51
|
Sivakolundu DK, West KL, Maruthy GB, Zuppichini M, Turner MP, Abdelkarim D, Zhao Y, Nguyen D, Spence JS, Lu H, Okuda DT, Rypma B. Reduced arterial compliance along the cerebrovascular tree predicts cognitive slowing in multiple sclerosis: Evidence for a neurovascular uncoupling hypothesis. Mult Scler 2019; 26:1486-1496. [PMID: 31373536 DOI: 10.1177/1352458519866605] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive slowing occurs in ~70% of multiple sclerosis (MS) patients. The pathophysiology of this slowing is unknown. Neurovascular coupling, acute localized blood flow increases following neural activity, is essential for efficient cognition. Loss of vascular compliance along the cerebrovascular tree would result in suboptimal vasodilation, neurovascular uncoupling, and cognitive slowing. OBJECTIVE To assess vascular compliance along the cerebrovascular tree and its relationship to MS-related cognition. METHODS We tested vascular compliance along the cerebrovascular tree by dividing cerebral cortex into nested layers. MS patients and healthy controls were scanned using a dual-echo functional magnetic resonance imaging (fMRI) sequence while they periodically inhaled room air and hypercapnic gas mixture. Cerebrovascular reactivity was calculated from both cerebral blood flow (arterial) and blood-oxygen-level-dependent signal (venous) increases per unit increase in end-tidal CO2. RESULTS Arterial cerebrovascular reactivity changes along the cerebrovascular tree were reduced in cognitively slow MS compared to cognitively normal MS and healthy controls. These changes were fit to exponential functions, the decay constant (arterial compliance index; ACI) of which was associated with individual subjects' reaction time and predicted reaction time after controlling for disease processes. CONCLUSION Such associations suggest prospects for utility of ACI in predicting future cognitive disturbances, monitoring cognitive deficiencies and therapeutic responses, and implicates neurovascular uncoupling as a mechanism of cognitive slowing in MS.
Collapse
Affiliation(s)
- Dinesh K Sivakolundu
- NeuroPsychometric Research Laboratory, Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| | - Kathryn L West
- NeuroPsychometric Research Laboratory, Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| | - Gayathri B Maruthy
- NeuroPsychometric Research Laboratory, Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| | - Mark Zuppichini
- NeuroPsychometric Research Laboratory, Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| | - Monroe P Turner
- NeuroPsychometric Research Laboratory, Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| | - Dema Abdelkarim
- NeuroPsychometric Research Laboratory, Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| | - Yuguang Zhao
- NeuroPsychometric Research Laboratory, Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| | - Dylan Nguyen
- Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, Clinical Center for Multiple Sclerosis, Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey S Spence
- NeuroPsychometric Research Laboratory, Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Darin T Okuda
- Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, Clinical Center for Multiple Sclerosis, Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Bart Rypma
- NeuroPsychometric Research Laboratory, Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA/Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
52
|
Mouraux A, Iannetti GD. The search for pain biomarkers in the human brain. Brain 2019; 141:3290-3307. [PMID: 30462175 PMCID: PMC6262221 DOI: 10.1093/brain/awy281] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 10/04/2018] [Indexed: 01/22/2023] Open
Abstract
Non-invasive functional brain imaging is used more than ever to investigate pain in health and disease, with the prospect of finding new means to alleviate pain and improve patient wellbeing. The observation that several brain areas are activated by transient painful stimuli, and that the magnitude of this activity is often graded with pain intensity, has prompted researchers to extract features of brain activity that could serve as biomarkers to measure pain objectively. However, most of the brain responses observed when pain is present can also be observed when pain is absent. For example, similar brain responses can be elicited by salient but non-painful auditory, tactile and visual stimuli, and such responses can even be recorded in patients with congenital analgesia. Thus, as argued in this review, there is still disagreement on the degree to which current measures of brain activity exactly relate to pain. Furthermore, whether more recent analysis techniques can be used to identify distributed patterns of brain activity specific for pain can be only warranted using carefully designed control conditions. On a more general level, the clinical utility of current pain biomarkers derived from human functional neuroimaging appears to be overstated, and evidence for their efficacy in real-life clinical conditions is scarce. Rather than searching for biomarkers of pain perception, several researchers are developing biomarkers to achieve mechanism-based stratification of pain conditions, predict response to medication and offer personalized treatments. Initial results with promising clinical perspectives need to be further tested for replicability and generalizability.
Collapse
Affiliation(s)
- André Mouraux
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
| | - Gian Domenico Iannetti
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK.,Neuroscience and Behaviour Laboratory, Istituto Italiano di Tecnologia, Rome, Italy
| |
Collapse
|
53
|
Jakimovski D, Topolski M, Kimura K, Pandya V, Weinstock-Guttman B, Zivadinov R. Decrease in Secondary Neck Vessels in Multiple Sclerosis: A 5-year Longitudinal Magnetic Resonance Angiography Study. Curr Neurovasc Res 2019; 16:215-223. [PMID: 31195944 DOI: 10.2174/1567202616666190612111127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies have previously shown greater arterial and venous extracranial vascular changes in persons with multiple sclerosis (PwMS) when compared to healthy controls (HCs). OBJECTIVES To determine the change in the number and size of secondary neck vessels in PwMS and HCs over a 5-year follow-up period. METHODS Both at baseline and follow-up, 83 PwMS and 25 HCs underwent magnetic resonance angiography (MRA) imaging and analysis. The number and cross-sectional area (CSA) of all secondary neck vessels (excluding the common/internal carotid, vertebral artery, and internal jugular vein) measured at levels from C2-T1 were determined by semi-automated edge detection/ contouring software. The longitudinal change in the number and CSA of the secondary neck vessels from the PwMS and HCs were analyzed by non-parametric Wilcoxon repeated measure. Benjamini-Hochberg procedure adjusted for false discovery rate (FDR). RESULTS For over 5 years, PwMS demonstrated a consistent longitudinal decrease in both the number of secondary neck vessels (Z-change between -3.3 and -5.4, q=0.001) and their CSA (Zchange between -2.9 and -5.2, q=0.004). On the contrary, the HCs did not demonstrate a significant longitudinal change in secondary neck vessels over the follow-up period. Due to the longitudinal decrease, the PwMS showed a lower number of secondary neck vessels when compared to HCs measured at follow-up (p<0.029, except for C4 with trending p=0.071). The PwMS changes were also corroborated within each MS phenotype. CONCLUSION PwMS demonstrate a significant mid-term decrease in the number and the size of the secondary neck vessels. The clinical relevance of these findings and the effect on intracranial blood flow are currently unknown.
Collapse
Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Matthew Topolski
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Kana Kimura
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Virja Pandya
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States.,enter for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, United States
| |
Collapse
|
54
|
Tarasova IV, Trubnikova OA, Barbarash OL. EEG and Clinical Factors Associated with Mild Cognitive Impairment in Coronary Artery Disease Patients. Dement Geriatr Cogn Disord 2019; 46:275-284. [PMID: 30404079 DOI: 10.1159/000493787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although an impaired cognitive status in patients with coronary artery disease (CAD) is not rare, the neurophysiological and clinical indicators of mild cognitive impairment (MCI) have been insufficiently investigated so far. METHODS EEG and neuropsychological testing as well as clinical examination were performed on 122 patients with CAD, who were divided into two groups, those with MCI (n = 60; mean age 57.4 ± 5.81 years) and those without MCI (n = 62; mean age 57.0 ± 5.04 years). Binary logistic regression was used to identify the relationship between EEG and clinical variables and the probability of MCI. RESULTS Higher theta/alpha ratios, theta1 rhythm power with closed eyes in the frontal and occipital areas of the left hemisphere, and alpha2 rhythm power with eyes open in the frontal areas of the right hemisphere were associated with an increased risk for MCI in CAD patients. A low educational level, type 2 diabetes mellitus, and severe coronary lesions according to the SYNTAX Score (≥23 points) increased the risk for MCI as well. CONCLUSIONS The findings of our study show that a theta activity increase in frontal and occipital sites, as well as high theta/alpha ratios, may be considered as the earliest EEG markers of vascular cognitive disorders.
Collapse
Affiliation(s)
- Irina V Tarasova
- Department of Cardiovascular Diagnostics, Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Kemerovo, Russian Federation,
| | - Olga A Trubnikova
- Department of Multifocal Atherosclerosis, Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Kemerovo, Russian Federation
| | - Olga L Barbarash
- Department of Multifocal Atherosclerosis, Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Kemerovo, Russian Federation
| |
Collapse
|
55
|
Jakimovski D, Topolski M, Genovese AV, Weinstock-Guttman B, Zivadinov R. Vascular aspects of multiple sclerosis: emphasis on perfusion and cardiovascular comorbidities. Expert Rev Neurother 2019; 19:445-458. [PMID: 31003583 DOI: 10.1080/14737175.2019.1610394] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic inflammatory, demyelinating, and neurodegenerative disease of the central nervous system. Over the last two decades, more favorable MS long-term outcomes have contributed toward increase in prevalence of the aged MS population. Emergence of age-associated pathology, such as cardiovascular diseases, may interact with the MS pathophysiology and further contribute to disease progression. Areas covered: This review summarizes the cardiovascular involvement in MS pathology, its disease activity, and progression. The cardiovascular health, the presence of various cardiovascular diseases, and their effect on MS cognitive performance are further explored. In similar fashion, the emerging evidence of a higher incidence of extracranial arterial pathology and its association with brain MS pathology are discussed. Finally, the authors outline the methodologies behind specific perfusion magnetic resonance imaging (MRI) and ultrasound Doppler techniques, which allow measurement of disease-specific and age-specific vascular changes in the aging population and MS patients. Expert opinion: Cardiovascular pathology significantly contributes to worse clinical and MRI-derived disease outcomes in MS. Global and regional cerebral hypoperfusion may be associated with poorer physical and cognitive performance. Prevention, improved detection, and treatment of the cardiovascular-based pathology may improve the overall long-term health of MS patients.
