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Wegener S, Baron JC, Derdeyn CP, Fierstra J, Fromm A, Klijn CJM, van Niftrik CHB, Schaafsma JD. Hemodynamic Stroke: Emerging Concepts, Risk Estimation, and Treatment. Stroke 2024; 55:1940-1950. [PMID: 38864227 DOI: 10.1161/strokeaha.123.044386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Ischemic stroke can arise from the sudden occlusion of a brain-feeding artery by a clot (embolic), or local thrombosis. Hemodynamic stroke occurs when blood flow does not sufficiently meet the metabolic demand of a brain region at a certain time. This discrepancy between demand and supply can occur with cerebropetal arterial occlusion or high-grade stenosis but also arises with systemic conditions reducing blood pressure. Treatment of hemodynamic stroke is targeted toward increasing blood flow to the affected area by either systemically or locally enhancing perfusion. Thus, blood pressure is often maintained above normal values, and extra-intracranial flow augmentation bypass surgery is increasingly considered. Still, current evidence supporting the superiority of pressure or flow increase over conservative measures is limited. However, methods assessing hemodynamic impairment and identifying patients at risk of hemodynamic stroke are rapidly evolving. Sophisticated models incorporating clinical and imaging factors have been suggested to aid patient selection. In this narrative review, we provide current state-of-the-art knowledge about hemodynamic stroke, tools for assessment, and treatment options.
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Affiliation(s)
- Susanne Wegener
- Department of Neurology (S.W.), University Hospital Zurich (USZ) and University of Zurich (UZH), Switzerland
- Clinical Neurocenter Zurich and Neuroscience Center Zurich (ZNZ), Switzerland (S.W., J.F., C.H.B.v.N.)
| | - Jean Claude Baron
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Université Paris Cité, Inserm U1266, FHU NeuroVasc, France (J.C.B.)
| | - Colin P Derdeyn
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville (C.P.D.)
| | - Jorn Fierstra
- Department of Neurosurgery (J.F., C.H.B.v.N.), University Hospital Zurich (USZ) and University of Zurich (UZH), Switzerland
- Clinical Neurocenter Zurich and Neuroscience Center Zurich (ZNZ), Switzerland (S.W., J.F., C.H.B.v.N.)
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway (A.F.)
| | - Catharina J M Klijn
- Department of Neurology at Radboud University Nijmegen, the Netherlands (C.J.M.K.)
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery (J.F., C.H.B.v.N.), University Hospital Zurich (USZ) and University of Zurich (UZH), Switzerland
- Clinical Neurocenter Zurich and Neuroscience Center Zurich (ZNZ), Switzerland (S.W., J.F., C.H.B.v.N.)
| | - Joanna D Schaafsma
- Division of Neurology, Department of Medicine (JDS) and Division of Neuroradiology, Department of Medical Imaging, University Health Network, Toronto, Canada (DJM, DMM) (J.D.S.)
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2
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van Niftrik CHB, Sebök M, Germans MR, Halter M, Pokorny T, Stumpo V, Bellomo J, Piccirelli M, Pangalu A, Katan M, Wegener S, Tymianski M, Kulcsár Z, Luft AR, Fisher JA, Mikulis DJ, Regli L, Fierstra J. Increased Risk of Recurrent Stroke in Symptomatic Large Vessel Disease With Impaired BOLD Cerebrovascular Reactivity. Stroke 2024; 55:613-621. [PMID: 38328926 DOI: 10.1161/strokeaha.123.044259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Impaired cerebrovascular reactivity (CVR) has been correlated with recurrent ischemic stroke. However, for clinical purposes, most CVR techniques are rather complex, time-consuming, and lack validation for quantitative measurements. The recent adaptation of a standardized hypercapnic stimulus in combination with a blood-oxygenation-level-dependent (BOLD) magnetic resonance imaging signal as a surrogate for cerebral blood flow offers a potential universally comparable CVR assessment. We investigated the association between impaired BOLD-CVR and risk for recurrent ischemic events. METHODS We conducted a retrospective analysis of patients with symptomatic cerebrovascular large vessel disease who had undergone a prospective hypercapnic-challenged BOLD-CVR protocol at a single tertiary stroke referral center between June 2014 and April 2020. These patients were followed up for recurrent acute ischemic events for up to 3 years. BOLD-CVR (%BOLD signal change per mm Hg CO2) was calculated on a voxel-by-voxel basis. Impaired BOLD-CVR of the affected (ipsilateral to the vascular pathology) hemisphere was defined as an average BOLD-CVR, falling 2 SD below the mean BOLD-CVR of the right hemisphere in a healthy age-matched reference cohort (n=20). Using a multivariate Cox proportional hazards model, the association between impaired BOLD-CVR and ischemic stroke recurrence was assessed and Kaplan-Meier survival curves to visualize the acute ischemic stroke event rate. RESULTS Of 130 eligible patients, 28 experienced recurrent strokes (median, 85 days, interquartile range, 5-166 days). Risk factors associated with an increased recurrent stroke rate included impaired BOLD-CVR, a history of atrial fibrillation, and heart insufficiency. After adjusting for sex, age group, and atrial fibrillation, impaired BOLD-CVR exhibited a hazard ratio of 10.73 (95% CI, 4.14-27.81; P<0.001) for recurrent ischemic stroke. CONCLUSIONS Among patients with symptomatic cerebrovascular large vessel disease, those exhibiting impaired BOLD-CVR in the affected hemisphere had a 10.7-fold higher risk of recurrent ischemic stroke events compared with individuals with nonimpaired BOLD-CVR.
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Affiliation(s)
- Christiaan H B van Niftrik
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Martina Sebök
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Menno R Germans
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Matthias Halter
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Thomas Pokorny
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Vittorio Stumpo
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Jacopo Bellomo
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Marco Piccirelli
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (M.P., A.P., Z.K.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Athina Pangalu
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (M.P., A.P., Z.K.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Mira Katan
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Michael Tymianski
- Division of Neurosurgery, Toronto Western Hospital (M.T., J.F.), University of Toronto, ON, Canada
| | - Zsolt Kulcsár
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (M.P., A.P., Z.K.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Andreas R Luft
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Joseph A Fisher
- Institute of Medical Science (J.A.F.), University of Toronto, ON, Canada
- Department of Anesthesia and Pain Management (J.A.F.), University Health Network, Toronto, ON, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and Functional Neuroimaging Laboratory (D.J.M.), University Health Network, Toronto, ON, Canada
| | - Luca Regli
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Division of Neurosurgery, Toronto Western Hospital (M.T., J.F.), University of Toronto, ON, Canada
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3
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Chen DY, Di X, Yu X, Biswal BB. The significance and limited influence of cerebrovascular reactivity on age and sex effects in task- and resting-state brain activity. Cereb Cortex 2024; 34:bhad448. [PMID: 38212284 PMCID: PMC10832986 DOI: 10.1093/cercor/bhad448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/31/2023] [Indexed: 01/13/2024] Open
Abstract
Functional MRI measures the blood-oxygen-level dependent signals, which provide an indirect measure of neural activity mediated by neurovascular responses. Cerebrovascular reactivity affects both task-induced and resting-state blood-oxygen-level dependent activity and may confound inter-individual effects, such as those related to aging and biological sex. We examined a large dataset containing breath-holding, checkerboard, and resting-state tasks. We used the breath-holding task to measure cerebrovascular reactivity, used the checkerboard task to obtain task-based activations, and quantified resting-state activity with amplitude of low-frequency fluctuations and regional homogeneity. We hypothesized that cerebrovascular reactivity would be correlated with blood-oxygen-level dependent measures and that accounting for these correlations would result in better estimates of age and sex effects. We found that cerebrovascular reactivity was correlated with checkerboard task activations in the visual cortex and with amplitude of low-frequency fluctuations and regional homogeneity in widespread fronto-parietal regions, as well as regions with large vessels. We also found significant age and sex effects in cerebrovascular reactivity, some of which overlapped with those observed in amplitude of low-frequency fluctuations and regional homogeneity. However, correcting for the effects of cerebrovascular reactivity had very limited influence on the estimates of age and sex. Our results highlight the limitations of accounting for cerebrovascular reactivity with the current breath-holding task.
