part A: Concept, Differential Diagnosis and Tumor Grading. Cancers (Basel) 2022; 14:cancers14061432. [PMID: 35326580 PMCID: PMC8946242 DOI: 10.3390/cancers14061432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
Diffuse gliomas are the most common primary malignant intracranial neoplasms. Aside from the challenges pertaining to their treatment-glioblastomas, in particular, have a dismal prognosis and are currently incurable-their pre-operative assessment using standard neuroimaging has several drawbacks, including broad differentials diagnosis, imprecise characterization of tumor subtype and definition of its infiltration in the surrounding brain parenchyma for accurate resection planning. As the pathophysiological alterations of tumor tissue are tightly linked to an aberrant vascularization, advanced hemodynamic imaging, in addition to other innovative approaches, has attracted considerable interest as a means to improve diffuse glioma characterization. In the present part A of our two-review series, the fundamental concepts, techniques and parameters of hemodynamic imaging are discussed in conjunction with their potential role in the differential diagnosis and grading of diffuse gliomas. In particular, recent evidence on dynamic susceptibility contrast, dynamic contrast-enhanced and arterial spin labeling magnetic resonance imaging are reviewed together with perfusion-computed tomography. While these techniques have provided encouraging results in terms of their sensitivity and specificity, the limitations deriving from a lack of standardized acquisition and processing have prevented their widespread clinical adoption, with current efforts aimed at overcoming the existing barriers.
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Stumpo V, Guida L, Bellomo J, Van Niftrik CHB, Sebök M, Berhouma M, Bink A, Weller M, Kulcsar Z, Regli L, Fierstra J. Hemodynamic Imaging in Cerebral Diffuse Glioma-Part B: Molecular Correlates, Treatment Effect Monitoring, Prognosis, and Future Directions. Cancers (Basel) 2022; 14:1342. [PMID: 35267650 PMCID: PMC8909110 DOI: 10.3390/cancers14051342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 02/05/2023] Open
Abstract
Gliomas, and glioblastoma in particular, exhibit an extensive intra- and inter-tumoral molecular heterogeneity which represents complex biological features correlating to the efficacy of treatment response and survival. From a neuroimaging point of view, these specific molecular and histopathological features may be used to yield imaging biomarkers as surrogates for distinct tumor genotypes and phenotypes. The development of comprehensive glioma imaging markers has potential for improved glioma characterization that would assist in the clinical work-up of preoperative treatment planning and treatment effect monitoring. In particular, the differentiation of tumor recurrence or true progression from pseudoprogression, pseudoresponse, and radiation-induced necrosis can still not reliably be made through standard neuroimaging only. Given the abundant vascular and hemodynamic alterations present in diffuse glioma, advanced hemodynamic imaging approaches constitute an attractive area of clinical imaging development. In this context, the inclusion of objective measurable glioma imaging features may have the potential to enhance the individualized care of diffuse glioma patients, better informing of standard-of-care treatment efficacy and of novel therapies, such as the immunotherapies that are currently increasingly investigated. In Part B of this two-review series, we assess the available evidence pertaining to hemodynamic imaging for molecular feature prediction, in particular focusing on isocitrate dehydrogenase (IDH) mutation status, MGMT promoter methylation, 1p19q codeletion, and EGFR alterations. The results for the differentiation of tumor progression/recurrence from treatment effects have also been the focus of active research and are presented together with the prognostic correlations identified by advanced hemodynamic imaging studies. Finally, the state-of-the-art concepts and advancements of hemodynamic imaging modalities are reviewed together with the advantages derived from the implementation of radiomics and machine learning analyses pipelines.
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Affiliation(s)
- Vittorio Stumpo
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Lelio Guida
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Jacopo Bellomo
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Christiaan Hendrik Bas Van Niftrik
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Moncef Berhouma
- Department of Neurosurgical Oncology and Vascular Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, 69500 Lyon, France;
| | - Andrea Bink
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
- Department of Neuroradiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Michael Weller
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Zsolt Kulcsar
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
- Department of Neuroradiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
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Stumpo V, Sebök M, van Niftrik CHB, Seystahl K, Hainc N, Kulcsar Z, Weller M, Regli L, Fierstra J. Feasibility of glioblastoma tissue response mapping with physiologic BOLD imaging using precise oxygen and carbon dioxide challenge. MAGMA (NEW YORK, N.Y.) 2022; 35:29-44. [PMID: 34874499 DOI: 10.1007/s10334-021-00980-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Innovative physiologic MRI development focuses on depiction of heterogenous vascular and metabolic features in glioblastoma. For this feasibility study, we employed blood oxygenation level-dependent (BOLD) MRI with standardized and precise carbon dioxide (CO2) and oxygen (O2) modulation to investigate specific tumor tissue response patterns in patients with newly diagnosed glioblastoma. MATERIALS AND METHODS Seven newly diagnosed untreated patients with suspected glioblastoma were prospectively included to undergo a BOLD study with combined CO2 and O2 standardized protocol. %BOLD signal change/mmHg during hypercapnic, hypoxic, and hyperoxic stimulus was calculated in the whole brain, tumor lesion and segmented volumes of interest (VOI) [contrast-enhancing (CE) - tumor, necrosis and edema] to analyze their tissue response patterns. RESULTS Quantification of BOLD signal change after gas challenges can be used to identify specific responses to standardized stimuli in glioblastoma patients. Integration of this approach with automatic VOI segmentation grants improved characterization of tumor subzones and edema. Magnitude of BOLD signal change during the 3 stimuli can be visualized at voxel precision through color-coded maps overlayed onto whole brain and identified VOIs. CONCLUSIONS Our preliminary investigation shows good feasibility of BOLD with standardized and precise CO2 and O2 modulation as an emerging physiologic imaging technique to detail specific glioblastoma characteristics. The unique tissue response patterns generated can be further investigated to better detail glioblastoma lesions and gauge treatment response.