Collapse
Affiliation(s)
- Dejan Jakimovski
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA
| | - Matthew Topolski
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Antonia Valentina Genovese
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,c Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences , University of Pavia , Pavia , Italy
| | - Bianca Weinstock-Guttman
- b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA
| | - Robert Zivadinov
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA.,d Center for Biomedical Imaging at Clinical Translational Science Institute , University at Buffalo, State University of New York , Buffalo , NY , USA
| |
Collapse
|
56
|
Krogias C, Christou I, Tsivgoulis G, Koutroulou I, Schroeder C, Lantinioti C, Richter D, Karapanayiotides T, Haghikia A, Gold R, Voumvourakis K. Functional Neurosonology Reveals Impaired Cerebrovascular Reactivity in Multiple Sclerosis. J Neuroimaging 2019; 29:589-591. [DOI: 10.1111/jon.12617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Christos Krogias
- Department of Neurology, St. Josef‐Hospital, Medical FacultyRuhr University Bochum Germany
| | - Ioannis Christou
- Second Department of Neurology, “Attikon” Hospital, School of Medicine University of Athens Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” Hospital, School of Medicine University of Athens Greece
| | - Ioanna Koutroulou
- Second Department of Neurology, AHEPA HospitalAristotle University of Thessaloniki Greece
| | - Christoph Schroeder
- Department of Neurology, St. Josef‐Hospital, Medical FacultyRuhr University Bochum Germany
| | - Chrissoula Lantinioti
- Second Department of Neurology, “Attikon” Hospital, School of Medicine University of Athens Greece
| | - Daniel Richter
- Department of Neurology, St. Josef‐Hospital, Medical FacultyRuhr University Bochum Germany
| | | | - Aiden Haghikia
- Department of Neurology, St. Josef‐Hospital, Medical FacultyRuhr University Bochum Germany
| | - Ralf Gold
- Department of Neurology, St. Josef‐Hospital, Medical FacultyRuhr University Bochum Germany
| | | |
Collapse
|
57
|
Turner MP, Hubbard NA, Sivakolundu DK, Himes LM, Hutchison JL, Hart J, Spence JS, Frohman EM, Frohman TC, Okuda DT, Rypma B. Preserved canonicality of the BOLD hemodynamic response reflects healthy cognition: Insights into the healthy brain through the window of Multiple Sclerosis. Neuroimage 2019; 190:46-55. [PMID: 29454932 DOI: 10.1016/j.neuroimage.2017.12.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022] Open
Abstract
The hemodynamic response function (HRF), a model of brain blood-flow changes in response to neural activity, reflects communication between neurons and the vasculature that supplies these neurons in part by means of glial cell intermediaries (e.g., astrocytes). Intact neural-vascular communication might play a central role in optimal cognitive performance. This hypothesis can be tested by comparing healthy individuals to those with known white-matter damage and impaired performance, as seen in Multiple Sclerosis (MS). Glial cell intermediaries facilitate the ability of neurons to adequately convey metabolic needs to cerebral vasculature for sufficient oxygen and nutrient perfusion. In this study, we isolated measurements of the HRF that could quantify the extent to which white-matter affects neural-vascular coupling and cognitive performance. HRFs were modeled from multiple brain regions during multiple cognitive tasks using piecewise cubic spline functions, an approach that minimized assumptions regarding HRF shape that may not be valid for diseased populations, and were characterized using two shape metrics (peak amplitude and time-to-peak). Peak amplitude was reduced, and time-to-peak was longer, in MS patients relative to healthy controls. Faster time-to-peak was predicted by faster reaction time, suggesting an important role for vasodilatory speed in the physiology underlying processing speed. These results support the hypothesis that intact neural-glial-vascular communication underlies optimal neural and cognitive functioning.
Collapse
Affiliation(s)
- Monroe P Turner
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Nicholas A Hubbard
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dinesh K Sivakolundu
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Lyndahl M Himes
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Joanna L Hutchison
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - John Hart
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA; Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey S Spence
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Teresa C Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Darin T Okuda
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bart Rypma
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
58
|
Pelizzari L, Laganà MM, Rossetto F, Bergsland N, Galli M, Baselli G, Clerici M, Nemni R, Baglio F. Cerebral blood flow and cerebrovascular reactivity correlate with severity of motor symptoms in Parkinson's disease. Ther Adv Neurol Disord 2019; 12:1756286419838354. [PMID: 30923574 PMCID: PMC6431769 DOI: 10.1177/1756286419838354] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/02/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a progressive neurodegenerative disorder that is mainly characterized by movement dysfunction. Neurovascular unit (NVU) disruption has been proposed to be involved in the disease, but its role in PD neurodegenerative mechanisms is still unclear. The aim of this study was to investigate cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) within the regions belonging to the motor network, in patients with mild to moderate stages of PD. METHODS Twenty-eight PD patients (66.6 ± 8.6 years, 22 males, median [interquartile range, IQR] Hoehn & Yahr = 1.5 [1-1.9]) and 32 age- and sex-matched healthy controls (HCs) were scanned with arterial spin labeling (ASL) magnetic resonance imaging (MRI) for CBF assessment. ASL MRI was also acquired in hypercapnic conditions to induce vasodilation and subsequently allow for CVR measurement in a subgroup of 13 PD patients and 13 HCs. Median CBF and CVR were extracted from cortical and subcortical regions belonging to the motor network and compared between PD patients and HCs. In addition, the correlation between these parameters and the severity of PD motor symptoms [quantified with Unified Parkinson's Disease Rating Scale part III (UPDRS III)] was assessed. The false discovery rate (FDR) method was used to correct for multiple comparisons. RESULTS No significant differences in terms of CBF and CVR were found between PD patients and HCs. Positive significant correlations were observed between CBF and UPDRS III within the precentral gyrus, postcentral gyrus, supplementary motor area, striatum, pallidum, thalamus, red nucleus, and substantia nigra (pFDR < 0.05). Conversely, significant negative correlation between CVR and UPDRS III was found in the corpus striatum (pFDR < 0.05). CONCLUSION CBF and CVR assessment provides information about NVU integrity in an indirect and noninvasive way. Our findings support the hypothesis of NVU involvement at the mild to moderate stages of PD, suggesting that CBF and CVR within the motor network might be used as either diagnostic or prognostic markers for PD.
Collapse
Affiliation(s)
| | | | | | - Niels Bergsland
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Mirco Galli
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Mario Clerici
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
- Department of Physiopathology and Transplants, University of Milano, Milan, Italy
| | - Raffaello Nemni
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
- Department of Physiopathology and Transplants, University of Milano, Milan, Italy
| | - Francesca Baglio
- IRCCS, Fondazione Don Carlo Gnocchi, CADiTeR, Via Alfonso Capecelatro 66, Milan, Italy
| |
Collapse
|
59
|
Evaluation of cerebrovascular reserve in patients with cerebrovascular diseases using resting-state MRI: A feasibility study. Magn Reson Imaging 2019; 59:46-52. [PMID: 30849484 DOI: 10.1016/j.mri.2019.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/03/2019] [Accepted: 03/04/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To demonstrate the feasibility of mapping cerebrovascular reactivity (CVR) using resting-state functional MRI (fMRI) data without gas or other challenges in patients with cerebrovascular diseases and to show that brain regions affected by the diseases have diminished vascular reactivity. MATERIALS AND METHODS Two sub-studies were performed on patients with stroke and Moyamoya disease. In Study 1, 20 stroke patients (56.3 ± 9.7 years, 7 females) were enrolled and resting-state blood‑oxygenation-level-dependent (rs-BOLD) fMRI data were collected, from which CVR maps were computed. CVR values were compared across lesion, perilesional and control ROIs defined on anatomic images. Reproducibility of the CVR measurement was tested in 6 patients with follow-up scans. In Study 2, rs-BOLD fMRI and dynamic susceptibility contrast (DSC) MRI scans were collected in 5 patients with Moyamoya disease (32.4 ± 8.2 years, 4 females). Cerebral blood flow (CBF), cerebral blood volume (CBV), and time-to-peak (TTP) maps were obtained from the DSC MRI data. CVR values were compared between stenotic brain regions and control regions perfused by non-stenotic arteries. RESULTS In stroke patients, lesion CVR (0.250 ± 0.055 relative unit (r.u.)) was lower than control CVR (0.731 ± 0.088 r.u., p = 0.0002). CVR was also lower in the perilesional regions in a graded manner (perilesion 1 CVR = 0.422 ± 0.051 r.u., perilesion 2 CVR = 0.492 ± 0.046 r.u.), relative to that in the control regions (p = 0.005 and 0.036, respectively). In the repeatability analysis, a strong correlation was observed between lesion CVR (r2 = 0.91, p = 0.006) measured at two time points, as well as between control CVR (r2 = 0.79, p = 0.036) at two time points. In Moyamoya patients, CVR in the perfusion deficit regions delineated by DSC TTP maps (0.178 ± 0.189 r.u.) was lower than that in the control regions (0.868 ± 0.214 r.u., p = 0.013). Furthermore, the extent of reduction in CVR was significantly correlated with the extent of lengthening in TTP (r2 = 0.91, p = 0.033). CONCLUSION Our findings suggested that rs-BOLD data can be used to reproducibly evaluate CVR in patients with cerebrovascular diseases without the use of any vasoactive challenges.
Collapse
|
60
|
Jakimovski D, Benedict RH, Marr K, Gandhi S, Bergsland N, Weinstock-Guttman B, Zivadinov R. Lower total cerebral arterial flow contributes to cognitive performance in multiple sclerosis patients. Mult Scler 2019; 26:201-209. [PMID: 30625030 DOI: 10.1177/1352458518819608] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The cognitive performance in multiple sclerosis (MS) patients declines with aging, longer disease duration, and possibly cardiovascular comorbidities. OBJECTIVES We investigated whether lower total cerebral arterial blood flow (CABF) measured at the level of the carotid and vertebral arteries may contribute to worse cognitive performance in 132 MS patients and 47 healthy controls. METHODS Total CABF was evaluated with extracranial Doppler, whereas structural T2-lesion volume (LV) and gray matter volume (GMV) were measured on 3T MRI. The cognitive performance was assessed by Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), and California Verbal Learning Test-Second Edition (CVLT-II). Analysis of covariance, partial correlation, and regression models were used to test the differences between study groups and cognition/CABF correlations. False discovery rate (FDR)-corrected (Benjamini-Hochberg) p-values (i.e. q-values) less than 0.05 were considered significant. RESULTS Association between lower total CABF and the lower cognitive performance was observed only in MS patients (r = 0.318, q < 0.001 and r = 0.244, q = 0.012 for SDMT and BVMT-R, respectively). Lower GMV, higher T2-LV, and CABF were significantly associated with poorer performance on the processing speed measure of SDMT (adjusted R2 = 0.295, t-statistics = 2.538, standardized β = 0.203, and q = 0.020), but not with memory tests. Cognitively impaired MS patients had lower total CABF compared to cognitively preserved (884.5 vs 1020.2 mL/min, q = 0.008). CONCLUSION Cognitively impaired MS patients presented with lower total CABF. Altered CABF may be a result of reduced metabolic rate and might contribute to abnormal cognitive aging in MS.
Collapse
Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Ralph Hb Benedict
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Karen Marr
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Sirin Gandhi
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/Center for Biomedical Imaging, Clinical Translational Science Institute, University at Buffalo, The State University of New York, Buffalo, NY, USA
| |
Collapse
|
61
|
Tzschätzsch H, Kreft B, Schrank F, Bergs J, Braun J, Sack I. In vivo time-harmonic ultrasound elastography of the human brain detects acute cerebral stiffness changes induced by intracranial pressure variations. Sci Rep 2018; 8:17888. [PMID: 30559367 PMCID: PMC6297160 DOI: 10.1038/s41598-018-36191-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022] Open
Abstract
Cerebral stiffness (CS) reflects the biophysical environment in which neurons grow and function. While long-term CS changes can occur in the course of chronic neurological disorders and aging, little is known about acute variations of CS induced by intracranial pressure variations. Current gold standard methods for CS and intracranial pressure such as magnetic resonance elastography and direct pressure recordings are either expensive and slow or invasive. The study objective was to develop a real-time method for in vivo CS measurement and to demonstrate its sensitivity to physiological aging and intracranial pressure variations induced by the Valsalva maneuver in healthy volunteers. We used trans-temporal ultrasound time-harmonic elastography (THE) with external shear-wave stimulation by continuous and superimposed vibrations in the frequency range from 27 to 56 Hz. Multifrequency wave inversion generated maps of shear wave speed (SWS) as a surrogate maker of CS. On average, cerebral SWS was 1.56 ± 0.08 m/s with a tendency to reduce with age (R = -0.76, p < 0.0001) while Valsalva maneuver induced an immediate stiffening of the brain as reflected by a 10.8 ± 2.5% increase (p < 0.0001) in SWS. Our results suggest that CS is tightly linked to intracranial pressure and might be used in the future as non-invasive surrogate marker for intracranial pressure, which otherwise requires invasive measurements.