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Affiliation(s)
- Donna Y Chen
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, United States
- Rutgers Biomedical and Health Sciences, Rutgers School of Graduate Studies, Newark, NJ 08901, United States
| | - Xin Di
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, United States
| | - Xin Yu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA 02114, United States
| | - Bharat B Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, United States
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4
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Sayin ES, Duffin J, Poublanc J, Venkatraghavan L, Mikulis DJ, Fisher JA, Sobczyk O. Determining the effects of elevated partial pressure of oxygen on hypercapnia-induced cerebrovascular reactivity. J Cereb Blood Flow Metab 2023; 43:2085-2095. [PMID: 37632334 PMCID: PMC10925865 DOI: 10.1177/0271678x231197000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/28/2023]
Abstract
Evaluation of cerebrovascular reactivity (CVR) to hypo- and hypercapnia is a valuable test for the assessment of vasodilatory reserve. While hypercapnia-induced CVR testing is usually performed at normoxia, mild hyperoxia may increase tolerability of hypercapnia by reducing the ventilatory distress. However, the effects of mild hyperoxia on CVR was unknown. We therefore recruited 21 patients with a range of steno-occlusive diseases and 12 healthy participants who underwent a standardized 13-minute step plus ramp CVR test with a carbon dioxide gas challenge at the subject's resting end-tidal partial pressure of oxygen or at mild hyperoxia (PetO2 = 150 mmHg) depending on to which group they were assigned. In 11 patients, the second CVR test was at normoxia to examine test-retest differences. CVR was defined as % Δ Signal/ΔPetCO2. We found that there was no significant difference between CVR test results conducted at normoxia and at mild hyperoxia for participants in Groups 1 and 2 for the step and ramp portion. We also found no difference between test and retest CVR at normoxia for patients with cerebrovascular pathology (Group 3) for step and ramp portion. We concluded normoxic CVR is repeatable, and that mild hyperoxia does not affect CVR.
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Affiliation(s)
- Ece Su Sayin
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
| | - Lashmikumar Venkatraghavan
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David John Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
| | - Joseph Arnold Fisher
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Olivia Sobczyk
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
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5
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Zhao MY, Armindo RD, Gauden AJ, Yim B, Tong E, Moseley M, Steinberg GK, Zaharchuk G. Revascularization improves vascular hemodynamics - a study assessing cerebrovascular reserve and transit time in Moyamoya patients using MRI. J Cereb Blood Flow Metab 2023; 43:138-151. [PMID: 36408536 PMCID: PMC10638998 DOI: 10.1177/0271678x221140343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/04/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022]
Abstract
Cerebrovascular reserve (CVR) reflects the capacity of cerebral blood flow (CBF) to change. Decreased CVR implies poor hemodynamics and is linked to a higher risk for stroke. Revascularization has been shown to improve CBF in patients with vasculopathy such as Moyamoya disease. Dynamic susceptibility contrast (DSC) can measure transit time to evaluate patients suspected of stroke. Arterial spin labeling (ASL) is a non-invasive technique for CBF, CVR, and arterial transit time (ATT) measurements. Here, we investigate the change in hemodynamics 4-12 months after extracranial-to-intracranial direct bypass in 52 Moyamoya patients using ASL with single and multiple post-labeling delays (PLD). Images were collected using ASL and DSC with acetazolamide. CVR, CBF, ATT, and time-to-maximum (Tmax) were measured in different flow territories. Results showed that hemodynamics improved significantly in regions affected by arterial occlusions after revascularization. CVR increased by 16 ± 11% (p < 0.01) and 25 ± 13% (p < 0.01) for single- and multi-PLD ASL, respectively. Transit time measured by multi-PLD ASL and post-vasodilation DSC reduced by 13 ± 7% (p < 0.01) and 9 ± 5% (p < 0.01), respectively. For all regions, ATT correlated significantly with Tmax (R2 = 0.59, p < 0.01). Thus, revascularization improved CVR and decreased transit times. Multi-PLD ASL can serve as an effective and non-invasive modality to examine vascular hemodynamics in Moyamoya patients.
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Affiliation(s)
- Moss Y Zhao
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Rui Duarte Armindo
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Neuroradiology, Hospital Beatriz Ângelo, Loures, Lisbon, Portugal
| | - Andrew J Gauden
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Benjamin Yim
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Elizabeth Tong
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Michael Moseley
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA, USA
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6
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Chen DY, Di X, Yu X, Biswal BB. The Significance and Limited Influence of Cerebrovascular Reactivity on Age and Sex Effects in Task- and Resting-State Brain Activity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.18.553848. [PMID: 37662201 PMCID: PMC10473673 DOI: 10.1101/2023.08.18.553848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Functional MRI (fMRI) measures the blood-oxygen-level dependent (BOLD) signals, which provide an indirect measure of neural activity mediated by neurovascular responses. Cerebrovascular reactivity affects both task-induced and resting-state BOLD activity and may confound inter-individual effects observed in BOLD-based measures, such as those related to aging and biological sex. To investigate this, we examined a large open-access fMRI dataset containing a breath-holding task, checkerboard task, and resting-state scans. We used the breath-holding task to measure cerebrovascular reactivity, used the checkerboard task to obtain task-based activations, and from the resting-state data, we quantified the resting-state amplitude of low-frequency fluctuations (ALFF), and resting-state regional homogeneity (ReHo). We hypothesized that cerebrovascular reactivity would be correlated with BOLD measures and that accounting for these correlations would result in better estimates of age and sex effects. Our analysis showed that cerebrovascular reactivity was correlated with checkerboard task activations in the visual cortex and with ALFF and ReHo in widespread fronto-parietal regions, as well as regions with large vessels. We also found significant age and sex effects in cerebrovascular reactivity, some of which overlapped with those observed in ALFF and ReHo scores. Finally, we demonstrated that correcting for the effects of cerebrovascular reactivity had very limited influence on the estimates of age and sex. Our results highlight the limitations of accounting for cerebrovascular reactivity with the current breath-holding task.
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Affiliation(s)
- Donna Y. Chen
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
- Rutgers Biomedical and Health Sciences, Rutgers School of Graduate Studies, Newark, NJ, USA
| | - Xin Di
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - Xin Yu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Bharat B. Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
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7
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Wang C, Reid G, Mackay CE, Hayes G, Bulte DP, Suri S. A Systematic Review of the Association Between Dementia Risk Factors and Cerebrovascular Reactivity. Neurosci Biobehav Rev 2023; 148:105140. [PMID: 36944391 DOI: 10.1016/j.neubiorev.2023.105140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/15/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023]
Abstract
Cumulative evidence suggests that impaired cerebrovascular reactivity (CVR), a regulatory response critical for maintaining neuronal health, is amongst the earliest pathological changes in dementia. However, we know little about how CVR is affected by dementia risk, prior to disease onset. Understanding this relationship would improve our knowledge of disease pathways and help inform preventative interventions. This systematic review investigates 59 studies examining how CVR (measured by magnetic resonance imaging) is affected by modifiable, non-modifiable, and clinical risk factors for dementia. We report that non-modifiable risk (older age and apolipoprotein ε4), some modifiable factors (diabetes, traumatic brain injury, hypertension) and some clinical factors (stroke, carotid artery occlusion, stenosis) were consistently associated with reduced CVR. We also note a lack of conclusive evidence on how other behavioural factors such as physical inactivity, obesity, or depression, affect CVR. This review explores the biological mechanisms underpinning these brain- behaviour associations, highlights evident gaps in the literature, and identifies the risk factors that could be managed to preserve CVR in an effort to prevent dementia.
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Affiliation(s)
- Congxiyu Wang
- Department of Psychiatry, University of Oxford, UK; Wellcome Centre for Integrative Neuroimaging, University of Oxford, UK
| | - Graham Reid
- Department of Psychiatry, University of Oxford, UK; Department of Experimental Psychology, University of Oxford, UK
| | - Clare E Mackay
- Department of Psychiatry, University of Oxford, UK; Wellcome Centre for Integrative Neuroimaging, University of Oxford, UK
| | - Genevieve Hayes
- Institute of Biomedical Engineering, University of Oxford, UK
| | - Daniel P Bulte
- Institute of Biomedical Engineering, University of Oxford, UK
| | - Sana Suri
- Department of Psychiatry, University of Oxford, UK; Wellcome Centre for Integrative Neuroimaging, University of Oxford, UK.
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8
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Sleight E, Stringer MS, Mitchell I, Murphy M, Marshall I, Wardlaw JM, Thrippleton MJ. Cerebrovascular reactivity measurements using 3T BOLD MRI and a fixed inhaled CO 2 gas challenge: Repeatability and impact of processing strategy. Front Physiol 2023; 14:1070233. [PMID: 36814481 PMCID: PMC9939770 DOI: 10.3389/fphys.2023.1070233] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/19/2023] [Indexed: 02/09/2023] Open
Abstract
Introduction: Cerebrovascular reactivity (CVR) measurements using blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) are commonly used to assess the health of cerebral blood vessels, including in patients with cerebrovascular diseases; however, evidence and consensus regarding reliability and optimal processing are lacking. We aimed to assess the repeatability, accuracy and precision of voxel- and region-based CVR measurements at 3 T using a fixed inhaled (FI) CO2 stimulus in a healthy cohort. Methods: We simulated the effect of noise, delay constraints and voxel- versus region-based analysis on CVR parameters. Results were verified in 15 healthy volunteers (28.1±5.5 years, female: 53%) with a test-retest MRI experiment consisting of two CVR scans. CVR magnitude and delay in grey matter (GM) and white matter were computed for both analyses assuming a linear relationship between the BOLD signal and time-shifted end-tidal CO2 (EtCO2) profile. Results: Test-retest repeatability was high [mean (95% CI) inter-scan difference: -0.01 (-0.03, -0.00) %/mmHg for GM CVR magnitude; -0.3 (-1.2,0.6) s for GM CVR delay], but we detected a small systematic reduction in CVR magnitude at scan 2 versus scan 1, accompanied by a greater EtCO2 change [±1.0 (0.4,1.5) mmHg] and lower heart rate [-5.5 (-8.6,-2.4] bpm]. CVR magnitude estimates were higher for voxel- versus region-based analysis [difference in GM: ±0.02 (0.01,0.03) %/mmHg]. Findings were supported by simulation results, predicting a positive bias for voxel-based CVR estimates dependent on temporal contrast-to-noise ratio and delay fitting constraints and an underestimation for region-based CVR estimates. Discussion: BOLD CVR measurements using FI stimulus have good within-day repeatability in healthy volunteers. However, measurements may be influenced by physiological effects and the analysis protocol. Voxel-based analyses should be undertaken with care due to potential for systematic bias; region-based analyses are more reliable in such cases.