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Affiliation(s)
- Vittorio Stumpo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. .,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katharina Seystahl
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Nicolin Hainc
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Weller
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Effects of different insulation temperatures of an inflatable insulation system on patients receiving right hemicolectomy using the laparoscopic caudal approach. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
The study assesses the effects of different insulation temperatures of an inflatable insulation system on right hemicolectomy.
Materials and Methods
A total of 132 patients receiving right hemicolectomy using the laparoscopic caudal approach were randomly divided into four groups. The inflatable insulation system was used immediately after they entered the operating room. The perioperative core body temperature, blood coagulation index, stress index, recovery time from anesthesia, and postoperative BIS recovery were recorded 5 minutes before induction of anesthesia (T0), immediately (T1), 30 minutes (T2), 60 minutes (T3), and 120 minutes after induction of general anesthesia (T4), and at the end of operation (T5).
Results
Group C had significantly lower IL1, IL-6, IL-23, IL-13, IL-17A, TNF-α, and CRP levels but a higher IL-12 level than those of other three groups (P < 0.05). The MAP and HR values of groups A and C were significantly lower than those of groups B and D at T2, T3 and T4, which were lowest in group C (P < 0.05). The blood glucose levels of groups A and C during and after operation were lower than those of groups B and D, being lowest in group C (P < 0.05). The anesthesia recovery time and extubation time of groups A and C were shorter than those of groups B and D, being shortest in group C (P < 0.05). The time from discontinuation to BIS>80 of group C was significantly shorter than those of other three groups (P < 0.05).
Conclusions
Comprehensive insulation (43°C automatically adjusted to 38°C after 1 hour) exerts satisfactory effects on right hemicolectomy.
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Sayin ES, Davidian A, Levine H, Venkatraghavan L, Mikulis DJ, Fisher JA, Sobczyk O, Duffin J. Does breathing pattern affect cerebrovascular reactivity? Exp Physiol 2021; 107:183-191. [PMID: 34961983 DOI: 10.1113/ep090122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Is cerebrovascular reactivity affected by isocapnic changes in breathing pattern? What is the main finding and its importance? The main finding is that cerebrovascular reactivity does not change with isocapnic variations in tidal volume and frequency. ABSTRACT Deviations of arterial carbon dioxide tension from resting values affect cerebral blood vessel tone and thereby cerebral blood flow. Arterial carbon dioxide tension also affects central respiratory chemoreceptors, adjusting respiratory drive. This coincidence raises the question whether respiratory drive also affects the cerebral blood flow response to carbon dioxide. A change in cerebral blood flow for a given change in the arterial carbon dioxide tension is defined as cerebrovascular reactivity. Two studies have reached conflicting conclusions on this question, using voluntary control of breathing as a disturbing factor during measurements of cerebrovascular reactivity. Here we address some of the methodological limitations of both studies by using sequential gas delivery and targeted control of carbon dioxide and oxygen to enable a separation of the effects of carbon dioxide on cerebrovascular reactivity from breathing vigor. We confirm there is no detectable superimposed effect of breathing efforts on cerebrovascular reactivity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ece Su Sayin
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Canada
| | - Anahis Davidian
- Department of Physiology, University of Toronto, Toronto, Canada
| | - Harrison Levine
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Canada
| | - Lashmi Venkatraghavan
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Canada
| | - David J Mikulis
- Institute of Medical Sciences, University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Canada
| | - Joseph A Fisher
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Olivia Sobczyk
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Canada.,Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Canada
| | - James Duffin
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Canada
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Liu P, Jiang D, Albert M, Bauer CE, Caprihan A, Gold BT, Greenberg SM, Helmer KG, Jann K, Jicha G, Rodriguez P, Satizabal CL, Seshadri S, Singh H, Thompson JF, Wang DJJ, Lu H. Multi-vendor and multisite evaluation of cerebrovascular reactivity mapping using hypercapnia challenge. Neuroimage 2021; 245:118754. [PMID: 34826595 PMCID: PMC8783393 DOI: 10.1016/j.neuroimage.2021.118754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/05/2021] [Accepted: 11/22/2021] [Indexed: 01/22/2023] Open
Abstract