Collapse
Affiliation(s)
- Heiko Tzschätzsch
- Department of Radiology, , Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernhard Kreft
- Department of Radiology, , Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Schrank
- Department of Radiology, , Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bergs
- Department of Radiology, , Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, , Charité - Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
62
|
Zulfiqar M, Qeadan F, Ikram A, Farooqui M, Richardson SP, Calder CS, Quadri SA, Mathur P, Ford C, O Gutierrez S, Liera E, Snow H, N Gonzalez J, Zafar A. Intracerebral Hemorrhage in Multiple Sclerosis: A Retrospective Cohort Study. J Stroke Cerebrovasc Dis 2018; 28:267-275. [PMID: 30385221 DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/21/2018] [Accepted: 09/27/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To identify the vascular risk factors associated with the occurrence of intracerebral hemorrhage (ICH) in Multiple Sclerosis (MS) patients. METHODS This is an observational, retrospective cohort study using the nationwide electronic medical records (EMR) database. Patients with the diagnosis of MS were extracted from inpatient and outpatient EMR using the international classification of diseases, ninth/tenth revisions, clinical modification codes. We excluded patients younger than 18 years, and those where gender was not specified. Patients were further stratified based on their demographics, risk factors, medications, and comorbidities. Tobacco, diabetes, hypertension, and alcohol were the predicting variables; antiplatelet medication, and anticoagulant agents were the primary exposures for the development of ICH. A validated diagnosis code algorithm defined the diagnosis of ICH. Multivariable logistic regression models were utilized to assess the risk of ICH in MS patients. RESULTS Of the total 57,099 MS patients (women: 75%, n = 41,517), 107 (.19%) sustained an ICH. Age (OR = 2.74, CI = 1.13-6.62), use of anticoagulants (OR = 2.15, 95% CI = 1.30-3.56, P = .0028), and history of tobacco exposure (OR = 2.44, CI = 1.37-4.36, P = .0025) were associated with increased risk of ICH. Use of antiplatelet and disease-modifying drugs (DMDs) showed a protective trend against ICH. CONCLUSIONS Tobacco exposure and anticoagulant use were strongly associated with increased risk of ICH in patients with MS. There might be a protective effect that antiplatelet and DMDs have in the pathophysiology of this disease. Further prospective investigations are warranted to establish these associations.
Collapse
Affiliation(s)
- Maryam Zulfiqar
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Fares Qeadan
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico
| | - Asad Ikram
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Mudassir Farooqui
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Sarah P Richardson
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | | | - Syed A Quadri
- Department of Neurosurgery, California Institute of Neurosciences, Thousand Oaks, California
| | - Puja Mathur
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Corey Ford
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Santiago O Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinic, Iowa City, Iowa
| | - Enrique Liera
- Department of Neurology, University of Iowa Hospitals and Clinic, Iowa City, Iowa
| | - Harry Snow
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico
| | - Joel N Gonzalez
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Atif Zafar
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico.
| |
Collapse
|
63
|
Pelizzari L, Jakimovski D, Laganà MM, Bergsland N, Hagemeier J, Baselli G, Weinstock-Guttman B, Zivadinov R. Five-Year Longitudinal Study of Neck Vessel Cross-Sectional Area in Multiple Sclerosis. AJNR Am J Neuroradiol 2018; 39:1703-1709. [PMID: 30049718 DOI: 10.3174/ajnr.a5738] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/06/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Alterations of neck vessel cross-sectional area in multiple sclerosis have been reported. Our aim was to investigate the evolution of the neck vessel cross-sectional area in patients with MS and healthy controls during 5 years. MATERIALS AND METHODS Sixty-nine patients with MS (44 relapsing-remitting MS, 25 progressive MS) and 22 age- and sex-matched healthy controls were examined twice, 5 years apart, on a 3T MR imaging scanner using 2D neck MR angiography. Cross-sectional areas were computed for the common carotid/internal carotid arteries, vertebral arteries, and internal jugular veins for all slices between the C3 and C7 cervical levels. Longitudinal cross-sectional area differences at each cervical level and the whole-vessel course were tested within study groups and between patients with MS with and without cardiovascular disease using mixed-model analysis and the related-samples Wilcoxon singed rank test. The Benjamini-Hochberg procedure was performed to correct for multiple comparisons. RESULTS No significant cross-sectional area differences were seen between patients with MS and healthy controls at baseline or at follow-up. During the follow-up, significant cross-sectional area decrease was found in patients with MS for the common carotid artery-ICAs (C4: P = .048; C7: P = .005; whole vessel: P = .012), for vertebral arteries (C3: P = .028; C4: P = .028; C7: P = .028; whole vessel: P = .012), and for the internal jugular veins (C3: P = .014; C4: P = .008; C5: P = .010; C6: P = .010; C7: P = .008; whole vessel: P = .002). Patients with MS without cardiovascular disease had significantly greater change than patients with MS with cardiovascular disease for internal jugular veins at all levels. CONCLUSIONS For 5 years, patients with MS showed significant cross-sectional area decrease of all major neck vessels, regardless of the disease course and cardiovascular status.
Collapse
Affiliation(s)
- L Pelizzari
- From the Department of Electronics Information and Bioengineering (L.P., G.B.), Politecnico di Milano, Milan, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (L.P., M.M.L.), Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - D Jakimovski
- Buffalo Neuroimaging Analysis Center (D.J., N.B., J.H., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences
| | - M M Laganà
- Istituto di Ricovero e Cura a Carattere Scientifico (L.P., M.M.L.), Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - N Bergsland
- Buffalo Neuroimaging Analysis Center (D.J., N.B., J.H., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences
| | - J Hagemeier
- Buffalo Neuroimaging Analysis Center (D.J., N.B., J.H., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences
| | - G Baselli
- From the Department of Electronics Information and Bioengineering (L.P., G.B.), Politecnico di Milano, Milan, Italy
| | - B Weinstock-Guttman
- Jacobs Multiple Sclerosis Center (B.W.-G.), Department of Neurology, School of Medicine and Biomedical Sciences
| | - R Zivadinov
- Buffalo Neuroimaging Analysis Center (D.J., N.B., J.H., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences .,Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, Buffalo, New York
| |
Collapse
|
64
|
Zhang X, Guo X, Zhang N, Cai H, Sun J, Wang Q, Qi Y, Zhang L, Yang L, Shi FD, Yu C. Cerebral Blood Flow Changes in Multiple Sclerosis and Neuromyelitis Optica and Their Correlations With Clinical Disability. Front Neurol 2018; 9:305. [PMID: 29780351 PMCID: PMC5946009 DOI: 10.3389/fneur.2018.00305] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/18/2018] [Indexed: 11/13/2022] Open
Abstract
Distinguishing relapsing-remitting multiple sclerosis (RRMS) and neuromyelitis optica (NMO) is clinically important because they differ in prognosis and treatment. This study aimed to identify perfusion abnormalities in RRMS and NMO and their correlations with gray matter volume (GMV) atrophy and clinical parameters. Structural and arterial spin labeling MRI scans were performed in 39 RRMS patients, 62 NMO patients, and 73 healthy controls. The gray matter cerebral blood flow (CBF) values were voxel-wisely compared among the three groups with and without GMV correction. The regional CBF changes were correlated with the Expanded Disability Status Scale scores in the corresponding patient groups. Although multiple brain regions showed CBF differences among the three groups without GMV correction, only three of these regions remained significant after GMV correction. Specifically, both the RRMS and NMO groups showed reduced CBF in the occipital cortex and increased CBF in the right putamen compared to the control group. The RRMS group had increased CBF only in the medial prefrontal cortex compared to the other two groups. The occipital CBF was negatively correlated with clinical disability in the NMO group; however, the CBF in the right putamen was positively correlated with clinical disability in both patient groups. These findings suggest that there are perfusion alterations independent of GMV atrophy in RRMS and NMO patients. The regional CBF in the occipital cortex and putamen could be used as imaging features to objectively assess clinical disability in these patients.
Collapse
Affiliation(s)
- Xue Zhang
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin, China
| | - Xi Guo
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin, China
| | - Ningnannan Zhang
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin, China
| | - Huanhuan Cai
- Laboratory of Digital Medical Imaging, Medical Imaging Center, The First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei, China
| | - Jie Sun
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin, China
| | - Qiuhui Wang
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin, China
| | - Yuan Qi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Linjie Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Yang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Fu-Dong Shi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunshui Yu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin, China
| |
Collapse
|
65
|
Catchlove SJ, Pipingas A, Hughes ME, Macpherson H. Magnetic resonance imaging for assessment of cerebrovascular reactivity and its relationship to cognition: a systematic review. BMC Neurosci 2018; 19:21. [PMID: 29649969 PMCID: PMC5898077 DOI: 10.1186/s12868-018-0421-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/27/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Cerebrovascular reactivity (CVR) refers to the responsiveness of cerebral vasculature to vasoactive stimuli. CVR is an indicator of brain health and can be assessed using vasodilatory techniques and magnetic resonance imaging (MRI). Using such approaches, some researchers have explored the relationship between CVR and cognition; here we systematically review this work. RESULTS We extracted information pertaining to: (1) study location and design, participant characteristics, sample sizes, (2) design of vascular challenge, end-tidal CO 2 (etCO 2 ) concentrations (if applicable), (3) MRI protocol, (4) cognitive assessment, (5) CVR values, and outcomes of statistical analyses with cognitive tests. Five studies assessed participants with cognitive impairment compared to controls, one studied patients with multiple sclerosis with or without cognitive impairment compared to controls, one examined patients with moyamoya disease with or without cognitive impairment, two investigated patients with Type 2 diabetes mellitus (T2DM), and one was a cross-sectional study with younger and older healthy adults. Cognition was typically probed using the MMSE and tests of executive function, while a number of vasodilatory techniques were employed. CONCLUSION CVR was associated with cognition in six of ten studies, but heterogeneity of study samples, designs and vasodilatory methods may have a role in the inconsistent findings. We make recommendations for future research that includes use of a multi-domain cognitive assessment and standardised hypercapnic challenge with MRI.
Collapse
Affiliation(s)
- Sarah J. Catchlove
- Centre for Human Psychopharmacology, Swinburne University, Hawthorn, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University, Hawthorn, Australia
| | - Matthew E. Hughes
- Centre for Mental Health, Swinburne University, Hawthorn, Australia
- Australian National Imaging Facility, St. Lucia, Australia
| | - Helen Macpherson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| |
Collapse
|
66
|
Stickland R, Allen M, Magazzini L, Singh KD, Wise RG, Tomassini V. Neurovascular Coupling During Visual Stimulation in Multiple Sclerosis: A MEG-fMRI Study. Neuroscience 2018; 403:54-69. [PMID: 29580963 PMCID: PMC6458991 DOI: 10.1016/j.neuroscience.2018.03.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 03/04/2018] [Accepted: 03/13/2018] [Indexed: 01/23/2023]
Abstract
A reduced electrophysiological response to a visual stimulus in MS, characterized by reduced gamma power (30–80 Hz), with MEG. A reduced hemodynamic response to a visual stimulus in MS, characterized by reduced BOLD and CBF responses, with fMRI. The coupling between gamma power and BOLD/CBF was not significantly impaired in the MS group.
The process of neurovascular coupling ensures that increases in neuronal activity are fed by increases in cerebral blood flow. Evidence suggests that neurovascular coupling may be impaired in Multiple Sclerosis (MS) due to a combination of brain hypoperfusion, altered cerebrovascular reactivity and oxygen metabolism, and altered levels of vasoactive compounds. Here, we tested the hypothesis that neurovascular coupling is impaired in MS. We characterized neurovascular coupling as the relationship between changes in neuronal oscillatory power within the gamma frequency band (30–80 Hz), as measured by magnetoencephalography (MEG), and associated hemodynamic changes (blood oxygenation level dependent, BOLD, and cerebral blood flow, CBF) as measured by functional MRI. We characterized these responses in the visual cortex in 13 MS patients and in 10 matched healthy controls using a reversing checkerboard stimulus at five visual contrasts. There were no significant group differences in visual acuity, P100 latencies, occipital gray matter (GM) volumes and baseline CBF. However, in the MS patients we found a significant reduction in peak gamma power, BOLD and CBF responses. There were no significant differences in neurovascular coupling between groups, in the visual cortex. Our results suggest that neuronal and vascular responses are altered in MS. Gamma power reduction could be an indicator of GM dysfunction, possibly mediated by GABAergic changes. Altered hemodynamic responses confirm previous reports of a vascular dysfunction in MS. Despite altered neuronal and vascular responses, neurovascular coupling appears to be preserved in MS, at least within the range of damage and disability studied here.