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Affiliation(s)
- Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael S. Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Isla Mitchell
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom
| | - Madeleine Murphy
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom,Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom,Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom,*Correspondence: Michael J. Thrippleton,
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9
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Hopman LH, Hillier E, Liu Y, Hamilton J, Fischer K, Seiberlich N, Friedrich MG. Dynamic Cardiac Magnetic Resonance Fingerprinting During Vasoactive Breathing Maneuvers: First Results. J Cardiovasc Imaging 2023; 31:71-82. [PMID: 37096671 PMCID: PMC10133810 DOI: 10.4250/jcvi.2022.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance fingerprinting (cMRF) enables simultaneous mapping of myocardial T1 and T2 with very short acquisition times. Breathing maneuvers have been utilized as a vasoactive stress test to dynamically characterize myocardial tissue in vivo. We tested the feasibility of sequential, rapid cMRF acquisitions during breathing maneuvers to quantify myocardial T1 and T2 changes. METHODS We measured T1 and T2 values using conventional T1 and T2-mapping techniques (modified look locker inversion [MOLLI] and T2-prepared balanced-steady state free precession), and a 15 heartbeat (15-hb) and rapid 5-hb cMRF sequence in a phantom and in 9 healthy volunteers. The cMRF5-hb sequence was also used to dynamically assess T1 and T2 changes over the course of a vasoactive combined breathing maneuver. RESULTS In healthy volunteers, the mean myocardial T1 of the different mapping methodologies were: MOLLI 1,224 ± 81 ms, cMRF15-hb 1,359 ± 97 ms, and cMRF5-hb 1,357 ± 76 ms. The mean myocardial T2 measured with the conventional mapping technique was 41.7 ± 6.7 ms, while for cMRF15-hb 29.6 ± 5.8 ms and cMRF5-hb 30.5 ± 5.8 ms. T2 was reduced with vasoconstriction (post-hyperventilation compared to a baseline resting state) (30.15 ± 1.53 ms vs. 27.99 ± 2.07 ms, p = 0.02), while T1 did not change with hyperventilation. During the vasodilatory breath-hold, no significant change of myocardial T1 and T2 was observed. CONCLUSIONS cMRF5-hb enables simultaneous mapping of myocardial T1 and T2, and may be used to track dynamic changes of myocardial T1 and T2 during vasoactive combined breathing maneuvers.
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Affiliation(s)
- Luuk H.G.A. Hopman
- Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Elizabeth Hillier
- Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Yuchi Liu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Jesse Hamilton
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicole Seiberlich
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Matthias G. Friedrich
- Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Departments of Cardiology and Diagnostic Radiology, McGill University Health Centre, Montreal, QC, Canada
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10
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Zhao MY, Fan AP, Chen DYT, Ishii Y, Khalighi MM, Moseley M, Steinberg GK, Zaharchuk G. Using arterial spin labeling to measure cerebrovascular reactivity in Moyamoya disease: Insights from simultaneous PET/MRI. J Cereb Blood Flow Metab 2022; 42:1493-1506. [PMID: 35236136 PMCID: PMC9274857 DOI: 10.1177/0271678x221083471] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebrovascular reactivity (CVR) reflects the CBF change to meet different physiological demands. The reference CVR technique is PET imaging with vasodilators but is inaccessible to most patients. DSC can measure transit time to evaluate patients suspected of stroke, but the use of gadolinium may cause side-effects. Arterial spin labeling (ASL) is a non-invasive MRI technique for CBF measurements. Here, we investigate the effectiveness of ASL with single and multiple post labeling delays (PLD) to replace PET and DSC for CVR and transit time mapping in 26 Moyamoya patients. Images were collected using simultaneous PET/MRI with acetazolamide. CVR, CBF, arterial transit time (ATT), and time-to-maximum (Tmax) were measured in different flow territories. Results showed that CVR was lower in occluded regions than normal regions (by 68 ± 12%, 52 ± 5%, and 56 ± 9%, for PET, single- and multi-PLD PCASL, respectively, all p < 0.05). Multi-PLD PCASL correlated slightly higher with PET (CCC = 0.36 and 0.32 in affected and unaffected territories respectively). Vasodilation caused ATT to reduce by 4.5 ± 3.1% (p < 0.01) in occluded regions. ATT correlated significantly with Tmax (R2 > 0.35, p < 0.01). Therefore, multi-PLD ASL is recommended for CVR studies due to its high agreement with the reference PET technique and the capability of measuring transit time.
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Affiliation(s)
- Moss Y Zhao
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Audrey P Fan
- Department of Biomedical Engineering, University of California Davis, Davis, CA, USA.,Department of Neurology, University of California Davis, Davis, CA, USA
| | - David Yen-Ting Chen
- Department of Medical Imaging, Taipei Medical University - Shuan-Ho Hospital, New Taipei City.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Yosuke Ishii
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Michael Moseley
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA, USA
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11
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Zhao MY, Woodward A, Fan AP, Chen KT, Yu Y, Chen DY, Moseley ME, Zaharchuk G. Reproducibility of cerebrovascular reactivity measurements: A systematic review of neuroimaging techniques . J Cereb Blood Flow Metab 2022; 42:700-717. [PMID: 34806918 PMCID: PMC9254040 DOI: 10.1177/0271678x211056702] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cerebrovascular reactivity (CVR), the capacity of the brain to increase cerebral blood flow (CBF) to meet changes in physiological demand, is an important biomarker to evaluate brain health. Typically, this brain "stress test" is performed by using a medical imaging modality to measure the CBF change between two states: at baseline and after vasodilation. However, since there are many imaging modalities and many ways to augment CBF, a wide range of CVR values have been reported. An understanding of CVR reproducibility is critical to determine the most reliable methods to measure CVR as a clinical biomarker. This review focuses on CVR reproducibility studies using neuroimaging techniques in 32 articles comprising 427 total subjects. The literature search was performed in PubMed, Embase, and Scopus. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We identified 5 factors of the experimental subjects (such as sex, blood characteristics, and smoking) and 9 factors of the measuring technique (such as the imaging modality, the type of the vasodilator, and the quantification method) that have strong effects on CVR reproducibility. Based on this review, we recommend several best practices to improve the reproducibility of CVR quantification in neuroimaging studies.