Cerebrovascular reactivity (CVR), which measures the ability of cerebral blood vessels to dilate or constrict in response to vasoactive stimuli such as CO2 inhalation, is an important index of the brain's vascular health. Quantification of CVR using BOLD MRI with hypercapnia challenge has shown great promises in research and clinical studies. However, in order for it to be used as a potential imaging biomarker in large-scale and multi-site studies, the reliability of CO2-CVR quantification across different MRI acquisition platforms and researchers/raters must be examined. The goal of this report from the MarkVCID small vessel disease biomarkers consortium is to evaluate the reliability of CO2-CVR quantification in three studies. First, the inter-rater reliability of CO2-CVR data processing was evaluated by having raters from 5 MarkVCID sites process the same 30 CVR datasets using a cloud-based CVR data processing pipeline. Second, the inter-scanner reproducibility of CO2-CVR quantification was assessed in 10 young subjects across two scanners of different vendors. Third, test-retest repeatability was evaluated in 20 elderly subjects from 4 sites with a scan interval of less than 2 weeks. In all studies, the CO2 CVR measurements were performed using the fixed inspiration method, where the subjects wore a nose clip and a mouthpiece and breathed room air and 5% CO2 air contained in a Douglas bag alternatively through their mouth. The results showed that the inter-rater CoV of CVR processing was 0.08 ± 0.08% for whole-brain CVR values and ranged from 0.16% to 0.88% in major brain regions, with ICC of absolute agreement above 0.9959 for all brain regions. Inter-scanner CoV was found to be 6.90 ± 5.08% for whole-brain CVR values, and ranged from 4.69% to 12.71% in major brain regions, which are comparable to intra-session CoVs obtained from the same scanners on the same day. ICC of consistency between the two scanners was 0.8498 for whole-brain CVR and ranged from 0.8052 to 0.9185 across major brain regions. In the test-retest evaluation, test-retest CoV across different days was found to be 18.29 ± 17.12% for whole-brain CVR values, and ranged from 16.58% to 19.52% in major brain regions, with ICC of absolute agreement ranged from 0.6480 to 0.7785. These results demonstrated good inter-rater, inter-scanner, and test-retest reliability in healthy volunteers, and suggested that CO2-CVR has suitable instrumental properties for use as an imaging biomarker of cerebrovascular function in multi-site and longitudinal observational studies and clinical trials.
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Affiliation(s)
- Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dengrong Jiang
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Brian T Gold
- Department of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Karl G Helmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Kay Jann
- Laboratory of Functional MRI Technology, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gregory Jicha
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Pavel Rodriguez
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Herpreet Singh
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey F Thompson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Danny J J Wang
- Laboratory of Functional MRI Technology, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore 21287, USA; F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, 21205, USA.
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40
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Tiberini P, D'Antona G, Cicchella A. Brain Oxygenation in Post-concussion Combat Sport Athletes. Front Sports Act Living 2021; 3:725096. [PMID: 34917937 PMCID: PMC8669507 DOI: 10.3389/fspor.2021.725096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Investigate the feasibility of a non-invasive method to evaluate the physical and cognitive repercussions of long-lasting post-concussion effects in professional combat sports athletes. To help athletes return to professional combat, there is a need for unbiased objective tools and techniques used as a prognostic method of recovery after Sport Related Concussion (SRC). Methods: Six mild Traumatic Brain Injury (mTBI) athletes, age 20 ÷ 43 yr (1 female, 5 males) and 7 not concussed (NC) participants (amateur), age 24 ÷ 38 yr (3 females, 4 males), were tested Inspired/expired gas concentration, Cerebral changes in oxygenated hemoglobin (Δ[HbO2]) and deoxygenated hemoglobin (Δ[HHb]) were measured using near infrared spectroscopy (NIRS) with a 3-step protocol: rest before maximal oxygen uptake (VO2max) test, hypercapnia, and recovery after VO2max test. The brain oxygenation and respiratory parameters of both sample sets were calculated using a non-parametric test (Mann-Whitney U test). Aerobic fitness outcome was quantified through mean average using the Bruce test. Participants performed Fitt's test using a laptop and analysis of medio-lateral and anterior-posterior range of oscillation was carried out via a force platform Romberg test. Results: mTBI group showed statistically significant differences in saturated hemoglobin Δ[HbO2] (p < 0.001) during rest and recovery phase after maximal incremental exercise, in medio-lateral sway eyes open (p = 0.008, NC 25.35 ± 4.11 mm and mTBI 17.65 ± 4.79 mm). VO2max revealed no significant differences between the two groups: NC 47.47 ± 4.91 mTBI 49.58 ± 5.19 ml/kg/min-1. The 2 groups didn't differ for maximum power output (NC 220 ± 34, mTBI 255 ± 50 W). End-tidal fractional concentration of O2 (FetO2 NC15.20 ± 0.41, mTBI 16.09 ± 0.68) throughout hypercapnia, saturated blood hemoglobin (Δ[HbO2]) revealed significant differences with the mTBI group. No differences emerged from Fitt's test. Conclusions: It emerges that NIRS is able to reveal differences in long time outcomes of mTBI. The medio-lateral variations cannot be considered as a marker of long-term damage in athletes specifically trained for balance.