Collapse
Affiliation(s)
- Rachael Stickland
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University School of Psychology, Maindy Road, Cardiff CF24 4HQ, UK
| | - Marek Allen
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University School of Psychology, Maindy Road, Cardiff CF24 4HQ, UK
| | - Lorenzo Magazzini
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University School of Psychology, Maindy Road, Cardiff CF24 4HQ, UK
| | - Krish D Singh
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University School of Psychology, Maindy Road, Cardiff CF24 4HQ, UK
| | - Richard G Wise
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University School of Psychology, Maindy Road, Cardiff CF24 4HQ, UK
| | - Valentina Tomassini
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University School of Psychology, Maindy Road, Cardiff CF24 4HQ, UK; Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital Wales, Heath Park, CF14 4XN, UK.
| |
Collapse
|
67
|
Age-related changes in cerebrovascular reactivity and their relationship to cognition: A four-year longitudinal study. Neuroimage 2018; 174:257-262. [PMID: 29567504 DOI: 10.1016/j.neuroimage.2018.03.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/07/2018] [Accepted: 03/16/2018] [Indexed: 11/20/2022] Open
Abstract
Although cerebrovascular factors are the second leading cause of cognitive impairment and dementia in elderly, the precise spatial and temporal trajectories of vascular decline in aging have not been fully characterized. With an advanced cerebrovascular reactivity (CVR) MRI technique that specifically informs vascular stiffness and dilatory ability of cerebral vessels, we present four-year longitudinal CVR data measured in 116 healthy individuals (20-88 years of age). Our data revealed a spatial heterogeneity in vascular decline in aging (p = 0.003), in that temporal lobe showed the fastest rate of longitudinal CVR decline, followed by parietal and frontal lobes. The rate of CVR decline was also age-dependent. Middle age, not older age, manifested the fastest rate of longitudinal CVR decline (p < 0.05). Longitudinal changes in CVR were associated with changes in processing speed (p = 0.031) and episodic memory (p = 0.022), but not with working memory or reasoning. The rate of longitudinal CVR change was not different between hypertensive and normotensive participants. However, cross-sectionally, individuals with hypertension revealed in a lower CVR compared to normotensive participants (p = 0.016). These findings help elucidate age-related decline in brain hemodynamics and support CVR as a non-invasive biomarker in evaluating cerebrovascular conditions in elderly individuals.
Collapse
|
68
|
Sweeney MD, Sagare AP, Zlokovic BV. Blood-brain barrier breakdown in Alzheimer disease and other neurodegenerative disorders. Nat Rev Neurol 2018; 14:133-150. [PMID: 29377008 PMCID: PMC5829048 DOI: 10.1038/nrneurol.2017.188] [Citation(s) in RCA: 1693] [Impact Index Per Article: 282.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The blood-brain barrier (BBB) is a continuous endothelial membrane within brain microvessels that has sealed cell-to-cell contacts and is sheathed by mural vascular cells and perivascular astrocyte end-feet. The BBB protects neurons from factors present in the systemic circulation and maintains the highly regulated CNS internal milieu, which is required for proper synaptic and neuronal functioning. BBB disruption allows influx into the brain of neurotoxic blood-derived debris, cells and microbial pathogens and is associated with inflammatory and immune responses, which can initiate multiple pathways of neurodegeneration. This Review discusses neuroimaging studies in the living human brain and post-mortem tissue as well as biomarker studies demonstrating BBB breakdown in Alzheimer disease, Parkinson disease, Huntington disease, amyotrophic lateral sclerosis, multiple sclerosis, HIV-1-associated dementia and chronic traumatic encephalopathy. The pathogenic mechanisms by which BBB breakdown leads to neuronal injury, synaptic dysfunction, loss of neuronal connectivity and neurodegeneration are described. The importance of a healthy BBB for therapeutic drug delivery and the adverse effects of disease-initiated, pathological BBB breakdown in relation to brain delivery of neuropharmaceuticals are briefly discussed. Finally, future directions, gaps in the field and opportunities to control the course of neurological diseases by targeting the BBB are presented.
Collapse
Affiliation(s)
- Melanie D Sweeney
- Department of Physiology and Neuroscience and the Zilkha Neurogenetic Institute, Keck School of Medicine of the University of Southern California, 1501 San Pablo Street, Los Angeles, California 90089, USA
| | - Abhay P Sagare
- Department of Physiology and Neuroscience and the Zilkha Neurogenetic Institute, Keck School of Medicine of the University of Southern California, 1501 San Pablo Street, Los Angeles, California 90089, USA
| | - Berislav V Zlokovic
- Department of Physiology and Neuroscience and the Zilkha Neurogenetic Institute, Keck School of Medicine of the University of Southern California, 1501 San Pablo Street, Los Angeles, California 90089, USA
| |
Collapse
|
69
|
Faraco G, Brea D, Garcia-Bonilla L, Wang G, Racchumi G, Chang H, Buendia I, Santisteban MM, Segarra SG, Koizumi K, Sugiyama Y, Murphy M, Voss H, Anrather J, Iadecola C. Dietary salt promotes neurovascular and cognitive dysfunction through a gut-initiated TH17 response. Nat Neurosci 2018; 21:240-249. [PMID: 29335605 DOI: 10.1038/s41593-017-0059-z] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
A diet rich in salt is linked to an increased risk of cerebrovascular diseases and dementia, but it remains unclear how dietary salt harms the brain. We report that, in mice, excess dietary salt suppresses resting cerebral blood flow and endothelial function, leading to cognitive impairment. The effect depends on expansion of TH17 cells in the small intestine, resulting in a marked increase in plasma interleukin-17 (IL-17). Circulating IL-17, in turn, promotes endothelial dysfunction and cognitive impairment by the Rho kinase-dependent inhibitory phosphorylation of endothelial nitric oxide synthase and reduced nitric oxide production in cerebral endothelial cells. The findings reveal a new gut-brain axis linking dietary habits to cognitive impairment through a gut-initiated adaptive immune response compromising brain function via circulating IL-17. Thus, the TH17 cell-IL-17 pathway is a putative target to counter the deleterious brain effects induced by dietary salt and other diseases associated with TH17 polarization.
Collapse
Affiliation(s)
- Giuseppe Faraco
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - David Brea
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Lidia Garcia-Bonilla
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Gang Wang
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Gianfranco Racchumi
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Haejoo Chang
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Izaskun Buendia
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Monica M Santisteban
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Steven G Segarra
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Kenzo Koizumi
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Yukio Sugiyama
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Michelle Murphy
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Henning Voss
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Joseph Anrather
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
| |
Collapse
|
70
|
Lapointe E, Li DKB, Traboulsee AL, Rauscher A. What Have We Learned from Perfusion MRI in Multiple Sclerosis? AJNR Am J Neuroradiol 2018; 39:994-1000. [PMID: 29301779 DOI: 10.3174/ajnr.a5504] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Using MR imaging, perfusion can be assessed either by dynamic susceptibility contrast MR imaging or arterial spin-labeling. Alterations of cerebral perfusion have repeatedly been described in multiple sclerosis compared with healthy controls. Acute lesions exhibit relative hyperperfusion in comparison with normal-appearing white matter, a finding mostly attributed to inflammation in this stage of lesion development. In contrast, normal-appearing white and gray matter of patients with MS has been mostly found to be hypoperfused compared with controls, and correlations with cognitive impairment as well as fatigue in multiple sclerosis have been described. Mitochondrial failure, axonal degeneration, and vascular dysfunction have been hypothesized to underlie the perfusion MR imaging findings. Clinically, perfusion MR imaging could allow earlier detection of the acute focal inflammatory changes underlying relapses and new lesions, and could constitute a marker for cognitive dysfunction in MS. Nevertheless, the clinical relevance and pathogenesis of the brain perfusion changes in MS remain to be clarified.
Collapse
Affiliation(s)
- E Lapointe
- From the Division of Neurology (E.L., A.L.T.) .,Department of Medicine (E.L., A.L.T.)
| | - D K B Li
- Radiology (D.K.B.L.), University of British Columbia, Djavad Mowafaghian Center for Brain Health, Vancouver, British Columbia, Canada
| | - A L Traboulsee
- From the Division of Neurology (E.L., A.L.T.).,Department of Medicine (E.L., A.L.T.)
| | - A Rauscher
- MRI Research Center (A.R.).,Departments of Pediatrics (A.R.)
| |
Collapse
|
71
|
Zoghi A, Petramfar P, Nikseresht A, Sakhaee E. Investigation of ischemic and demyelinating lesions by cerebral vasoreactivity based on transcranial Doppler sonography: a comparative study. Neuropsychiatr Dis Treat 2018; 14:2323-2328. [PMID: 30254443 PMCID: PMC6141114 DOI: 10.2147/ndt.s150062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Variations of cerebral blood flow in response to hypoxia and hyperoxia in different disease conditions can provide new insights into disease etiopathogenesis. This study aimed to determine the characteristics of cerebral vasoreactivity for ischemia and demyelination. MATERIALS AND METHODS This case-control study included: 28 patients with lacunar infarctions verified by history, physical examination, and MRI; 28 age- and sex-matched healthy controls; 28 patients with relapsing-remitting multiple sclerosis (MS), based on McDonald criteria; and 28 age- and sex-matched healthy controls for the MS group. Transcranial Doppler sonography was undertaken in all subjects to calculate the mean flow velocity (MFV) of the right middle cerebral artery (MCA) and, after a breath-holding (BH) maneuver, the breath-holding index (BHI) was determined. RESULTS There was no significant difference of BHI and changes of MFV of the MCA in MS patients compared to controls (1.02 ± 0.4 vs 1.02 ± 0.3, p = 0.993; and 16.8 ± 8.1 vs 11.3 ± 10.8, p = 0.057). BHI in patients with lacunar infarctions was significantly lower (0.8 ± 0.4 vs 1.2 ± 0.3, p < 0.001) compared to controls. The BHI (p = 0.040) and variations of MFV of MCA (p = 0.007) in MS patients were significantly higher than in patients with lacunar infarctions. The vasoreactivity of demyelinating lesions was higher than that of ischemic ones. CONCLUSION Therefore, cerebral vasoreactivity determined by transcranial Doppler could be utilized for differentiating demyelinating from ischemic lesions.