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Affiliation(s)
- Moss Y Zhao
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Amanda Woodward
- Lane Medical Library, Stanford University, Stanford, CA, USA
| | - Audrey P Fan
- Department of Biomedical Engineering, University of California Davis, Davis, CA, USA.,Department of Neurology, University of California Davis, Davis, CA, USA
| | - Kevin T Chen
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Yannan Yu
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - David Y Chen
- Department of Medical Imaging, Taipei Medical University - Shuan-Ho Hospital, New Taipei City.,Department of Radiology, School of Medicine, Taipei Medical University, Taipei *Research materials supporting this publication can be accessed at https://doi.org/10.25740/hd852bg4538
| | | | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA, USA
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12
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Sayegh ALC, Fan JL, Vianna LC, Dawes M, Paton JFR, Fisher JP. Sex-differences in the sympathetic neurocirculatory responses to chemoreflex activation. J Physiol 2022; 600:2669-2689. [PMID: 35482235 PMCID: PMC9324851 DOI: 10.1113/jp282327] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/25/2022] [Indexed: 11/08/2022] Open
Abstract
Abstract The purpose of this study was to determine whether there are sex differences in the cardiorespiratory and sympathetic neurocirculatory responses to central, peripheral, and combined central and peripheral chemoreflex activation. Ten women (29 ± 6 years, 22.8 ± 2.4 kg/m2: mean ± SD) and 10 men (30 ± 7 years, 24.8 ± 3.2 kg/m2) undertook randomized 5 min breathing trials of: room air (eucapnia), isocapnic hypoxia (10% oxygen (O2); peripheral chemoreflex activation), hypercapnic hyperoxia (7% carbon dioxide (CO2), 50% O2; central chemoreflex activation) and hypercapnic hypoxia (7% CO2, 10% O2; central and peripheral chemoreflex activation). Control trials of isocapnic hyperoxia (peripheral chemoreflex inhibition) and hypocapnic hyperoxia (central and peripheral chemoreflex inhibition) were also included. Muscle sympathetic nerve activity (MSNA; microneurography), mean arterial pressure (MAP; finger photoplethysmography) and minute ventilation (V˙E; pneumotachometer) were measured. Total MSNA (P = 1.000 and P = 0.616), MAP (P = 0.265) and V˙E (P = 0.587 and P = 0.472) were not different in men and women during eucapnia and during isocapnic hypoxia. Women exhibited attenuated increases in V˙E during hypercapnic hyperoxia (27.3 ± 6.3 vs. 39.5 ± 7.5 l/min, P < 0.0001) and hypercapnic hypoxia (40.9 ± 9.1 vs. 53.8 ± 13.3 l/min, P < 0.0001) compared with men. However, total MSNA responses were augmented in women (hypercapnic hyperoxia 378 ± 215 vs. 258 ± 107%, P = 0.017; hypercapnic hypoxia 607 ± 290 vs. 362 ± 268%, P < 0.0001). No sex differences in total MSNA, MAP or V˙E were observed during isocapnic hyperoxia and hypocapnic hyperoxia. Our results indicate that young women have augmented sympathetic responses to central chemoreflex activation, which explains the augmented MSNA response to combined central and peripheral chemoreflex activation. Key points Sex differences in the control of breathing have been well studied, but whether there are differences in the sympathetic neurocirculatory responses to chemoreflex activation between healthy women and men is incompletely understood. We observed that, compared with young men, young women displayed augmented increases in muscle sympathetic nerve activity during both hypercapnic hyperoxia (central chemoreflex activation) and hypercapnic hypoxia (central and peripheral chemoreflex activation) but had attenuated increases in minute ventilation. In contrast, no sex differences were found in either muscle sympathetic nerve activity or minute ventilation responses to isocapnic hypoxia (peripheral chemoreceptor stimulation). Young women have blunted ventilator, but augmented sympathetic responses, to central (hypercapnic hyperoxia) and combined central and peripheral chemoreflex activation (hypercapnic hypoxia), compared with young men. The possible causative association between the reduced ventilation and heightened sympathetic responses in young women awaits validation.
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Affiliation(s)
- Ana Luiza C Sayegh
- Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, New Zealand
| | - Jui-Lin Fan
- Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, New Zealand
| | - Lauro C Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Mathew Dawes
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, New Zealand
| | - Julian F R Paton
- Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, New Zealand
| | - James P Fisher
- Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, New Zealand
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13
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Caldwell HG, Hoiland RL, Smith KJ, Brassard P, Bain AR, Tymko MM, Howe CA, Carr JMJR, Stacey BS, Bailey DM, Drapeau A, Sekhon MS, MacLeod DB, Ainslie PN. Trans-cerebral HCO 3- and PCO 2 exchange during acute respiratory acidosis and exercise-induced metabolic acidosis in humans. J Cereb Blood Flow Metab 2022; 42:559-571. [PMID: 34904461 PMCID: PMC8943603 DOI: 10.1177/0271678x211065924] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 01/06/2023]
Abstract
This study investigated trans-cerebral internal jugular venous-arterial bicarbonate ([HCO3-]) and carbon dioxide tension (PCO2) exchange utilizing two separate interventions to induce acidosis: 1) acute respiratory acidosis via elevations in arterial PCO2 (PaCO2) (n = 39); and 2) metabolic acidosis via incremental cycling exercise to exhaustion (n = 24). During respiratory acidosis, arterial [HCO3-] increased by 0.15 ± 0.05 mmol ⋅ l-1 per mmHg elevation in PaCO2 across a wide physiological range (35 to 60 mmHg PaCO2; P < 0.001). The narrowing of the venous-arterial [HCO3-] and PCO2 differences with respiratory acidosis were both related to the hypercapnia-induced elevations in cerebral blood flow (CBF) (both P < 0.001; subset n = 27); thus, trans-cerebral [HCO3-] exchange (CBF × venous-arterial [HCO3-] difference) was reduced indicating a shift from net release toward net uptake of [HCO3-] (P = 0.004). Arterial [HCO3-] was reduced by -0.48 ± 0.15 mmol ⋅ l-1 per nmol ⋅ l-1 increase in arterial [H+] with exercise-induced acidosis (P < 0.001). There was no relationship between the venous-arterial [HCO3-] difference and arterial [H+] with exercise-induced acidosis or CBF; therefore, trans-cerebral [HCO3-] exchange was unaltered throughout exercise when indexed against arterial [H+] or pH (P = 0.933 and P = 0.896, respectively). These results indicate that increases and decreases in systemic [HCO3-] - during acute respiratory/exercise-induced metabolic acidosis, respectively - differentially affect cerebrovascular acid-base balance (via trans-cerebral [HCO3-] exchange).
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Affiliation(s)
- Hannah G Caldwell
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Ryan L Hoiland
- Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kurt J Smith
- Department of Exercise Science, Physical and Health Education, Faculty of Education, University of Victoria, Victoria, British Columbia, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada
| | - Anthony R Bain
- Faculty of Human Kinetics, Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - Michael M Tymko
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Connor A Howe
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Jay MJR Carr
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Audrey Drapeau
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada
| | - Mypinder S Sekhon
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - David B MacLeod
- Human Pharmacology and Physiology Lab, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
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14
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Stumpo V, Sebök M, van Niftrik CHB, Seystahl K, Hainc N, Kulcsar Z, Weller M, Regli L, Fierstra J. Feasibility of glioblastoma tissue response mapping with physiologic BOLD imaging using precise oxygen and carbon dioxide challenge. MAGMA (NEW YORK, N.Y.) 2022; 35:29-44. [PMID: 34874499 DOI: 10.1007/s10334-021-00980-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Innovative physiologic MRI development focuses on depiction of heterogenous vascular and metabolic features in glioblastoma. For this feasibility study, we employed blood oxygenation level-dependent (BOLD) MRI with standardized and precise carbon dioxide (CO2) and oxygen (O2) modulation to investigate specific tumor tissue response patterns in patients with newly diagnosed glioblastoma. MATERIALS AND METHODS Seven newly diagnosed untreated patients with suspected glioblastoma were prospectively included to undergo a BOLD study with combined CO2 and O2 standardized protocol. %BOLD signal change/mmHg during hypercapnic, hypoxic, and hyperoxic stimulus was calculated in the whole brain, tumor lesion and segmented volumes of interest (VOI) [contrast-enhancing (CE) - tumor, necrosis and edema] to analyze their tissue response patterns. RESULTS Quantification of BOLD signal change after gas challenges can be used to identify specific responses to standardized stimuli in glioblastoma patients. Integration of this approach with automatic VOI segmentation grants improved characterization of tumor subzones and edema. Magnitude of BOLD signal change during the 3 stimuli can be visualized at voxel precision through color-coded maps overlayed onto whole brain and identified VOIs. CONCLUSIONS Our preliminary investigation shows good feasibility of BOLD with standardized and precise CO2 and O2 modulation as an emerging physiologic imaging technique to detail specific glioblastoma characteristics. The unique tissue response patterns generated can be further investigated to better detail glioblastoma lesions and gauge treatment response.