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Affiliation(s)
- Paolo Tiberini
- Department of Movement Sciences and Well-being, University of Naples Parthenope, Naples, Italy
| | - Giuseppe D'Antona
- Criams-Sport Medicine Centre Voghera, University of Pavia, Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Antonio Cicchella
- Department for Quality of Life Studies, University of Bologna, Bologna, Italy
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Carr JMJR, Caldwell HG, Carter H, Smith K, Tymko MM, Green DJ, Ainslie PN, Hoiland RL. The stability of cerebrovascular CO 2 reactivity following attainment of physiological steady-state. Exp Physiol 2021; 106:2542-2555. [PMID: 34730862 DOI: 10.1113/ep089982] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? During a steady-state cerebrovascular CO2 reactivity test, do different data extraction time points change the outcome for cerebrovascular CO2 reactivity? What is the main finding and its importance? Once steady-state end-tidal pressure of CO2 and haemodynamics were achieved, cerebral blood flow was stable, and so cerebrovascular CO2 reactivity values remained unchanged regardless of data extraction length (30 vs. 60 s) and time point (at 2-5 min). ABSTRACT This study assessed cerebrovascular CO2 reactivity (CVR) and examined data extraction time points and durations with the hypotheses that: (1) there would be no difference in CVR values when calculated with cerebral blood flow (CBF) measures at different time points following the attainment of physiological steady-state, (2) once steady-state was achieved there would be no difference in CVR values derived from 60 to 30 s extracted means, and (3) that changes in V ̇ E would not be associated with any changes in CVR. We conducted a single step iso-oxic hypercapnic CVR test using dynamic end-tidal forcing (end-tidal P C O 2 , +9.4 ± 0.7 mmHg), and transcranial Doppler and Duplex ultrasound of middle cerebral artery (MCA) and internal carotid artery (ICA), respectively. From the second minute of hypercapnia onwards, physiological steady-state was apparent, with no subsequent changes in end-tidal P C O 2 , P O 2 or mean arterial pressure. Therefore, CVR measured in the ICA and MCA was stable following the second minute of hypercapnia onwards. Data extraction durations of 30 or 60 s did not give statistically different CVR values. No differences in CVR were detected following the second minute of hypercapnia after accounting for mean arterial pressure via calculated conductance or covariation of mean arterial pressure. These findings demonstrate that, provided the P C O 2 stimulus remains in a steady-state, data extracted from any minute of a CVR test during physiological steady-state conditions produce equivalent CVR values; any change in the CVR value would represent a failure of CVR mechanisms, a change in the magnitude of the stimulus, or measurement error.
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Affiliation(s)
- Jay M J R Carr
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Hannah G Caldwell
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Howard Carter
- Cardiovascular Research Group, School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia
| | - Kurt Smith
- Cerebrovascular Health, Exercise, and Environmental Research Sciences Laboratory (CHEERS), School of Exercise Science and Physical Health Education, Faculty of Education, University of Victoria, Victoria, British Columbia, Canada
| | - Michael M Tymko
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, & Recreation, University of Alberta, Edmonton, Canada
| | - Daniel J Green
- Cardiovascular Research Group, School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Ryan L Hoiland
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaborations on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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42
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Sebök M, Niftrik CHBV, Lohaus N, Esposito G, Amki ME, Winklhofer S, Wegener S, Regli L, Fierstra J. Leptomeningeal collateral activation indicates severely impaired cerebrovascular reserve capacity in patients with symptomatic unilateral carotid artery occlusion. J Cereb Blood Flow Metab 2021; 41:3039-3051. [PMID: 34112002 PMCID: PMC8545056 DOI: 10.1177/0271678x211024373] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For patients with symptomatic unilateral internal carotid artery (ICA) occlusion, impaired cerebrovascular reactivity (CVR) indicates increased stroke risk. Here, the role of collateral activation remains a matter of debate, whereas angio-anatomical collateral abundancy does not necessarily imply sufficient compensatory flow provided. We aimed to further elucidate the role of collateral activation in the presence of impaired CVR. From a prospective database, 62 patients with symptomatic unilateral ICA occlusion underwent blood oxygenation-level dependent (BOLD) fMRI CVR imaging and a transcranial Doppler (TCD) investigation for primary and secondary collateral activation. Descriptive statistic and multivariate analysis were used to evaluate the relationship between BOLD-CVR values and collateral activation. Patients with activated secondary collaterals exhibited more impaired BOLD-CVR values of the ipsilateral hemisphere (p = 0.02). Specifically, activation of leptomeningeal collaterals showed severely impaired ipsilateral hemisphere BOLD-CVR values when compared to activation of ophthalmic collaterals (0.05 ± 0.09 vs. 0.12 ± 0.04, p = 0.005). Moreover, the prediction analysis showed leptomeningeal collateral activation as a strong independent predictor for ipsilateral hemispheric BOLD-CVR. In our study, ipsilateral leptomeningeal collateral activation is the sole collateral pathway associated with severely impaired BOLD-CVR in patients with symptomatic unilateral ICA occlusion.