Collapse
Affiliation(s)
- Anahita Zoghi
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peyman Petramfar
- Clinical Neurology Research Center, Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - Alireza Nikseresht
- Clinical Neurology Research Center, Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - Ehsan Sakhaee
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
72
|
Belov P, Jakimovski D, Krawiecki J, Magnano C, Hagemeier J, Pelizzari L, Weinstock-Guttman B, Zivadinov R. Lower Arterial Cross-Sectional Area of Carotid and Vertebral Arteries and Higher Frequency of Secondary Neck Vessels Are Associated with Multiple Sclerosis. AJNR Am J Neuroradiol 2018; 39:123-130. [PMID: 29217748 DOI: 10.3174/ajnr.a5469] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/17/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Arterial and neck vessel system characteristics of patients with multiple sclerosis have not been previously investigated. Therefore, the aim of this study was to examine the frequency of neck vessels and their cross-sectional areas (in square millimeters) between patients with MS and healthy controls. MATERIALS AND METHODS In this study, 193 patients with MS and 193 age- and sex-matched healthy controls underwent 2D TOF venography at 3T. The main arterial (carotid and vertebral), venous (internal jugular), and secondary neck vessels were examined at 4 separate cervical levels (C2/3, C4, C5/6, and C7/T1). The ANCOVA adjusted for age, body mass index, smoking status, hypertension, and heart disease was used to compare the differences between patients with MS and healthy controls. RESULTS After controlling for all confounding factors, patients with MS had significantly lower cross-sectional areas of the carotid arteries at the C2/3 (P = .03), C5/6 (P = .026), and C7/T1 (P = .005) levels as well as of the vertebral arteries at the C2/3 (P = .02), C4 (P = .012), and C7/T1 (P = .006) levels, compared with healthy controls. A higher frequency of secondary neck vessels was found at all 4 levels in patients with MS: C2/3 (12.9 versus 10, P < .001), C4 (9.1 versus 7.5, P < .001), C5/6 (7.8 versus 6.8, P = .012), and C7/T1 (8.8 versus 6, P < .001). The total cross-sectional areas of secondary neck vessels were also significantly higher at all 4 levels (P < .03). No significant differences in the cross-sectional areas of jugular veins were found between patients with MS and healthy controls. CONCLUSIONS Patients with MS showed lower cross-sectional areas of the carotid and vertebral arteries and a higher frequency of secondary neck vessels and their cross-sectional areas compared with healthy controls.
Collapse
Affiliation(s)
- P Belov
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (P.B., D.J., J.K., C.M., J.H., R.Z.)
| | - D Jakimovski
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (P.B., D.J., J.K., C.M., J.H., R.Z.)
| | - J Krawiecki
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (P.B., D.J., J.K., C.M., J.H., R.Z.)
| | - C Magnano
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (P.B., D.J., J.K., C.M., J.H., R.Z.)
| | - J Hagemeier
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (P.B., D.J., J.K., C.M., J.H., R.Z.)
| | - L Pelizzari
- Department of Electronics, Information and Bioengineering (L.P.), Politecnico di Milano, Milan, Italy
- Fondazione Don Carlo Gnocchi Organizzazione Non Lucrativa di Utilita' Sociae (L.P.), Milan, Italy
| | | | - R Zivadinov
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (P.B., D.J., J.K., C.M., J.H., R.Z.)
- Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, Buffalo, New York
| |
Collapse
|
73
|
Bright MG, Croal PL, Blockley NP, Bulte DP. Multiparametric measurement of cerebral physiology using calibrated fMRI. Neuroimage 2017; 187:128-144. [PMID: 29277404 DOI: 10.1016/j.neuroimage.2017.12.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023] Open
Abstract
The ultimate goal of calibrated fMRI is the quantitative imaging of oxygen metabolism (CMRO2), and this has been the focus of numerous methods and approaches. However, one underappreciated aspect of this quest is that in the drive to measure CMRO2, many other physiological parameters of interest are often acquired along the way. This can significantly increase the value of the dataset, providing greater information that is clinically relevant, or detail that can disambiguate the cause of signal variations. This can also be somewhat of a double-edged sword: calibrated fMRI experiments combine multiple parameters into a physiological model that requires multiple steps, thereby providing more opportunity for error propagation and increasing the noise and error of the final derived values. As with all measurements, there is a trade-off between imaging time, spatial resolution, coverage, and accuracy. In this review, we provide a brief overview of the benefits and pitfalls of extracting multiparametric measurements of cerebral physiology through calibrated fMRI experiments.
Collapse
Affiliation(s)
- Molly G Bright
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Paula L Croal
- IBME, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Nicholas P Blockley
- FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Daniel P Bulte
- IBME, Department of Engineering Science, University of Oxford, Oxford, UK; FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| |
Collapse
|
74
|
Ferreira D, Castro P, Videira G, Filipe JP, Santos R, Sá MJ, Azevedo E, Abreu P. Cerebral autoregulation is preserved in multiple sclerosis patients. J Neurol Sci 2017; 381:298-304. [PMID: 28991702 DOI: 10.1016/j.jns.2017.09.009] [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: 07/02/2017] [Revised: 08/23/2017] [Accepted: 09/06/2017] [Indexed: 11/16/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory disease that may also be associated with vascular dysfunction. One master component of vascular regulation is cerebral autoregulation (CA). We aimed to investigate the integrity of CA in MS patients and study its relationship with autonomic dysfunction (AD), magnetic-resonance-imaging (MRI) lesion load and hemodynamic parameters. We enrolled 20 relapsing-remitting MS and 20 healthy subjects. CA was assessed by transfer function analysis parameters (coherence, gain and phase), as obtained in the very low, low and high-frequency domains (VLF, LF, HF, respectively). We evaluated the autonomic parameters heart rate variability and spontaneous baroreflex sensitivity (BRS). There were no significant differences in CA parameters between MS and controls (p>0.05). Lesion load was not correlated with any CA parameter. LF gain was positively correlated with BRS in both groups (MS: p=0.017; controls: p=0.025). Brainstem lesion load in MS was associated with higher systolic blood pressure (SBP; p=0.009). Our findings suggest that CA is preserved in our MS cohort. On the other hand, AD in MS patients with brainstem lesions could contribute to the increase of supine SBP. Whether this systemic deregulation could contribute to disease burden remains to be investigated.
Collapse
Affiliation(s)
- Daniel Ferreira
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal.
| | - Pedro Castro
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal; Department of Neurology, São João Hospital Center, 4200-319 Porto, Portugal
| | - Gonçalo Videira
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
| | - João Pedro Filipe
- Department of Neuroradiology, Hospital Center São João, 4200-319 Porto, Portugal
| | - Rosa Santos
- Department of Neurology, São João Hospital Center, 4200-319 Porto, Portugal
| | - Maria José Sá
- Department of Neurology, São João Hospital Center, 4200-319 Porto, Portugal; Faculty of Health Sciences, University Fernando Pessoa, 4249-004 Porto, Portugal
| | - Elsa Azevedo
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal; Department of Neurology, São João Hospital Center, 4200-319 Porto, Portugal
| | - Pedro Abreu
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal; Department of Neurology, São João Hospital Center, 4200-319 Porto, Portugal
| |
Collapse
|
75
|
Metzger A, Le Bars E, Deverdun J, Molino F, Maréchal B, Picot MC, Ayrignac X, Carra C, Bauchet L, Krainik A, Labauge P, Menjot de Champfleur N. Is impaired cerebral vasoreactivity an early marker of cognitive decline in multiple sclerosis patients? Eur Radiol 2017; 28:1204-1214. [PMID: 29026971 DOI: 10.1007/s00330-017-5068-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/27/2017] [Accepted: 09/08/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The link between cerebral vasoreactivity and cognitive status in multiple sclerosis remains unclear. The aim of the present study was to investigate a potential decrease of cerebral vasoreactivity in multiple sclerosis patients and correlate it with cognitive status. METHODS Thirty-three patients with multiple sclerosis (nine progressive and 24 remitting forms, median age: 39 years, 12 males) and 22 controls underwent MRI with a hypercapnic challenge to assess cerebral vasoreactivity and a neuropsychological assessment. Cerebral vasoreactivity, measured as the cerebral blood flow percent increase normalised by end-tidal carbon dioxide variation, was assessed globally and by regions of interest using the blood oxygen level-dependent technique. Non-parametric statistics tests were used to assess differences between groups, and associations were estimated using linear models. RESULTS Cerebral vasoreactivity was lower in patients with cognitive impairment than in cognitively normal patients (p=0.004) and was associated with education level in patients (R2 = 0.35; p = 0.047). There was no decrease in cerebral vasoreactivity between patients and controls. CONCLUSIONS Cognitive impairment in multiple sclerosis may be mediated through decreased cerebral vasoreactivity. Cerebral vasoreactivity could therefore be considered as a marker of cognitive decline in multiple sclerosis. KEY POINTS • Cerebral vasoreactivity does not differ between multiple sclerosis patients and controls. • Cerebral vasoreactivity measure is linked to cognitive impairment in multiple sclerosis. • Cerebral vasoreactivity is linked to level of education in multiple sclerosis.
Collapse
Affiliation(s)
- Aude Metzger
- Department of Neurology, University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.
- Department of Neurology, Memory Ressource and Research Center, University Hospital Center, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France.
| | - Emmanuelle Le Bars
- Département de Neuroradiologie, Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
- Institut d'Imagerie Fonctionnelle Humaine (I2FH), Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
- Laboratoire Charles Coulomb, CNRS UMR 5221, Université de Montpellier, Montpellier, France
| | - Jeremy Deverdun
- Département de Neuroradiologie, Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
- Institut d'Imagerie Fonctionnelle Humaine (I2FH), Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
- Laboratoire Charles Coulomb, CNRS UMR 5221, Université de Montpellier, Montpellier, France
| | - François Molino
- Laboratoire Charles Coulomb, CNRS UMR 5221, Université de Montpellier, Montpellier, France
- Institut de Génomique Fonctionnelle, CNRS UMR 5203, INSERM U661, Université de Montpellier, Montpellier, France
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthcare, HC CEMEA SUI DI, Lausanne, PI, Switzerland
- Department of Radiology, CHUV, Lausanne, Switzerland
- LTS5, EPFL, Lausanne, Switzerland
| | - Marie-Christine Picot
- Département de Biostatistiques, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
| | - Xavier Ayrignac
- Department of Neurology, University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Clarisse Carra
- Department of Neurology, University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Luc Bauchet
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
- Institut de Neurosciences de Montpellier, INSERM U1051, Hôpital Saint Eloi, Montpellier, France
| | | | - Pierre Labauge
- Department of Neurology, University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Nicolas Menjot de Champfleur
- Département de Neuroradiologie, Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
- Institut d'Imagerie Fonctionnelle Humaine (I2FH), Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
- Laboratoire Charles Coulomb, CNRS UMR 5221, Université de Montpellier, Montpellier, France
- Département d'Imagerie Médicale, Centre Hospitalier Universitaire Caremeau, Nîmes, France
| |
Collapse
|
76
|
Understanding a role for hypoxia in lesion formation and location in the deep and periventricular white matter in small vessel disease and multiple sclerosis. Clin Sci (Lond) 2017; 131:2503-2524. [PMID: 29026001 DOI: 10.1042/cs20170981] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 08/01/2017] [Accepted: 08/15/2017] [Indexed: 12/28/2022]
Abstract
The deep and periventricular white matter is preferentially affected in several neurological disorders, including cerebral small vessel disease (SVD) and multiple sclerosis (MS), suggesting that common pathogenic mechanisms may be involved in this injury. Here we consider the potential pathogenic role of tissue hypoxia in lesion development, arising partly from the vascular anatomy of the affected white matter. Specifically, these regions are supplied by a sparse vasculature fed by long, narrow end arteries/arterioles that are vulnerable to oxygen desaturation if perfusion is reduced (as in SVD, MS and diabetes) or if the surrounding tissue is hypoxic (as in MS, at least). The oxygen crisis is exacerbated by a local preponderance of veins, as these can become highly desaturated 'sinks' for oxygen that deplete it from surrounding tissues. Additional haemodynamic deficiencies, including sluggish flow and impaired vasomotor reactivity and vessel compliance, further exacerbate oxygen insufficiency. The cells most vulnerable to hypoxic damage, including oligodendrocytes, die first, resulting in demyelination. Indeed, in preclinical models, demyelination is prevented if adequate oxygenation is maintained by raising inspired oxygen concentrations. In agreement with this interpretation, there is a predilection of lesions for the anterior and occipital horns of the lateral ventricles, namely regions located at arterial watersheds, or border zones, known to be especially susceptible to hypoperfusion and hypoxia. Finally, mitochondrial dysfunction due to genetic causes, as occurs in leucodystrophies or due to free radical damage, as occurs in MS, will compound any energy insufficiency resulting from hypoxia. Viewing lesion formation from the standpoint of tissue oxygenation not only reveals that lesion distribution is partly predictable, but may also inform new therapeutic strategies.