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Affiliation(s)
- Vittorio Stumpo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. .,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katharina Seystahl
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Nicolin Hainc
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Weller
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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15
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Liu P, Jiang D, Albert M, Bauer CE, Caprihan A, Gold BT, Greenberg SM, Helmer KG, Jann K, Jicha G, Rodriguez P, Satizabal CL, Seshadri S, Singh H, Thompson JF, Wang DJJ, Lu H. Multi-vendor and multisite evaluation of cerebrovascular reactivity mapping using hypercapnia challenge. Neuroimage 2021; 245:118754. [PMID: 34826595 PMCID: PMC8783393 DOI: 10.1016/j.neuroimage.2021.118754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/05/2021] [Accepted: 11/22/2021] [Indexed: 01/22/2023] Open
Abstract
Cerebrovascular reactivity (CVR), which measures the ability of cerebral blood vessels to dilate or constrict in response to vasoactive stimuli such as CO2 inhalation, is an important index of the brain's vascular health. Quantification of CVR using BOLD MRI with hypercapnia challenge has shown great promises in research and clinical studies. However, in order for it to be used as a potential imaging biomarker in large-scale and multi-site studies, the reliability of CO2-CVR quantification across different MRI acquisition platforms and researchers/raters must be examined. The goal of this report from the MarkVCID small vessel disease biomarkers consortium is to evaluate the reliability of CO2-CVR quantification in three studies. First, the inter-rater reliability of CO2-CVR data processing was evaluated by having raters from 5 MarkVCID sites process the same 30 CVR datasets using a cloud-based CVR data processing pipeline. Second, the inter-scanner reproducibility of CO2-CVR quantification was assessed in 10 young subjects across two scanners of different vendors. Third, test-retest repeatability was evaluated in 20 elderly subjects from 4 sites with a scan interval of less than 2 weeks. In all studies, the CO2 CVR measurements were performed using the fixed inspiration method, where the subjects wore a nose clip and a mouthpiece and breathed room air and 5% CO2 air contained in a Douglas bag alternatively through their mouth. The results showed that the inter-rater CoV of CVR processing was 0.08 ± 0.08% for whole-brain CVR values and ranged from 0.16% to 0.88% in major brain regions, with ICC of absolute agreement above 0.9959 for all brain regions. Inter-scanner CoV was found to be 6.90 ± 5.08% for whole-brain CVR values, and ranged from 4.69% to 12.71% in major brain regions, which are comparable to intra-session CoVs obtained from the same scanners on the same day. ICC of consistency between the two scanners was 0.8498 for whole-brain CVR and ranged from 0.8052 to 0.9185 across major brain regions. In the test-retest evaluation, test-retest CoV across different days was found to be 18.29 ± 17.12% for whole-brain CVR values, and ranged from 16.58% to 19.52% in major brain regions, with ICC of absolute agreement ranged from 0.6480 to 0.7785. These results demonstrated good inter-rater, inter-scanner, and test-retest reliability in healthy volunteers, and suggested that CO2-CVR has suitable instrumental properties for use as an imaging biomarker of cerebrovascular function in multi-site and longitudinal observational studies and clinical trials.
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Affiliation(s)
- Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dengrong Jiang
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Brian T Gold
- Department of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Karl G Helmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Kay Jann
- Laboratory of Functional MRI Technology, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gregory Jicha
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Pavel Rodriguez
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Herpreet Singh
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey F Thompson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Danny J J Wang
- Laboratory of Functional MRI Technology, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore 21287, USA; F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, 21205, USA.
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16
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Sobczyk O, Sayin ES, Sam K, Poublanc J, Duffin J, Fisher JA, Mikulis DJ. The Reproducibility of Cerebrovascular Reactivity Across MRI Scanners. Front Physiol 2021; 12:668662. [PMID: 34025455 PMCID: PMC8134667 DOI: 10.3389/fphys.2021.668662] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Cerebrovascular reactivity (CVR) is defined as the ratio of the cerebral blood flow (CBF) response to an increase in a vasoactive stimulus. We used changes in blood oxygenation level-dependent (BOLD) MRI as surrogates for changes of CBF, and standardized quantitative changes in arterial partial pressure of carbon dioxide as the stimulus. Despite uniform stimulus and test conditions, differences in voxel-wise BOLD changes between testing sites may remain, attributable to physiologic and machine variability. We generated a reference atlas of normal CVR metrics (voxel-wise mean and SD) for each of two sites. We hypothesized that there would be no significant differences in CVR between the two atlases enabling each atlas to be used at any site. A total of 69 healthy subjects were tested to create site-specific atlases, with 20 of those individuals tested at both sites. 38 subjects were scanned at Site 1 (17F, 37.5 ± 16.8 y) and 51 subjects were tested at Site 2 (22F, 40.9 ± 17.4 y). MRI platforms were: Site 1, 3T Magnetom Skyra Siemens scanner with 20-channel head and neck coil; and Site 2, 3T HDx Signa GE scanner with 8-channel head coil. To construct the atlases, test results of individual subjects were co-registered into a standard space and voxel-wise mean and SD CVR metrics were calculated. Map comparisons of z scores found no significant differences between white matter or gray matter in the 20 subjects scanned at both sites when analyzed with either atlas. We conclude that individual CVR testing, and atlas generation are compatible across sites provided that standardized respiratory stimuli and BOLD MRI scan parameters are used. This enables the use of a single atlas to score the normality of CVR metrics across multiple sites.
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Affiliation(s)
- Olivia Sobczyk
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada.,Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Ece Su Sayin
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Kevin Sam
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - James Duffin
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Joseph A Fisher
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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17
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Zhao MY, Fan AP, Chen DYT, Sokolska MJ, Guo J, Ishii Y, Shin DD, Khalighi MM, Holley D, Halbert K, Otte A, Williams B, Rostami T, Park JH, Shen B, Zaharchuk G. Cerebrovascular reactivity measurements using simultaneous 15O-water PET and ASL MRI: Impacts of arterial transit time, labeling efficiency, and hematocrit. Neuroimage 2021; 233:117955. [PMID: 33716155 PMCID: PMC8272558 DOI: 10.1016/j.neuroimage.2021.117955] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/28/2021] [Accepted: 03/04/2021] [Indexed: 12/19/2022] Open
Abstract
Cerebrovascular reactivity (CVR) reflects the capacity of the brain to meet changing physiological demands and can predict the risk of cerebrovascular diseases. CVR can be obtained by measuring the change in cerebral blood flow (CBF) during a brain stress test where CBF is altered by a vasodilator such as acetazolamide. Although the gold standard to quantify CBF is PET imaging, the procedure is invasive and inaccessible to most patients. Arterial spin labeling (ASL) is a non-invasive and quantitative MRI method to measure CBF, and a consensus guideline has been published for the clinical application of ASL. Despite single post labeling delay (PLD) pseudo-continuous ASL (PCASL) being the recommended ASL technique for CBF quantification, it is sensitive to variations to the arterial transit time (ATT) and labeling efficiency induced by the vasodilator in CVR studies. Multi-PLD ASL controls for the changes in ATT, and velocity selective ASL is in theory insensitive to both ATT and labeling efficiency. Here we investigate CVR using simultaneous 15O-water PET and ASL MRI data from 19 healthy subjects. CVR and CBF measured by the ASL techniques were compared using PET as the reference technique. The impacts of blood T1 and labeling efficiency on ASL were assessed using individual measurements of hematocrit and flow velocity data of the carotid and vertebral arteries measured using phase-contrast MRI. We found that multi-PLD PCASL is the ASL technique most consistent with PET for CVR quantification (group mean CVR of the whole brain = 42 ± 19% and 40 ± 18% respectively). Single-PLD ASL underestimated the CVR of the whole brain significantly by 15 ± 10% compared with PET (p<0.01, paired t-test). Changes in ATT pre- and post-acetazolamide was the principal factor affecting ASL-based CVR quantification. Variations in labeling efficiency and blood T1 had negligible effects.
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Affiliation(s)
- Moss Y Zhao
- Department of Radiology, Stanford University, Stanford, CA, United States.
| | - Audrey P Fan
- Department of Biomedical Engineering, University of California Davis, Davis, CA, USA; Department of Neurology, University of California Davis, Davis, CA, USA
| | - David Yen-Ting Chen
- Department of Medical Imaging, Taipei Medical University - Shuan-Ho Hospital, New Taipei City, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Magdalena J Sokolska
- Medical Physics and Biomedical Engineering, University College London Hospitals, London, United Kingdom
| | - Jia Guo
- Department of Bioengineering, University of California Riverside, Riverside, CA, United States
| | - Yosuke Ishii
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | - Dawn Holley
- Department of Radiology, Stanford University, Stanford, CA, United States
| | - Kim Halbert
- Department of Radiology, Stanford University, Stanford, CA, United States
| | - Andrea Otte
- Department of Radiology, Stanford University, Stanford, CA, United States
| | - Brittney Williams
- Department of Radiology, Stanford University, Stanford, CA, United States
| | - Taghi Rostami
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Jun-Hyung Park
- Department of Radiology, Stanford University, Stanford, CA, United States
| | - Bin Shen
- Department of Radiology, Stanford University, Stanford, CA, United States
| | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA, United States.
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18
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Sleight E, Stringer MS, Marshall I, Wardlaw JM, Thrippleton MJ. Cerebrovascular Reactivity Measurement Using Magnetic Resonance Imaging: A Systematic Review. Front Physiol 2021; 12:643468. [PMID: 33716793 PMCID: PMC7947694 DOI: 10.3389/fphys.2021.643468] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022] Open
Abstract
Cerebrovascular reactivity (CVR) magnetic resonance imaging (MRI) probes cerebral haemodynamic changes in response to a vasodilatory stimulus. CVR closely relates to the health of the vasculature and is therefore a key parameter for studying cerebrovascular diseases such as stroke, small vessel disease and dementias. MRI allows in vivo measurement of CVR but several different methods have been presented in the literature, differing in pulse sequence, hardware requirements, stimulus and image processing technique. We systematically reviewed publications measuring CVR using MRI up to June 2020, identifying 235 relevant papers. We summarised the acquisition methods, experimental parameters, hardware and CVR quantification approaches used, clinical populations investigated, and corresponding summary CVR measures. CVR was investigated in many pathologies such as steno-occlusive diseases, dementia and small vessel disease and is generally lower in patients than in healthy controls. Blood oxygen level dependent (BOLD) acquisitions with fixed inspired CO2 gas or end-tidal CO2 forcing stimulus are the most commonly used methods. General linear modelling of the MRI signal with end-tidal CO2 as the regressor is the most frequently used method to compute CVR. Our survey of CVR measurement approaches and applications will help researchers to identify good practice and provide objective information to inform the development of future consensus recommendations.