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Affiliation(s)
- Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niklas Lohaus
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mohamad El Amki
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Winklhofer
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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43
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Poublanc J, Sobczyk O, Shafi R, Sayin ES, Schulman J, Duffin J, Uludag K, Wood JC, Vu C, Dharmakumar R, Fisher JA, Mikulis DJ. Perfusion MRI using endogenous deoxyhemoglobin as a contrast agent: Preliminary data. Magn Reson Med 2021; 86:3012-3021. [PMID: 34687064 DOI: 10.1002/mrm.28974] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/22/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE To demonstrate the feasibility of mapping cerebral perfusion metrics with BOLD MRI during modulation of pulmonary venous oxygen saturation. METHODS A gas blender with a sequential gas delivery breathing circuit was used to implement rapid isocapnic changes in the partial pressure of oxygen of the arterial blood. Partial pressure of oxygen was initially lowered to a baseline of 40 mmHg. It was then rapidly raised to 95 mmHg for 20 s before rapidly returning to baseline. The induced cerebral changes in deoxyhemoglobin concentration were tracked over time using BOLD MRI in 6 healthy subjects and 1 patient with cerebral steno-occlusive disease. BOLD signal change, contrast-to-noise ratio, and time delay metrics were calculated. Perfusion metrics such as mean transit time, relative cerebral blood volume, and relative cerebral blood flow were calculated using a parametrized method with a mono-exponential residue function. An arterial input function from within the middle cerebral artery was used to scale relative cerebral blood volume and calculate absolute cerebral blood volume and cerebral blood flow. RESULTS In normal subjects, average gray and white matter were: BOLD change = 6.3 ± 1.2% and 2.5 ± 0.6%, contrast-to-noise ratio = 4.3 ± 1.3 and 2.6 ± 0.7, time delay = 2.3 ± 0.6 s and 3.6 ± 0.7 s, mean transit time = 3.9 ± 0.6 s and 5.5 ± 0.6 s, relative cerebral blood volume = 3.7 ± 0.9 and 1.6 ± 0.4, relative cerebral blood flow = 70.1 ± 8.3 and 20.6 ± 4.0, cerebral blood flow volume = 4.1 ± 0.9 mL/100 g and 1.8 ± 0.5 mL/100 g, and cerebral blood flow = 97.2 ± 18.7 mL/100 g/min and 28.7 ± 5.9 mL/100 g/min. CONCLUSION This study demonstrates that induced abrupt changes in deoxyhemoglobin can function as a noninvasive vascular contrast agent that may be used for cerebral perfusion imaging.
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Affiliation(s)
- Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, Ontario, Canada
| | - Olivia Sobczyk
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, Ontario, Canada.,Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Reema Shafi
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, Ontario, Canada
| | - Ece Su Sayin
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Jacob Schulman
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - James Duffin
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Kamil Uludag
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Techna Institute & Koerner Scientist in MR Imaging, University Health Network, Toronto, Ontario, Canada.,Center for Neuroscience Imaging Research, Institute for Basic Science & Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - John C Wood
- Division of Cardiology, Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Chau Vu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Rohan Dharmakumar
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Joseph A Fisher
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - David J Mikulis
- The Joint Department of Medical Imaging, The Toronto Western Hospital, The University of Toronto, Toronto, Ontario, Canada
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Sebök M, van Niftrik CHB, Halter M, Hiller A, Seystahl K, Pangalu A, Weller M, Stippich C, Regli L, Fierstra J. Crossed Cerebellar Diaschisis in Patients with Diffuse Glioma Is Associated with Impaired Supratentorial Cerebrovascular Reactivity and Worse Clinical Outcome. THE CEREBELLUM 2021; 19:824-832. [PMID: 32737798 PMCID: PMC7588366 DOI: 10.1007/s12311-020-01174-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Crossed cerebellar diaschisis (CCD) can be associated with impaired cerebrovascular reactivity (CVR) and poor clinical outcome, but whether this holds true for patients with diffuse glioma is unknown. With blood oxygenation level-dependent (BOLD)-CVR imaging, we determined the presence of CCD in patients with diffuse glioma and investigated its relationship with cerebrovascular reactivity and clinical outcome. For eighteen enrolled subjects (nineteen datasets) with diffuse glioma, CCD was deferred from BOLD-CVR using a predetermined cerebellar asymmetry index (CAI) cutoff value of 6.0%. A FET-PET study was done as a verification of the CCD diagnosis. BOLD-CVR values as well as clinical performance scores (i.e., Karnofsky performance score (KPS), disability rating scale (DRS), and modified Rankin scale (mRS)) by BOLD-CVR scan at 3-month clinical follow-up were assessed and compared for the CCD-positive and CCD-negative group. CCD was present in 26.3% of subjects and strongly associated with impaired BOLD-CVR of the affected (i.e., the hemisphere harboring the glioma) and unaffected supratentorial hemisphere (CCD(+) vs. CCD(-): 0.08 ± 0.11 vs. 0.18 ± 0.04; p = 0.007 and 0.08 ± 0.12 vs. 0.19 ± 0.04; p = 0.007, respectively). This finding was independent of tumor volume (p = 0.48). Furthermore, poorer initial (by scan) clinical performance scores at follow-up were found for the CCD(+) group. The presence of crossed cerebellar diaschisis in patients with diffuse glioma is associated with impaired supratentorial cerebrovascular reactivity and worse clinical outcome.