Collapse
|
77
|
Chen TC, Yeh CY, Lin CW, Yang CM, Yang CH, Lin IH, Chen PY, Cheng JY, Hu FR. Vascular hypoperfusion in acute optic neuritis is a potentially new neurovascular model for demyelinating diseases. PLoS One 2017; 12:e0184927. [PMID: 28926646 PMCID: PMC5605049 DOI: 10.1371/journal.pone.0184927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/02/2017] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Optic neuritis is highly correlated with multiple sclerosis and is a major cause of acute visual loss and long-term neuronal degeneration. Primary cerebral hypoperfusion has been reported in brain demyelinating diseases. This study investigated whether peripapillary perfusion is changed in patients with acute optic neuritis (AON). METHODS This three-year cohort study was conducted from September 1 2012, to August 31, 2015. Two hundred and forty-one patients with non-glaucomatous acute optic neuropathy were screened, and 42 non-highly myopic patients who had suffered their first episode of unilaterally idiopathic AON were studied. All cases received spectral-domain optical coherence tomography (OCT) examination, general survey, and standard corticosteroid therapy. OCT images were analyzed using a customized MATLAB program for measuring peripapillary choroidal thickness (PCT). Multivariate regression models were constructed to identify factors that are significantly related to peripapillary perfusion. RESULTS Decreased PCT was found in eyes experiencing AON combined with disc swelling (the ratio of lesion eye PCT/fellow eye PCT was 0.87 ± 0.08; range, from 0.75 to 1.00). In comparison to the healthy fellow eyes, approximately every 26% increase in the thickness of the retinal nerve fiber layer due to axonal swelling was associated with a 10% decreased thickness of PCT. Thinner PCT is also correlated with poorer trough vision, which may lead to poorer final vision. These findings were obvious in patients with optic papillitis but not in patients with retrobulbar neuritis. CONCLUSIONS Peripapillary vascular hypoperfusion was found in patients experiencing AON combined with disc swelling. These findings are unlike those for other ocular inflammatory diseases but are consistent with cerebral hypoperfusion, which is found in brain demyelinating diseases; thus, these findings may represent a new neurovascular model in this field.
Collapse
Affiliation(s)
- Ta-Ching Chen
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Yuan Yeh
- Department of Pathology, University of Southern California, Los Angeles, California, United States of America
| | - Chao-Wen Lin
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Hung Lin
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pao-Yang Chen
- Institute of Plant and Microbial Biology, Academia Sinica, Taipei, Taiwan
| | - Jung-Yu Cheng
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
78
|
Evaluation of Visual-Evoked Cerebral Metabolic Rate of Oxygen as a Diagnostic Marker in Multiple Sclerosis. Brain Sci 2017; 7:brainsci7060064. [PMID: 28604606 PMCID: PMC5483637 DOI: 10.3390/brainsci7060064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/03/2017] [Accepted: 06/05/2017] [Indexed: 11/25/2022] Open
Abstract
A multiple sclerosis (MS) diagnosis often relies upon clinical presentation and qualitative analysis of standard, magnetic resonance brain images. However, the accuracy of MS diagnoses can be improved by utilizing advanced brain imaging methods. We assessed the accuracy of a new neuroimaging marker, visual-evoked cerebral metabolic rate of oxygen (veCMRO2), in classifying MS patients and closely age- and sex-matched healthy control (HC) participants. MS patients and HCs underwent calibrated functional magnetic resonance imaging (cfMRI) during a visual stimulation task, diffusion tensor imaging, T1- and T2-weighted imaging, neuropsychological testing, and completed self-report questionnaires. Using resampling techniques to avoid bias and increase the generalizability of the results, we assessed the accuracy of veCMRO2 in classifying MS patients and HCs. veCMRO2 classification accuracy was also examined in the context of other evoked visuofunctional measures, white matter microstructural integrity, lesion-based measures from T2-weighted imaging, atrophy measures from T1-weighted imaging, neuropsychological tests, and self-report assays of clinical symptomology. veCMRO2 was significant and within the top 16% of measures (43 total) in classifying MS status using both within-sample (82% accuracy) and out-of-sample (77% accuracy) observations. High accuracy of veCMRO2 in classifying MS demonstrated an encouraging first step toward establishing veCMRO2 as a neurodiagnostic marker of MS.
Collapse
|
79
|
Geraldes R, Esiri MM, DeLuca GC, Palace J. Age-related small vessel disease: a potential contributor to neurodegeneration in multiple sclerosis. Brain Pathol 2017; 27:707-722. [PMID: 27864848 DOI: 10.1111/bpa.12460] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system wherein, after an initial phase of transient neurological defects, slow neurological deterioration due to progressive neuronal loss ensues. Age is a major determinant of MS progression onset and disability. Over the past years, several mechanisms have been proposed to explain the key drivers of neurodegeneration and disability accumulation in MS. However, the effect of commonly encountered age-related cerebral vessel disease, namely small vessel disease (SVD), has been largely neglected and constitutes the aim of this review. SVD shares some features with MS, that is, white matter demyelination and brain atrophy, and has been shown to contribute to the neuronal damage seen in vascular cognitive impairment. Several lines of evidence suggest that an interaction between MS and SVD may influence MS-related neurodegeneration. SVD may contribute to hypoperfusion, reduced vascular reactivity and tissue hypoxia, features seen in MS. Venule and endothelium abnormalities have been documented in MS but the role of arterioles and of other neurovascular unit structures, such as the pericyte, has not been explored. Vascular risk factors (VRF) have recently been associated with faster progression in MS, though the mechanisms are unclear since very few studies have addressed the impact of VRF and SVD on MS imaging and pathology outcomes. Therapeutic agents targeting the microvasculature and the neurovascular unit may impact both SVD and MS and may benefit patients with dual pathology.
Collapse
Affiliation(s)
- Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Margaret M Esiri
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Gabriele C DeLuca
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
80
|
Doche E, Lecocq A, Maarouf A, Duhamel G, Soulier E, Confort-Gouny S, Rico A, Guye M, Audoin B, Pelletier J, Ranjeva JP, Zaaraoui W. Hypoperfusion of the thalamus is associated with disability in relapsing remitting multiple sclerosis. J Neuroradiol 2017; 44:158-164. [DOI: 10.1016/j.neurad.2016.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/12/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
|
81
|
Abstract
Several neuropathologic and imaging studies have consistently confirmed that multiple sclerosis affects both white (WM) and gray matter (GM) and that GM damage plays a key role in disability progression. However, differently from WM damage, the less inflammatory cell infiltration, the absence of significant blood-brain barrier damage, the low myelin density in upper cortical layers, as well as technical constraints, make the GM damage almost undetectable by means of conventional MR imaging.
Collapse
Affiliation(s)
- Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico GB Rossi, Piazzale LA Scuro 10, Verona 37134, Italy.
| | - Marco Castellaro
- Department of Information Engineering, University of Padova, Via G. Gradenigo 6/a, Padova 35135, Italy
| |
Collapse
|
82
|
Peng SL, Ravi H, Sheng M, Thomas BP, Lu H. Searching for a truly "iso-metabolic" gas challenge in physiological MRI. J Cereb Blood Flow Metab 2017; 37:715-725. [PMID: 26980756 PMCID: PMC5381460 DOI: 10.1177/0271678x16638103] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 01/14/2016] [Accepted: 01/25/2016] [Indexed: 11/16/2022]
Abstract
Hypercapnia challenge (e.g. inhalation of CO2) has been used in calibrated fMRI as well as in the mapping of vascular reactivity in cerebrovascular diseases. An important assumption underlying these measurements is that CO2 is a pure vascular challenge but does not alter neural activity. However, recent reports have suggested that CO2 inhalation may suppress neural activity and brain metabolic rate. Therefore, the goal of this study is to propose and test a gas challenge that is truly "iso-metabolic," by adding a hypoxic component to the hypercapnic challenge, since hypoxia has been shown to enhance cerebral metabolic rate of oxygen (CMRO2). Measurement of global CMRO2 under various gas challenge conditions revealed that, while hypercapnia (P = 0.002) and hypoxia (P = 0.002) individually altered CMRO2 (by -7.6 ± 1.7% and 16.7 ± 4.1%, respectively), inhalation of hypercapnic-hypoxia gas (5% CO2/13% O2) did not change brain metabolism (CMRO2 change: 1.5 ± 3.9%, P = 0.92). Moreover, cerebral blood flow response to the hypercapnic-hypoxia challenge (in terms of % change per mmHg CO2 change) was even greater than that to hypercapnia alone (P = 0.007). Findings in this study suggest that hypercapnic-hypoxia gas challenge may be a useful maneuver in physiological MRI as it preserves vasodilatory response yet does not alter brain metabolism.
Collapse
Affiliation(s)
- Shin-Lei Peng
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, USA
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Harshan Ravi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, USA
- Department of Bioengineering, UT Arlington, Arlington, USA
| | - Min Sheng
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, USA
| | - Binu P Thomas
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, USA
| |
Collapse
|
83
|
Marshall O, Chawla S, Lu H, Pape L, Ge Y. Cerebral blood flow modulation insufficiency in brain networks in multiple sclerosis: A hypercapnia MRI study. J Cereb Blood Flow Metab 2016; 36:2087-2095. [PMID: 27306754 PMCID: PMC5363669 DOI: 10.1177/0271678x16654922] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/11/2016] [Accepted: 03/22/2016] [Indexed: 01/08/2023]
Abstract
Cerebrovascular reactivity measures vascular regulation of cerebral blood flow and is responsible for maintaining healthy neurovascular coupling. Multiple sclerosis exhibits progressive neurodegeneration and global cerebrovascular reactivity deficits. This study investigates varied degrees of cerebrovascular reactivity impairment in different brain networks, which may be an underlying cause for functional changes in the brain, affecting long-distance projection integrity and cognitive function; 28 multiple sclerosis and 28 control subjects underwent pseudocontinuous arterial spin labeling perfusion MRI to measure cerebral blood flow under normocapnia (room air) and hypercapnia (5% carbon dioxide gas mixture) breathing. Cerebrovascular reactivity, measured as normocapnic to hypercapnic cerebral blood flow percent increase normalized by end-tidal carbon dioxide change, was determined from seven functional networks (default mode, frontoparietal, somatomotor, visual, limbic, dorsal, and ventral attention networks). Group analysis showed significantly decreased cerebrovascular reactivity in patients compared to controls within the default mode, frontoparietal, somatomotor, and ventral attention networks after multiple comparison correction. Regression analysis showed a significant correlation of cerebrovascular reactivity with lesion load in the default mode and ventral attention networks and with gray matter atrophy in the default mode network. Functional networks in multiple sclerosis patients exhibit varied amounts of cerebrovascular reactivity deficits. Such blood flow regulation abnormalities may contribute to functional communication disruption in multiple sclerosis.