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Affiliation(s)
- Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael S. Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom,*Correspondence: Michael S. Stringer
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
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19
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Tsvetanov KA, Henson RNA, Rowe JB. Separating vascular and neuronal effects of age on fMRI BOLD signals. Philos Trans R Soc Lond B Biol Sci 2021; 376:20190631. [PMID: 33190597 PMCID: PMC7741031 DOI: 10.1098/rstb.2019.0631] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 12/14/2022] Open
Abstract
Accurate identification of brain function is necessary to understand the neurobiology of cognitive ageing, and thereby promote well-being across the lifespan. A common tool used to investigate neurocognitive ageing is functional magnetic resonance imaging (fMRI). However, although fMRI data are often interpreted in terms of neuronal activity, the blood oxygenation level-dependent (BOLD) signal measured by fMRI includes contributions of both vascular and neuronal factors, which change differentially with age. While some studies investigate vascular ageing factors, the results of these studies are not well known within the field of neurocognitive ageing and therefore vascular confounds in neurocognitive fMRI studies are common. Despite over 10 000 BOLD-fMRI papers on ageing, fewer than 20 have applied techniques to correct for vascular effects. However, neurovascular ageing is not only a confound in fMRI, but an important feature in its own right, to be assessed alongside measures of neuronal ageing. We review current approaches to dissociate neuronal and vascular components of BOLD-fMRI of regional activity and functional connectivity. We highlight emerging evidence that vascular mechanisms in the brain do not simply control blood flow to support the metabolic needs of neurons, but form complex neurovascular interactions that influence neuronal function in health and disease. This article is part of the theme issue 'Key relationships between non-invasive functional neuroimaging and the underlying neuronal activity'.
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Affiliation(s)
- Kamen A. Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
- Department of Psychology, University of Cambridge, Cambridge CB2 3EB, UK
| | - Richard N. A. Henson
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SP, UK
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
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20
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Dodd AB, Lu H, Wertz CJ, Ling JM, Shaff NA, Wasserott BC, Meier TB, Park G, Oglesbee SJ, Phillips JP, Campbell RA, Liu P, Mayer AR. Persistent alterations in cerebrovascular reactivity in response to hypercapnia following pediatric mild traumatic brain injury. J Cereb Blood Flow Metab 2020; 40:2491-2504. [PMID: 31903838 PMCID: PMC7820694 DOI: 10.1177/0271678x19896883] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/15/2019] [Accepted: 11/21/2019] [Indexed: 12/31/2022]
Abstract
Much attention has been paid to the effects of mild traumatic brain injury (mTBI) on cerebrovascular reactivity in adult populations, yet it remains understudied in pediatric injury. In this study, 30 adolescents (12-18 years old) with pediatric mTBI (pmTBI) and 35 age- and sex-matched healthy controls (HC) underwent clinical and neuroimaging assessments during sub-acute (6.9 ± 2.2 days) and early chronic (120.4 ± 11.7 days) phases of injury. Relative to controls, pmTBI reported greater initial post-concussion symptoms, headache, pain, and anxiety, resolving by four months post-injury. Patients reported increased sleep issues and exhibited deficits in processing speed and attention across both visits. In grey-white matter interface areas throughout the brain, pmTBI displayed increased maximal fit/amplitude of a time-shifted end-tidal CO2 regressor to blood oxygen-level dependent response relative to HC, as well as increased latency to maximal fit. The alterations persisted through the early chronic phase of injury, with maximal fit being associated with complaints of ongoing sleep disturbances during post hoc analyses but not cognitive measures of processing speed or attention. Collectively, these findings suggest that deficits in the speed and degree of cerebrovascular reactivity may persist longer than current conceptualizations about clinical recovery within 30 days.
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Affiliation(s)
- Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher J Wertz
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Nicholas A Shaff
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Benjamin C Wasserott
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Departments of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Grace Park
- Department of Pediatric Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Scott J Oglesbee
- Department of Pediatric Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
| | - John P Phillips
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Richard A Campbell
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
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21
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Barnes JN, Charkoudian N. Integrative cardiovascular control in women: Regulation of blood pressure, body temperature, and cerebrovascular responsiveness. FASEB J 2020; 35:e21143. [PMID: 33151577 DOI: 10.1096/fj.202001387r] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/21/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022]
Abstract
Over the past several decades, it has become increasingly clear that women have distinct cardiovascular profiles compared to men. In this review, our goal is to provide an overview of the literature regarding the influences of female sex and reproductive hormones (primarily estradiol) on mechanisms of cardiovascular control relevant to regulation of blood pressure, body temperature, and cerebral blood flow. Young women tend to have lower resting blood pressure compared with men. This sex difference is reversed at menopause, when women develop higher sympathetic nerve activity and the risk of systemic hypertension increases sharply as postmenopausal women age. Vascular responses to thermal stress, including cutaneous vasodilation and vasoconstriction, are also affected by reproductive hormones in women, where estradiol appears to promote vasodilation and heat dissipation. The influence of reproductive hormones on cerebral blood flow and sex differences in the ability of the cerebral vasculature to increase its blood flow (cerebrovascular reactivity) are relatively new areas of investigation. Sex and hormonal influences on integrative blood flow regulation have further implications during challenges to physiological homeostasis, including exercise. We propose that increasing awareness of these sex-specific mechanisms is important for optimizing health care and promotion of wellness in women across the life span.
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Affiliation(s)
- Jill N Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Nisha Charkoudian
- US Army Research Institute of Environmental Medicine, Natick, MA, USA
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22
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Cerebrovascular Reactivity After Sport Concussion: From Acute Injury to 1 Year After Medical Clearance. Front Neurol 2020; 11:558. [PMID: 32760336 PMCID: PMC7371921 DOI: 10.3389/fneur.2020.00558] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/15/2020] [Indexed: 01/26/2023] Open
Abstract
Neuroimaging has identified significant disturbances in cerebrovascular reactivity (CVR) in the early symptomatic phase of sport-related concussion. However, less is known about how whole-brain alterations in CVR evolve after concussion and whether they remain present beyond medical clearance to return to play (RTP). In the present study, CVR was evaluated using blood-oxygenation-level-dependent functional magnetic resonance imaging (BOLD fMRI) during a respiratory challenge. Imaging data were collected for 110 university-level athletes, including 39 concussed athletes and 71 athletic controls. The concussed athletes were imaged at the acute phase of injury (1–7 days post-injury), the subacute phase (8-14 days post-injury), medical clearance to RTP, 1 month post-RTP, and 1 year post-RTP. Enhanced negative BOLD response to controlled breathing was seen at acute injury, with attenuation of the effect mainly occurring by 1 year post-RTP. Secondary analyses showed that greater symptom severity and prolonged recovery were associated with enhanced BOLD response in the acute phase of injury, but a more attenuated BOLD response in the subacute phase. This study provides novel information characterizing the CVR response after concussion and shows CVR to be a sensitive technique for evaluating long-term brain recovery.
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Affiliation(s)
- Nathan W Churchill
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada.,Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael G Hutchison
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Physical Sciences Platform, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada.,Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine (Neurosurgery) University of Toronto, Toronto, ON, Canada.,The Institute of Biomaterials & Biomedical Engineering (IBBME) at the University of Toronto, Toronto, ON, Canada
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23
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von Bieberstein L, van Niftrik CHB, Sebök M, El Amki M, Piccirelli M, Stippich C, Regli L, Luft AR, Fierstra J, Wegener S. Crossed Cerebellar Diaschisis Indicates Hemodynamic Compromise in Ischemic Stroke Patients. Transl Stroke Res 2020; 12:39-48. [PMID: 32506367 PMCID: PMC7803723 DOI: 10.1007/s12975-020-00821-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/21/2020] [Accepted: 05/11/2020] [Indexed: 12/02/2022]
Abstract
Crossed cerebellar diaschisis (CCD) in internal carotid artery (ICA) stroke refers to attenuated blood flow and energy metabolism in the contralateral cerebellar hemisphere. CCD is associated with an interruption of cerebro-cerebellar tracts, but the precise mechanism is unknown. We hypothesized that in patients with ICA occlusions, CCD might indicate severe hemodynamic impairment in addition to tissue damage. Duplex sonography and clinical data from stroke patients with unilateral ICAO who underwent blood oxygen-level-dependent MRI cerebrovascular reserve (BOLD-CVR) assessment were analysed. The presence of CCD (either CCD+ or CCD−) was inferred from BOLD-CVR. We considered regions with negative BOLD-CVR signal as areas suffering from hemodynamic steal. Twenty-five patients were included (11 CCD+ and 14 CCD−). Stroke deficits on admission and at 3 months were more severe in the CCD+ group. While infarct volumes were similar, CCD+ patients had markedly larger BOLD steal volumes than CCD− patients (median [IQR] 122.2 [111] vs. 11.6 [50.6] ml; p < 0.001). Furthermore, duplex revealed higher peak-systolic flow velocities in the intracranial collateral pathways. Strikingly, posterior cerebral artery (PCA)-P2 velocities strongly correlated with the National Institute of Health Stroke Scale on admission and BOLD-CVR steal volume. In patients with strokes due to ICAO, the presence of CCD indicated hemodynamic impairment with larger BOLD-defined steal volume and higher flow in the ACA/PCA collateral system. Our data support the concept of a vascular component of CCD as an indicator of hemodynamic failure in patients with ICAO.