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Affiliation(s)
- Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. .,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Halter
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Aimee Hiller
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katharina Seystahl
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Athina Pangalu
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christoph Stippich
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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45
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Troy AM, Cheng HM. Human microvascular reactivity: a review of vasomodulating stimuli and non-invasive imaging assessment. Physiol Meas 2021; 42. [PMID: 34325417 DOI: 10.1088/1361-6579/ac18fd] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/29/2021] [Indexed: 11/11/2022]
Abstract
The microvasculature serves an imperative function in regulating perfusion and nutrient exchange throughout the body, adaptively altering blood flow to preserve hemodynamic and metabolic homeostasis. Its normal functioning is vital to tissue health, whereas its dysfunction is present in many chronic conditions, including diabetes, heart disease, and cognitive decline. As microvascular dysfunction often appears early in disease progression, its detection can offer early diagnostic information. To detect microvascular dysfunction, one uses imaging to probe the microvasculature's ability to react to a stimulus, also known as microvascular reactivity (MVR). An assessment of MVR requires an integrated understanding of vascular physiology, techniques for stimulating reactivity, and available imaging methods to capture the dynamic response. Practical considerations, including compatibility between the selected stimulus and imaging approach, likewise require attention. In this review, we provide a comprehensive foundation necessary for informed imaging of MVR, with a particular focus on the challenging endeavor of assessing microvascular function in deep tissues.
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Affiliation(s)
- Aaron M Troy
- Institute of Biomedical Engineering, University of Toronto, Toronto, CANADA
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46
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Sobczyk O, Fierstra J, Venkatraghavan L, Poublanc J, Duffin J, Fisher JA, Mikulis DJ. Measuring Cerebrovascular Reactivity: Sixteen Avoidable Pitfalls. Front Physiol 2021; 12:665049. [PMID: 34305634 PMCID: PMC8294324 DOI: 10.3389/fphys.2021.665049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/07/2021] [Indexed: 12/04/2022] Open
Abstract
An increase in arterial PCO2 is the most common stressor used to increase cerebral blood flow for assessing cerebral vascular reactivity (CVR). That CO2 is readily obtained, inexpensive, easy to administer, and safe to inhale belies the difficulties in extracting scientifically and clinically relevant information from the resulting flow responses. Over the past two decades, we have studied more than 2,000 individuals, most with cervical and cerebral vascular pathology using CO2 as the vasoactive agent and blood oxygen-level-dependent magnetic resonance imaging signal as the flow surrogate. The ability to deliver different forms of precise hypercapnic stimuli enabled systematic exploration of the blood flow-related signal changes. We learned the effect on CVR of particular aspects of the stimulus such as the arterial partial pressure of oxygen, the baseline PCO2, and the magnitude, rate, and pattern of its change. Similarly, we learned to interpret aspects of the flow response such as its magnitude, and the speed and direction of change. Finally, we were able to test whether the response falls into a normal range. Here, we present a review of our accumulated insight as 16 “lessons learned.” We hope many of these insights are sufficiently general to apply to a range of types of CO2-based vasoactive stimuli and perfusion metrics used for CVR.