Collapse
Affiliation(s)
- Olga Marshall
- Radiology/Center for Biomedical Imaging, New York University School of Medicine, NY, USA
| | - Sanjeev Chawla
- Radiology/Center for Biomedical Imaging, New York University School of Medicine, NY, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Louise Pape
- Radiology/Center for Biomedical Imaging, New York University School of Medicine, NY, USA
| | - Yulin Ge
- Radiology/Center for Biomedical Imaging, New York University School of Medicine, NY, USA
| |
Collapse
|
84
|
Cerebrovascular reactivity mapping without gas challenges. Neuroimage 2016; 146:320-326. [PMID: 27888058 DOI: 10.1016/j.neuroimage.2016.11.054] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/16/2016] [Accepted: 11/21/2016] [Indexed: 11/22/2022] Open
Abstract
Cerebrovascular reactivity (CVR), the ability of cerebral vessels to dilate or constrict, has been shown to provide valuable information in the diagnosis and treatment evaluation of patients with various cerebrovascular conditions. CVR mapping is typically performed using hypercapnic gas inhalation as a vasoactive challenge while collecting BOLD images, but the inherent need of gas inhalation and the associated apparatus setup present a practical obstacle in applying it in routine clinical use. Therefore, we aimed to develop a new method to map CVR using resting-state BOLD data without the need of gas inhalation. This approach exploits the natural variation in respiration and measures its influence on BOLD MRI signal. In this work, we first identified a surrogate of the arterial CO2 fluctuation during spontaneous breathing from the global BOLD signal. Second, we tested the feasibility and reproducibility of the proposed approach to use the above-mentioned surrogate as a regressor to estimate voxel-wise CVR. Third, we validated the "resting-state CVR map" with a conventional CVR map obtained with hypercapnic gas inhalation in healthy volunteers. Finally, we tested the utility of this new approach in detecting abnormal CVR in a group of patients with Moyamoya disease, and again validated the results using the conventional gas inhalation method. Our results showed that global BOLD signal fluctuation in the frequency range of 0.02-0.04Hz contains the most prominent contribution from natural variation in arterial CO2. The CVR map calculated using this signal as a regressor is reproducible across runs (ICC=0.91±0.06), and manifests a strong spatial correlation with results measured with a conventional hypercapnia-based method in healthy subjects (r=0.88, p<0.001). We also found that resting-state CVR was able to identify vasodilatory deficit in patients with steno-occlusive disease, the spatial pattern of which matches that obtained using the conventional gas method (r=0.71±0.18). These results suggest that CVR obtained with resting-state BOLD may be a useful alternative in detecting vascular deficits in clinical applications when gas challenge is not feasible.
Collapse
|
85
|
Hubbard NA, Turner M, Hutchison JL, Ouyang A, Strain J, Oasay L, Sundaram S, Davis S, Remington G, Brigante R, Huang H, Hart J, Frohman T, Frohman E, Biswal BB, Rypma B. Multiple sclerosis-related white matter microstructural change alters the BOLD hemodynamic response. J Cereb Blood Flow Metab 2016; 36:1872-1884. [PMID: 26661225 PMCID: PMC5094308 DOI: 10.1177/0271678x15615133] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/15/2015] [Indexed: 01/21/2023]
Abstract
Multiple sclerosis (MS) results in inflammatory damage to white matter microstructure. Prior research using blood-oxygen-level dependent (BOLD) imaging indicates MS-related alterations to brain function. What is currently unknown is the extent to which white matter microstructural damage influences BOLD signal in MS. Here we assessed changes in parameters of the BOLD hemodynamic response function (HRF) in patients with relapsing-remitting MS compared to healthy controls. We also used diffusion tensor imaging to assess whether MS-related changes to the BOLD-HRF were affected by changes in white matter microstructural integrity. Our results showed MS-related reductions in BOLD-HRF peak amplitude. These MS-related amplitude decreases were influenced by individual differences in white matter microstructural integrity. Other MS-related factors including altered reaction time, limited spatial extent of BOLD activity, elevated lesion burden, or lesion proximity to regions of interest were not mediators of group differences in BOLD-HRF amplitude. Results are discussed in terms of functional hyperemic mechanisms and implications for analysis of BOLD signal differences.
Collapse
Affiliation(s)
- Nicholas A Hubbard
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Monroe Turner
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Joanna L Hutchison
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Austin Ouyang
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeremy Strain
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Larry Oasay
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Saranya Sundaram
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Scott Davis
- Department of Applied Physiology and Wellness, Southern Methodist University, Dallas, TX, USA
| | - Gina Remington
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ryan Brigante
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Hao Huang
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Teresa Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elliot Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bharat B Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - Bart Rypma
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA .,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
86
|
Liu P, Welch BG, Li Y, Gu H, King D, Yang Y, Pinho M, Lu H. Multiparametric imaging of brain hemodynamics and function using gas-inhalation MRI. Neuroimage 2016; 146:715-723. [PMID: 27693197 DOI: 10.1016/j.neuroimage.2016.09.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 12/30/2022] Open
Abstract
Diagnosis and treatment monitoring of cerebrovascular diseases routinely require hemodynamic imaging of the brain. Current methods either only provide part of the desired information or require the injection of multiple exogenous agents. In this study, we developed a multiparametric imaging scheme for the imaging of brain hemodynamics and function using gas-inhalation MRI. The proposed technique uses a single MRI scan to provide simultaneous measurements of baseline venous cerebral blood volume (vCBV), cerebrovascular reactivity (CVR), bolus arrival time (BAT), and resting-state functional connectivity (fcMRI). This was achieved with a novel, concomitant O2 and CO2 gas inhalation paradigm, rapid MRI image acquisition with a 9.3min BOLD sequence, and an advanced algorithm to extract multiple hemodynamic information from the same dataset. In healthy subjects, CVR and vCBV values were 0.23±0.03%/mmHg and 0.0056±0.0006%/mmHg, respectively, with a strong correlation (r=0.96 for CVR and r=0.91 for vCBV) with more conventional, separate acquisitions that take twice the scan time. In patients with Moyamoya syndrome, CVR in the stenosis-affected flow territories (typically anterior-cerebral-artery, ACA, and middle-cerebral-artery, MCA, territories) was significantly lower than that in posterior-cerebral-artery (PCA), which typically has minimal stenosis, flow territories (0.12±0.06%/mmHg vs. 0.21±0.05%/mmHg, p<0.001). BAT of the gas bolus was significantly longer (p=0.008) in ACA/MCA territories, compared to PCA, and the maps were consistent with the conventional contrast-enhanced CT perfusion method. FcMRI networks were robustly identified from the gas-inhalation MRI data after factoring out the influence of CO2 and O2 on the signal time course. The spatial correspondence between the gas-data-derived fcMRI maps and those using a separate, conventional fcMRI scan was excellent, showing a spatial correlation of 0.58±0.17 and 0.64±0.20 for default mode network and primary visual network, respectively. These findings suggest that advanced gas-inhalation MRI provides reliable measurements of multiple hemodynamic parameters within a clinically acceptable imaging time and is suitable for patient examinations.
Collapse
Affiliation(s)
- Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Babu G Welch
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX 75390, United States; Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Yang Li
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States; Biomedical Engineering Graduate Program, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Hong Gu
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, United States
| | - Darlene King
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Yihong Yang
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, United States
| | - Marco Pinho
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
| |
Collapse
|
87
|
Nagata K, Yamazaki T, Takano D, Maeda T, Fujimaki Y, Nakase T, Sato Y. Cerebral circulation in aging. Ageing Res Rev 2016; 30:49-60. [PMID: 27484894 DOI: 10.1016/j.arr.2016.06.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 12/20/2022]
Abstract
Cerebral circulation is known to be protected by the regulatory function against the hypoperfusion that will affect the cognitive function as a result of brain ischemia and energy failure. The regulatory function includes cerebrovascular autoregulation, chemical control, metabolic control, and neurogenic control, and those compensatory mechanisms can be influenced by hypertension, atherosclerosis, cardiac diseases, cerebrovascular diseases and aging. On the other hand, large and/or small infarction, intracranial hemorrhage, subarachnoid hemorrhage, atherosclerosis, amylod angiopathy are also more directly associated with cognitive decline not only in those with vascular cognitive impairment or vascular dementia but also those with Alzheimer's disease.
Collapse
Affiliation(s)
- Ken Nagata
- Department of Neurology, Clinical Research Institute, Yokohama General Hospital, Yokohama, Japan.
| | - Takashi Yamazaki
- Department of Neurology, Clinical Research Institute, Yokohama General Hospital, Yokohama, Japan
| | - Daiki Takano
- Department of Neurology, Clinical Research Institute, Yokohama General Hospital, Yokohama, Japan
| | - Tetsuya Maeda
- Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan
| | - Yumi Fujimaki
- Department of Neurology, Research Institute for Brain and Blood Vessels, Akita, Japan
| | - Taizen Nakase
- Department of Neurology, Research Institute for Brain and Blood Vessels, Akita, Japan
| | - Yuichi Sato
- Department of Neurology, Noshiro Yamamoto Medical Association Hospital, Noshiro, Japan
| |
Collapse
|
88
|
Smoliński Ł, Członkowska A. Cerebral vasomotor reactivity in neurodegenerative diseases. Neurol Neurochir Pol 2016; 50:455-462. [PMID: 27553189 DOI: 10.1016/j.pjnns.2016.07.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 11/26/2022]
Abstract
Small-caliber cerebral vessels change their diameters in response to alterations of key metabolite concentrations such as carbon dioxide or oxygen. This phenomenon, termed the cerebral vasomotor reactivity (CVMR), is the basis for blood flow regulation in the brain in accordance with its metabolic status. Typically, CVMR is determined as the amount of change in cerebral blood flow in response to a vasodilating stimulus, which can be measured by various neuroimaging methods or by transcranial Doppler. It has been shown that CVMR is impaired in cerebrovascular diseases, but there is also evidence of a similar dysfunction in neurodegenerative disorders. Here, we review studies that have investigated CVMR in the common neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease and multiple sclerosis. Moreover, we discuss potential neurodegenerative mechanisms responsible for the impairment of CVMR.
Collapse
Affiliation(s)
- Łukasz Smoliński
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland.
| |
Collapse
|
89
|
Chawla S, Ge Y, Lu H, Marshall O, Davitz MS, Fatterpekar G, Soher BJ, Gonen O. Whole-Brain N-Acetylaspartate Concentration Is Preserved during Mild Hypercapnia Challenge. AJNR Am J Neuroradiol 2015; 36:2055-61. [PMID: 26294651 PMCID: PMC4644678 DOI: 10.3174/ajnr.a4424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/01/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although NAA is often used as a marker of neuronal health and integrity in neurologic disorders, its normal response to physiologic challenge is not well-established and its changes are almost always attributed exclusively to brain pathology. The purpose of this study was to test the hypothesis that the neuronal cell marker NAA, often used to assess neuronal health and integrity in neurologic disorders, is not confounded by (possibly transient) physiologic changes. Therefore, its decline, when observed by using (1)H-MR spectroscopy, can almost always be attributed exclusively to brain pathology. MATERIALS AND METHODS Twelve healthy young male adults underwent a transient hypercapnia challenge (breathing 5% CO2 air mixture), a potent vasodilator known to cause a substantial increase in CBF and venous oxygenation. We evaluated their whole-brain NAA by using nonlocalizing proton MR spectroscopy, venous oxygenation with T2-relaxation under spin-tagging MR imaging, CBF with pseudocontinuous arterial spin-labeling, and the cerebral metabolic rate of oxygen, during normocapnia (breathing room air) and hypercapnia. RESULTS There was insignificant whole-brain NAA change (P = .88) from normocapnia to hypercapnia and back to normocapnia in this cohort, as opposed to highly significant increases: 28.0 ± 10.3% in venous oxygenation and 49.7 ± 16.6% in global CBF (P < 10(-4)); and a 6.4 ± 10.9% decrease in the global cerebral metabolic rate of oxygen (P = .04). CONCLUSIONS Stable whole-brain NAA during normocapnia and hypercapnia, despite significant global CBF and cerebral metabolic rate of oxygen changes, supports the hypothesis that global NAA changes are insensitive to transient physiology. Therefore, when observed, they most likely reflect underlying pathology resulting from neuronal cell integrity/viability changes, instead of a response to physiologic changes.