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Affiliation(s)
- Lita von Bieberstein
- Dept. of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | | | - Martina Sebök
- Dept. of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zürich, Switzerland
| | - Mohamad El Amki
- Dept. of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Marco Piccirelli
- Dept. of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Zürich, Switzerland
| | - Christoph Stippich
- Dept. of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Zürich, Switzerland
| | - Luca Regli
- Dept. of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zürich, Switzerland
| | - Andreas R Luft
- Dept. of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Jorn Fierstra
- Dept. of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zürich, Switzerland
| | - Susanne Wegener
- Dept. of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
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24
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Waschkies CF, Pfiffner FK, Heuberger DM, Schneider MA, Tian Y, Wolint P, Calcagni M, Giovanoli P, Buschmann J. Tumor grafts grown on the chicken chorioallantoic membrane are distinctively characterized by MRI under functional gas challenge. Sci Rep 2020; 10:7505. [PMID: 32371865 PMCID: PMC7200801 DOI: 10.1038/s41598-020-64290-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 04/14/2020] [Indexed: 11/09/2022] Open
Abstract
Recently, a tumor model based on the chorioallantoic membrane (CAM) was characterized structurally with Magnetic Resonance Imaging (MRI). Yet, capability of MRI to assess vascular functional reserve and potential of oxygenation-sensitive MRI remain largely unexplored in this model. For this purpose, we compared MC-38 colon and A549 lung adenocarcinoma cell grafts grown on the CAM, using quantitative T1 and T2* MRI readouts as imaging markers. These are associated with vascular functionality and oxygenation status when compared between periods of air and carbogen exposure. Our data show that in A549 lung adenocarcinoma cell grafts T2* values increased significantly upon carbogen exposure (p < 0.004, Wilcoxon test; no change in T1), while MC-38 grafts displayed no changes in T1 and T2*), indicating that the grafts differ in their vascular response. Heterogeneity with regard to T1 and T2* distribution within the grafts was noted. MC-38 grafts displayed larger T1 and T2* in the graft centre, while in A549 they were distributed more towards the graft surface. Finally, qualitative assessment of gadolinium-enhancement suggests that A549 grafts display more prominent enhancement compared to MC-38 grafts. Furthermore, MC-38 grafts had 65% larger volumes than A549 grafts. Histology revealed distinct underlying phenotypes of the two tumor grafts, pertaining to the proliferative status (Ki-67) and cellularity (H&E). In sum, a functional gas challenge with carbogen is feasible through gas exchange on the CAM, and it affects MRI signals associated with vascular reactivity and oxygenation status of the tumor graft planted on the CAM. Different grafts based on A549 lung adenocarcinoma and MC-38 colon carcinoma cell lines, respectively, display distinct phenotypes that can be distinguished and characterized non-invasively in ovo using MRI in the living chicken embryo.
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Affiliation(s)
- Conny F Waschkies
- Center for Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | | | - Dorothea M Heuberger
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marcel A Schneider
- Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Yinghua Tian
- Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Petra Wolint
- Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Calcagni
- Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Pietro Giovanoli
- Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Johanna Buschmann
- Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
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25
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Peng SL, Yang HC, Chen CM, Shih CT. Short- and long-term reproducibility of BOLD signal change induced by breath-holding at 1.5 and 3 T. NMR IN BIOMEDICINE 2020; 33:e4195. [PMID: 31885110 DOI: 10.1002/nbm.4195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
Cerebrovascular reactivity (CVR) can give insight into the cerebrovascular function. CVR can be estimated by measuring a blood-oxygen-level-dependent (BOLD) response combined with breath-holding (BH). The reproducibility of this technique has been addressed and existing studies have focused on short-term reproducibility using a 3 T magnetic resonance imaging (MRI) system. However, little is known about the long-term reproducibility of this procedure and the corresponding reproducibility using a 1.5 T MRI system. Here, we systematically examined the short- and long-term reproducibility of BOLD responses to BH across field strengths. Nine subjects participated in three MRI sessions separated by 30 minutes (sessions 1 and 2: short term) and 68-92 days (sessions 1 and 3, long term) at both 1.5 and 3 T MRI. Our findings revealed that significant differences between field strengths were detected in the activated gray matter volume and BOLD signal change (both P < 0.001), with smaller magnitudes at 1.5 T. However, activation patterns were reproducible, independent of the time interval, brain region or field strength. All interscan coefficient of variation values were below the 33% fiducial limit, and the intraclass correlation coefficient values were above 0.4, which is usually considered the acceptability limit in functional studies. These findings suggest that the response of BOLD signal to BH for assessing CVR is reproducible over time at 1.5 and 3 T. This technique can be considered a tool for monitoring longitudinal changes in patients with cerebrovascular diseases, and its use should be encouraged for clinical 1.5 T MRI systems.
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Affiliation(s)
- Shin-Lei Peng
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Hui-Chieh Yang
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Chun-Ming Chen
- Department of Radiology, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Ting Shih
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
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26
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Miller KB, Howery AJ, Rivera-Rivera LA, Johnson SC, Rowley HA, Wieben O, Barnes JN. Age-Related Reductions in Cerebrovascular Reactivity Using 4D Flow MRI. Front Aging Neurosci 2019; 11:281. [PMID: 31680935 PMCID: PMC6811507 DOI: 10.3389/fnagi.2019.00281] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022] Open
Abstract
Cerebrovascular reactivity (CVR), is important for determining future risk of cerebrovascular disease. It is unclear if primary aging is associated with reductions in CVR because previous studies often include participants with vascular risk factors. Additionally, the inconsistency in the literature may be due to the inherent difficulty in quantifying intracranial cerebral blood flow and CVR. To address these limitations, we determined the effect of age on CVR in the large intracranial vessels in adults with low vascular risk using state-of-the-art MRI techniques. We also determined if the effect of age on CVR was sex-specific. Young (n = 20; 25 ± 3 years) and older (n = 19; 61 ± 5 years) healthy, physically active adults participated in the study. CVR was measured in response to hypercapnia using 4D flow MRI, which allows for simultaneous angiographic and quantitative blood flow measurements in the intracranial arteries. Older adults had lower global CVR and CVR in multiple intracranial arteries [right and left internal carotid arteries (ICA), right and left middle cerebral arteries (MCA), and basilar artery (BA)] compared with young adults (p < 0.05 for all). In addition, the MCA dilated significantly in response to hypercapnia in young (p < 0.05), but not older adults. Young men demonstrated higher global CVR and CVR in multiple intracranial arteries (ICAs, MCAs, and BA) compared with young women and older men (p < 0.05 for both); however, CVR did not differ between young women and older women. Our results demonstrate that, using 4D flow MRI, primary aging is associated with lower CVR in adults with low vascular risk. In addition, the effect of age on CVR may be driven by men. The 4D flow MRI technique may provide a promising new alternative to measure cerebrovascular physiology without the limitations of commonly used techniques. Future studies could utilize this MRI technique to examine interventions to maintain CVR with advancing age. This study was registered under clinicaltrials.gov # NCT02840851.
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Affiliation(s)
- Kathleen B Miller
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Anna J Howery
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Leonardo A Rivera-Rivera
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.,William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, WI, United States
| | - Howard A Rowley
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.,Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Oliver Wieben
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Jill N Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
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27
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Reginold W, Sam K, Poublanc J, Fisher J, Crawley A, Mikulis DJ. The efficiency of the brain connectome is associated with cerebrovascular reactivity in persons with white matter hyperintensities. Hum Brain Mapp 2019; 40:3647-3656. [PMID: 31115127 DOI: 10.1002/hbm.24622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/14/2019] [Accepted: 04/29/2019] [Indexed: 01/06/2023] Open
Abstract
The purpose of this study was to determine the relationship between the organization of the brain connectome and cerebrovascular reactivity (CVR) in persons with white matter hyperintensities. Diffusion tensor and CVR mapping 3T MRI scans were acquired in 31 participants with white matter hyperintensities. In each participant, the connectome was assessed by reconstructing all white matter tracts with tractography and segmenting the whole brain into multiple regions. Graph theory analysis was performed to quantify how effectively tracts connected brain regions by measuring the global and local efficiency of the connectome. CVR in white matter and gray matter was correlated with the global and local efficiency of the connectome, while adjusting for age, gender, and gray matter volume. For comparison, white matter hyperintensity volume was also correlated with global and local efficiency. White matter CVR was positively correlated with the global efficiency (coefficient: 23.3, p = .005) and local efficiency (coefficient: 2850, p = .004) of the connectome. Gray matter CVR was positively correlated with the global efficiency (coefficient: 21.3, p < .001) and local efficiency (coefficient: 2670, p < .001) of the connectome. White matter hyperintensity volume was negatively correlated with global efficiency (coefficient: -0.0002, p = .003) and local efficiency (coefficient: -0.024, p = .003) of the connectome. The association between CVR and the brain connectome suggests that impaired cerebrovascular function may be part of the pathophysiology of the disruption of the brain connectome in persons with white matter hyperintensities.