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Affiliation(s)
- Olivia Sobczyk
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, Zürich, Switzerland
| | - Lakshmikumar Venkatraghavan
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - James Duffin
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Joseph A Fisher
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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van Niftrik CHB, Sebök M, Muscas G, Wegener S, Luft AR, Stippich C, Regli L, Fierstra J. Investigating the Association of Wallerian Degeneration and Diaschisis After Ischemic Stroke With BOLD Cerebrovascular Reactivity. Front Physiol 2021; 12:645157. [PMID: 34248656 PMCID: PMC8264262 DOI: 10.3389/fphys.2021.645157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Wallerian degeneration and diaschisis are considered separate remote entities following ischemic stroke. They may, however, share common neurophysiological denominators, since they are both related to disruption of fiber tracts and brain atrophy over time. Therefore, with advanced multimodal neuroimaging, we investigate Wallerian degeneration and its association with diaschisis. Methods In order to determine different characteristics of Wallerian degeneration, we conducted examinations on seventeen patients with chronic unilateral ischemic stroke and persisting large vessel occlusion, conducting high-resolution anatomical magnetic resonance imaging (MRI) and blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) tests, as well as Diamox 15(O)–H2O–PET hemodynamic examinations. Wallerian degeneration was determined using a cerebral peduncle asymmetry index (% difference of volume of ipsilateral and contralateral cerebral peduncle) of more than two standard deviations away from the average of age-matched, healthy subjects (Here a cerebral peduncle asymmetry index > 11%). Diaschisis was derived from BOLD-CVR to assess the presence of ipsilateral thalamus diaschisis and/or crossed cerebellar diaschisis. Results Wallerian degeneration, found in 8 (47%) subjects, had a strong association with ipsilateral thalamic volume reduction (r2 = 0.60) and corticospinal-tract involvement of stroke (p < 0.001). It was also associated with ipsilateral thalamic diaschisis (p = 0.021), No cerebral peduncular hemodynamic differences were found in patients with Wallerian degeneration. In particular, no CBF decrease or BOLD-CVR impairment was found. Conclusion We show a strong association between Wallerian degeneration and ipsilateral thalamic diaschisis, indicating a structural pathophysiological relationship.
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Affiliation(s)
- C H B van Niftrik
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - G Muscas
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Careggi University Hospital, University of Florence, Florence, Italy
| | - S Wegener
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A R Luft
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - C Stippich
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - L Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Al-Khazraji BK, Buch S, Kadem M, Matushewski BJ, Norozi K, Menon RS, Shoemaker JK. Protocol-dependence of middle cerebral artery dilation to modest hypercapnia. Appl Physiol Nutr Metab 2021; 46:1038-1046. [PMID: 34139129 DOI: 10.1139/apnm-2021-0220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is a need for improved understanding of how different cerebrovascular reactivity (CVR) protocols affect vascular cross-sectional area (CSA) to reduce error in CVR calculations when measures of vascular CSA are not feasible. In human participants, we delivered ∼±4 mm Hg end-tidal partial pressure of CO2 (PETCO2) relative to baseline through controlled delivery, and measured changes in middle cerebral artery (MCA) CSA (7 Tesla magnetic resonance imaging (MRI)), blood velocity (transcranial Doppler and Phase contrast MRI), and calculated CVR based on a 3-minute steady-state (+4 mm Hg PETCO2) and a ramp (-3 to +4 mm Hg of PETCO2). We observed that (1) the MCA did not dilate during the ramp protocol (slope for CSA across time P > 0.05; R2 = 0.006), but did dilate by ∼7% during steady-state hypercapnia (P < 0.05); and (2) MCA blood velocity CVR was not different between ramp and steady-state hypercapnia protocols (ramp: 3.8 ± 1.7 vs. steady-state: 4.0 ± 1.6 cm/s/mm Hg), although calculated MCA blood flow CVR was ∼40% greater during steady-state hypercapnia than during ramp (P < 0.05) with the discrepancy due to MCA CSA changes during steady-state hypercapnia. We propose that a ramp model, across a delta of -3 to +4 mm Hg PETCO2, may provide an alternative approach to collecting CVR measures in young adults with transcranial Doppler when CSA measures are not feasible. Novelty: We optimized a magnetic resonance imaging sequence to measure dynamic middle cerebral artery (MCA) cross-sectional area (CSA). A ramp model of hypercapnia elicited similar MCA blood velocity reactivity as the steady-state model while maintaining MCA CSA.
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Affiliation(s)
- Baraa K Al-Khazraji
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Sagar Buch
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, London, ON, Canada
| | - Mason Kadem
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Brad J Matushewski
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Kambiz Norozi
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Pediatric Cardiology, Hannover Medical School, Hannover, Germany
| | - Ravi S Menon
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Centre for Functional and Metabolic Mapping, Robarts Research Institute
| | - J Kevin Shoemaker
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,School of Kinesiology, Faculty of Health Sciences
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Poublanc J, Shafi R, Sobczyk O, Sam K, Mandell DM, Venkatraghavan L, Duffin J, Fisher JA, Mikulis DJ. Normal BOLD Response to a Step CO 2 Stimulus After Correction for Partial Volume Averaging. Front Physiol 2021; 12:639360. [PMID: 34194335 PMCID: PMC8236700 DOI: 10.3389/fphys.2021.639360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
Cerebrovascular reactivity (CVR) is defined as the change in cerebral blood flow induced by a change in a vasoactive stimulus. CVR using BOLD MRI in combination with changes in end-tidal CO2 is a very useful method for assessing vascular performance. In recent years, this technique has benefited from an advanced gas delivery method where end-tidal CO2 can be targeted, measured very precisely, and validated against arterial blood gas sampling (Ito et al., 2008). This has enabled more precise comparison of an individual patient against a normative atlas of healthy subjects. However, expected control ranges for CVR metrics have not been reported in the literature. In this work, we calculate and report the range of control values for the magnitude (mCVR), the steady state amplitude (ssCVR), and the speed (TAU) of the BOLD response to a standard step stimulus, as well as the time delay (TD) as observed in a cohort of 45 healthy controls. These CVR metrics maps were corrected for partial volume averaging for brain tissue types using a linear regression method to enable more accurate quantitation of CVR metrics. In brief, this method uses adjacent voxel CVR metrics in combination with their tissue composition to write the corresponding set of linear equations for estimating CVR metrics of gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF). After partial volume correction, mCVR and ssCVR increase as expected in gray matter, respectively, by 25 and 19%, and decrease as expected in white matter by 33 and 13%. In contrast, TAU and TD decrease in gray matter by 33 and 13%. TAU increase in white matter by 24%, but TD surprisingly decreased by 9%. This correction enables more accurate voxel-wise tissue composition providing greater precision when reporting gray and white matter CVR values.