Collapse
Affiliation(s)
- S Chawla
- From the Department of Radiology (S.C., Y.G., O.M., M.S.D., G.F., O.G.), Center for Advanced Imaging Innovation and Research and Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, New York
| | - Y Ge
- From the Department of Radiology (S.C., Y.G., O.M., M.S.D., G.F., O.G.), Center for Advanced Imaging Innovation and Research and Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, New York
| | - H Lu
- The Russell H. Morgan Department of Radiology and Radiological Science (H.L.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - O Marshall
- From the Department of Radiology (S.C., Y.G., O.M., M.S.D., G.F., O.G.), Center for Advanced Imaging Innovation and Research and Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, New York
| | - M S Davitz
- From the Department of Radiology (S.C., Y.G., O.M., M.S.D., G.F., O.G.), Center for Advanced Imaging Innovation and Research and Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, New York
| | - G Fatterpekar
- From the Department of Radiology (S.C., Y.G., O.M., M.S.D., G.F., O.G.), Center for Advanced Imaging Innovation and Research and Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, New York
| | - B J Soher
- Department of Radiology (B.J.S.), Center for Advanced MR Development, Duke University Medical Center, Durham, North Carolina
| | - O Gonen
- From the Department of Radiology (S.C., Y.G., O.M., M.S.D., G.F., O.G.), Center for Advanced Imaging Innovation and Research and Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, New York
| |
Collapse
|
90
|
Marshall O, Uh J, Lurie D, Lu H, Milham MP, Ge Y. The influence of mild carbon dioxide on brain functional homotopy using resting-state fMRI. Hum Brain Mapp 2015; 36:3912-21. [PMID: 26138728 PMCID: PMC6320689 DOI: 10.1002/hbm.22886] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 06/09/2015] [Accepted: 06/16/2015] [Indexed: 11/10/2022] Open
Abstract
Homotopy reflects the intrinsic functional architecture of the brain through synchronized spontaneous activity between corresponding bilateral regions, measured as voxel mirrored homotopic connectivity (VMHC). Hypercapnia is known to have clear impact on brain hemodynamics through vasodilation, but have unclear effect on neuronal activity. This study investigates the effect of hypercapnia on brain homotopy, achieved by breathing 5% carbon dioxide (CO2 ) gas mixture. A total of 14 healthy volunteers completed three resting state functional MRI (RS-fMRI) scans, the first and third under normocapnia and the second under hypercapnia. VMHC measures were calculated as the correlation between the BOLD signal of each voxel and its counterpart in the opposite hemisphere. Group analysis was performed between the hypercapnic and normocapnic VMHC maps. VMHC showed a diffused decrease in response to hypercapnia. Significant regional decreases in VMHC were observed in all anatomical lobes, except for the occipital lobe, in the following functional hierarchical subdivisions: the primary sensory-motor, unimodal, heteromodal, paralimbic, as well as in the following functional networks: ventral attention, somatomotor, default frontoparietal, and dorsal attention. Our observation that brain homotopy in RS-fMRI is affected by arterial CO2 levels suggests that caution should be used when comparing RS-fMRI data between healthy controls and patients with pulmonary diseases and unusual respiratory patterns such as sleep apnea or chronic obstructive pulmonary disease.
Collapse
Affiliation(s)
- Olga Marshall
- Radiology/Center for Biomedical ImagingNew York University School of MedicineNew YorkNew York
| | - Jinsoo Uh
- Advanced Imaging Research CenterUniversity of Texas Southwestern Medical CenterDallasTexas
| | - Daniel Lurie
- Center for the Developing Brain, Child Mind InstituteNew YorkNew York
| | - Hanzhang Lu
- Advanced Imaging Research CenterUniversity of Texas Southwestern Medical CenterDallasTexas
- Department of RadiologyJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Michael P. Milham
- Center for the Developing Brain, Child Mind InstituteNew YorkNew York
- Nathan S Kline Institute for Psychiatric ResearchNew York
| | - Yulin Ge
- Radiology/Center for Biomedical ImagingNew York University School of MedicineNew YorkNew York
| |
Collapse
|
91
|
A neuroradiologist's guide to arterial spin labeling MRI in clinical practice. Neuroradiology 2015; 57:1181-202. [PMID: 26351201 PMCID: PMC4648972 DOI: 10.1007/s00234-015-1571-z] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/05/2015] [Indexed: 01/01/2023]
Abstract
Arterial spin labeling (ASL) is a non-invasive MRI technique to measure cerebral blood flow (CBF). This review provides a practical guide and overview of the clinical applications of ASL of the brain, as well its potential pitfalls. The technical and physiological background is also addressed. At present, main areas of interest are cerebrovascular disease, dementia and neuro-oncology. In cerebrovascular disease, ASL is of particular interest owing to its quantitative nature and its capability to determine cerebral arterial territories. In acute stroke, the source of the collateral blood supply in the penumbra may be visualised. In chronic cerebrovascular disease, the extent and severity of compromised cerebral perfusion can be visualised, which may be used to guide therapeutic or preventative intervention. ASL has potential for the detection and follow-up of arteriovenous malformations. In the workup of dementia patients, ASL is proposed as a diagnostic alternative to PET. It can easily be added to the routinely performed structural MRI examination. In patients with established Alzheimer’s disease and frontotemporal dementia, hypoperfusion patterns are seen that are similar to hypometabolism patterns seen with PET. Studies on ASL in brain tumour imaging indicate a high correlation between areas of increased CBF as measured with ASL and increased cerebral blood volume as measured with dynamic susceptibility contrast-enhanced perfusion imaging. Major advantages of ASL for brain tumour imaging are the fact that CBF measurements are not influenced by breakdown of the blood–brain barrier, as well as its quantitative nature, facilitating multicentre and longitudinal studies.
Collapse
|
92
|
Cerebral hypoperfusion: a new pathophysiologic concept in multiple sclerosis? J Cereb Blood Flow Metab 2015; 35:1406-10. [PMID: 26104292 PMCID: PMC4640326 DOI: 10.1038/jcbfm.2015.131] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/08/2015] [Accepted: 05/04/2015] [Indexed: 01/28/2023]
Abstract
The exact pathogenesis of multiple sclerosis (MS) is incompletely understood. Although auto-immune responses have an important role in the development of hallmark focal demyelinating lesions, the underlying mechanism of axonal degeneration, the other key player in MS pathology and main determinant of long-term disability, remains unclear and corresponds poorly with inflammatory disease activity. Perfusion-weighted imaging studies have demonstrated that there is a widespread cerebral hypoperfusion in patients with MS, which is present from the early beginning to more advanced disease stages. This reduced cerebral blood flow (CBF) does not seems to be secondary to loss of axonal integrity with decreased metabolic demands but appears to be mediated by elevated levels of the potent vasospastic peptide endothelin-1 in the cerebral circulation. Evidence is evolving that cerebral hypoperfusion in MS is associated with chronic hypoxia, focal lesion formation, diffuse axonal degeneration, cognitive dysfunction, and fatigue. Restoring CBF may therefore emerge as a new therapeutic target in MS.
Collapse
|
93
|
Ravi H, Thomas BP, Peng SL, Liu H, Lu H. On the optimization of imaging protocol for the mapping of cerebrovascular reactivity. J Magn Reson Imaging 2015; 43:661-8. [PMID: 26268541 DOI: 10.1002/jmri.25028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To devise an improved blood-oxygen-level-dependent (BOLD) imaging protocol for cerebrovascular reactivity (CVR) measurement that can remove a known artifact of negative values. METHODS Theoretical and simulation studies were first performed to understand the biophysical mechanism of the negative CVR signals, through which improved BOLD sequence parameters were proposed. This was achieved by equating signal intensities between cerebrospinal fluid and blood, by means of shortening the echo time (TE) of the BOLD sequence. Then, 10 healthy volunteers were recruited to participate in an experimental study, in which we compared the CVR results of two versions of the optimized ("Opt1" and "Opt2") protocols with that of the standard protocol at 3 Tesla. Two sessions were performed for each subject to test the reproducibility of all three protocols. RESULTS Experimental results demonstrated that the optimized protocols resulted in elimination of negative-CVR voxels. Quantitative CVR results were compared across protocols, which show that the optimized protocols yielded smaller CVR values (Opt1: 0.16 ± 0.01 %BOLD/mmHg CO2 ; Opt2: 0.15 ± 0.01 %BOLD/mmHg CO2 ) than (P < 0.001) the standard protocol (0.21 ± 0.01 %BOLD/mmHg CO2 ), but the CNR was comparable (P = 0.1) to the standard protocol. The coefficient-of-variation between repetitions was found to be 5.6 ± 1.4%, 6.3 ± 1.6%, and 6.9 ± 0.9% for the three protocols, but there were no significant differences (P = 0.65). CONCLUSION Based on the theoretical and experimental results obtained from this study, we suggest that the use of a TE shorter than those used in fMRI is necessary to minimize negative artifact in CVR results.
Collapse
Affiliation(s)
- Harshan Ravi
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
| | - Binu P Thomas
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
| | - Shin-Lei Peng
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
94
|
Abstract
Aspirin is widely used to lessen the risks of cardiovascular events. Some studies suggest that patients with multiple sclerosis have an increased risk for some cardiovascular events, for example, venous thromboembolism and perhaps ischemic strokes, raising the possibility that aspirin could lessen these increased risks in this population or subgroups (patients with limited mobility and/or antiphospholipid antibodies). However, aspirin causes a small increased risk of hemorrhagic stroke, which is a concern as it could potentially worsen a compromised blood-brain barrier. Aspirin has the potential to ameliorate the disease process in multiple sclerosis (for example, by limiting some components of inflammation), but aspirin also has the potential to inhibit mitochondrial complex I activity, which is already reduced in multiple sclerosis. In an experimental setting of a cerebral ischemic lesion, aspirin promoted the proliferation and/or differentiation of oligodendrocyte precursors, raising the possibility that aspirin could facilitate remyelination efforts in multiple sclerosis. Other actions by aspirin may lead to small improvements of some symptoms (for example, lessening fatigue). Here we consider potential benefits and risks of aspirin usage by patients with multiple sclerosis.
Collapse
Affiliation(s)
- Sheila Tsau
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Mitchell R Emerson
- Department of Pharmaceutical Sciences, College of Pharmacy-Glendale, Midwestern University, Glendale, AZ, USA.
| | - Sharon G Lynch
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Steven M LeVine
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.
| |
Collapse
|
95
|
Koudriavtseva T, Plantone D, Renna R, Inglese M. Brain perfusion by arterial spin labeling MRI in multiple sclerosis. J Neurol 2015; 262:1769-71. [PMID: 26016686 DOI: 10.1007/s00415-015-7792-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/21/2015] [Accepted: 05/21/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Tatiana Koudriavtseva
- Unit of Neurology, Multiple Sclerosis Center, Regina Elena National Cancer Institute, IFO, Rome, Italy,
| | | | | | | |
Collapse
|
96
|
Koudriavtseva T, Sbardella E, Mainero C. Brain perfusion and vasoreactivity in multiple sclerosis. AJNR Am J Neuroradiol 2015; 36:E27-8. [PMID: 25593205 DOI: 10.3174/ajnr.a4249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- T Koudriavtseva
- Neurology Unit, Multiple Sclerosis Center Regina Elena National Cancer Institute Istituti Fisioterapici Ospitalieri Rome, Italy
| | - E Sbardella
- Neurology Unit, Multiple Sclerosis Center Regina Elena National Cancer Institute Istituti Fisioterapici Ospitalieri Rome, Italy
| | - C Mainero
- Athinoula A. Martinos Center for Biomedical Imaging Massachusetts General Hospital Boston, Massachusetts Harvard Medical School Boston, Massachusetts
| |
Collapse
|