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Affiliation(s)
- Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Reema Shafi
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Olivia Sobczyk
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Kevin Sam
- Department of Radiology and Radiological Sciences, Johns Hopkins University, United States
| | - Daniel M Mandell
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | | | - James Duffin
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Joseph A Fisher
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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50
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Sebök M, van Niftrik CHB, Winklhofer S, Wegener S, Esposito G, Stippich C, Luft A, Regli L, Fierstra J. Mapping Cerebrovascular Reactivity Impairment in Patients With Symptomatic Unilateral Carotid Artery Disease. J Am Heart Assoc 2021; 10:e020792. [PMID: 34102856 PMCID: PMC8477889 DOI: 10.1161/jaha.121.020792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Comprehensive hemodynamic impairment mapping using blood oxygenation‐level dependent (BOLD) cerebrovascular reactivity (CVR) can be used to identify hemodynamically relevant symptomatic unilateral carotid artery disease. Methods and Results This prospective cohort study was conducted between February 2015 and July 2020 at the Clinical Neuroscience Center of the University Hospital Zurich, Zurich, Switzerland. One hundred two patients with newly diagnosed symptomatic unilateral internal carotid artery (ICA) occlusion or with 70% to 99% ICA stenosis were included. An age‐matched healthy cohort of 12 subjects underwent an identical BOLD functional magnetic resonance imaging examination. Using BOLD functional magnetic resonance imaging with a standardized CO2 stimulus, CVR impairment was evaluated. Moreover, embolic versus hemodynamic ischemic patterns were evaluated on diffusion‐weighted imaging. Sixty‐seven patients had unilateral ICA occlusion and 35 patients unilateral 70% to 99% ICA stenosis. Patients with ICA occlusion exhibited lower whole‐brain and ipsilateral hemisphere mean BOLD‐CVR values as compared with healthy subjects (0.12±0.08 versus 0.19±0.04, P=0.004 and 0.09±0.09 versus 0.18±0.04, P<0.001) and ICA stenosis cohort (0.12±0.08 versus 0.16±0.05, P=0.01 and 0.09±0.09 versus 0.15±0.05, P=0.01); however, only 40 (58%) patients of the cohort showed significant BOLD‐CVR impairment. Conversely, there was no difference in mean BOLD‐CVR values between healthy patients and patients with ICA stenosis, although 5 (14%) patients with ICA stenosis showed a significant BOLD‐CVR impairment. No significant BOLD‐CVR difference was discernible between patients with hemodynamic ischemic infarcts versus those with embolic infarct distribution (0.11±0.08 versus 0.13±0.06, P=0.12). Conclusions Comprehensive BOLD‐CVR mapping allows for identification of hemodynamically relevant symptomatic unilateral carotid artery stenosis or occlusion.
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Affiliation(s)
- Martina Sebök
- Department of Neurosurgery University Hospital ZurichUniversity of Zurich Switzerland.,Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery University Hospital ZurichUniversity of Zurich Switzerland.,Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland
| | - Sebastian Winklhofer
- Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland.,Department of Neuroradiology University Hospital ZurichUniversity of Zurich Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland.,Department of Neurology University Hospital ZurichUniversity of Zurich Switzerland
| | - Giuseppe Esposito
- Department of Neurosurgery University Hospital ZurichUniversity of Zurich Switzerland.,Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland
| | - Christoph Stippich
- Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland.,Neuroradiology and Radiology Schmieder Clinic Allensbach Germany
| | - Andreas Luft
- Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland.,Department of Neurology University Hospital ZurichUniversity of Zurich Switzerland.,Cereneo Center for Neurology and Rehabilitation Vitznau Switzerland
| | - Luca Regli
- Department of Neurosurgery University Hospital ZurichUniversity of Zurich Switzerland.,Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery University Hospital ZurichUniversity of Zurich Switzerland.,Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland
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