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Affiliation(s)
- William Reginold
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Division of Neuroradiology, Joint Department of Medical Imaging at the University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Kevin Sam
- Russell H. Morgan Department of Radiology & Radiologic Science, The John Hopkins University School of Medicine, Baltimore, Maryland
| | - Julien Poublanc
- Division of Neuroradiology, Joint Department of Medical Imaging at the University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Joe Fisher
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Crawley
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Division of Neuroradiology, Joint Department of Medical Imaging at the University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - David J Mikulis
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Division of Neuroradiology, Joint Department of Medical Imaging at the University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
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28
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Atwi S, Shao H, Crane DE, da Costa L, Aviv RI, Mikulis DJ, Black SE, MacIntosh BJ. BOLD-based cerebrovascular reactivity vascular transfer function isolates amplitude and timing responses to better characterize cerebral small vessel disease. NMR IN BIOMEDICINE 2019; 32:e4064. [PMID: 30693582 DOI: 10.1002/nbm.4064] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
Cerebrovascular reactivity (CVR) is a dynamic measure of the cerebral blood vessel response to vasoactive stimulus. Conventional CVR measures amplitude changes in the blood-oxygenation-level-dependent (BOLD) signal per unit change in end-tidal CO2 (PET CO2 ), effectively discarding potential timing information. This study proposes a deconvolution procedure to characterize CVR responses based on a vascular transfer function (VTF) that separates amplitude and timing CVR effects. We implemented the CVR-VTF to primarily evaluate normal-appearing white matter (WM) responses in those with a range of small vessel disease. Comparisons between simulations of PET CO2 input models revealed that boxcar and ramp hypercapnia paradigms had the lowest relative deconvolution error. We used a T2 * BOLD-MRI sequence on a 3 T MRI scanner, with a boxcar delivery model of CO2 , to test the CVR-VTF approach in 18 healthy adults and three white matter hyperintensity (WMH) groups: 20 adults with moderate WMH, 12 adults with severe WMH, and 10 adults with genetic WMH (CADASIL). A subset of participants performed a second CVR session at a one-year follow-up. Conventional CVR, area under the curve of VTF (VTF-AUC), and VTF time-to-peak (VTF-TTP) were assessed in WM and grey matter (GM) at baseline and one-year follow-up. WMH groups had lower WM VTF-AUC compared with the healthy group (p < 0.0001), whereas GM CVR did not differ between groups (p > 0.1). WM VTF-TTP of the healthy group was less than that in the moderate WMH group (p = 0.016). Baseline VTF-AUC was lower than follow-up VTF-AUC in WM (p = 0.013) and GM (p = 0.026). The intraclass correlation for VTF-AUC in WM was 0.39 and coefficient of repeatability was 0.08 [%BOLD/mm Hg]. This study assessed CVR timing and amplitude information without applying model assumptions to the CVR response; this approach may be useful in the development of robust clinical biomarkers of CSVD.
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Affiliation(s)
- Sarah Atwi
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Han Shao
- Division of Engineering Science, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, Canada
| | - David E Crane
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Leodante da Costa
- Division of Neurosurgery, Department of Surgery, Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Richard I Aviv
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - David J Mikulis
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Centre, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
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29
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Dlamini N, Shah-Basak P, Leung J, Kirkham F, Shroff M, Kassner A, Robertson A, Dirks P, Westmacott R, deVeber G, Logan W. Breath-Hold Blood Oxygen Level-Dependent MRI: A Tool for the Assessment of Cerebrovascular Reserve in Children with Moyamoya Disease. AJNR Am J Neuroradiol 2018; 39:1717-1723. [PMID: 30139753 DOI: 10.3174/ajnr.a5739] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/10/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is a critical need for a reliable and clinically feasible imaging technique that can enable prognostication and selection for revascularization surgery in children with Moyamoya disease. Blood oxygen level-dependent MR imaging assessment of cerebrovascular reactivity, using voluntary breath-hold hypercapnic challenge, is one such simple technique. However, its repeatability and reliability in children with Moyamoya disease are unknown. The current study sought to address this limitation. MATERIALS AND METHODS Children with Moyamoya disease underwent dual breath-hold hypercapnic challenge blood oxygen level-dependent MR imaging of cerebrovascular reactivity in the same MR imaging session. Within-day, within-subject repeatability of cerebrovascular reactivity estimates, derived from the blood oxygen level-dependent signal, was computed. Estimates were associated with demographics and intellectual function. Interrater reliability of a qualitative and clinically applicable scoring scheme was assessed. RESULTS Twenty children (11 males; 12.1 ± 3.3 years) with 30 MR imaging sessions (60 MR imaging scans) were included. Repeatability was "good" on the basis of the intraclass correlation coefficient (0.70 ± 0.19). Agreement of qualitative scores was "substantial" (κ = 0.711), and intrarater reliability of scores was "almost perfect" (κ = 0.83 and 1). Younger participants exhibited lower repeatability (P = .027). Repeatability was not associated with cognitive function (P > .05). However, abnormal cerebrovascular reactivity was associated with slower processing speed (P = .015). CONCLUSIONS Breath-hold hypercapnic challenge blood oxygen level-dependent MR imaging is a repeatable technique for the assessment of cerebrovascular reactivity in children with Moyamoya disease and is reliably interpretable for use in clinical practice. Standardization of such protocols will allow further research into its application for the assessment of ischemic risk in childhood cerebrovascular disease.
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Affiliation(s)
- N Dlamini
- From the Division of Neurology (N.D., G.d.V., W.L.)
- Neurosciences and Mental Health Program (N.D.)
- Child Health Evaluative Sciences Program (N.D., A.R., G.d.V.)
- Institute of Medical Science (N.D., G.d.V.)
- Developmental Neurosciences (N.D., F.K.), University College London, Great Ormond Street Institute of Child Health, London, UK
| | - P Shah-Basak
- Diagnostic Imaging (P.S.-B., M.S.)
- Rotman Research Institute (P.S.-B.), Baycrest, Toronto, Ontario, Canada
| | - J Leung
- Translational Medicine (J.L., A.K.)
| | - F Kirkham
- Developmental Neurosciences (N.D., F.K.), University College London, Great Ormond Street Institute of Child Health, London, UK
| | - M Shroff
- Diagnostic Imaging (P.S.-B., M.S.)
| | - A Kassner
- Translational Medicine (J.L., A.K.)
- Department of Medical Imaging (A.K.), University of Toronto, Toronto, Ontario, Canada
| | - A Robertson
- Child Health Evaluative Sciences Program (N.D., A.R., G.d.V.)
| | - P Dirks
- Department of Neurosurgery (P.D.)
| | - R Westmacott
- Department of Neuropsychology (R.W.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - G deVeber
- From the Division of Neurology (N.D., G.d.V., W.L.)
- Child Health Evaluative Sciences Program (N.D., A.R., G.d.V.)
- Institute of Medical Science (N.D., G.d.V.)
| | - W Logan
- From the Division of Neurology (N.D., G.d.V., W.L.)
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30
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Chen JJ. Cerebrovascular-Reactivity Mapping Using MRI: Considerations for Alzheimer's Disease. Front Aging Neurosci 2018; 10:170. [PMID: 29922153 PMCID: PMC5996106 DOI: 10.3389/fnagi.2018.00170] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/18/2018] [Indexed: 01/14/2023] Open
Abstract
Alzheimer’s disease (AD) is associated with well-established macrostructural and cellular markers, including localized brain atrophy and deposition of amyloid. However, there is growing recognition of the link between cerebrovascular dysfunction and AD, supported by continuous experimental evidence in the animal and human literature. As a result, neuroimaging studies of AD are increasingly aiming to incorporate vascular measures, exemplified by measures of cerebrovascular reactivity (CVR). CVR is a measure that is rooted in clinical practice, and as non-invasive CVR-mapping techniques become more widely available, routine CVR mapping may open up new avenues of investigation into the development of AD. This review focuses on the use of MRI to map CVR, paying specific attention to recent developments in MRI methodology and on the emerging stimulus-free approaches to CVR mapping. It also summarizes the biological basis for the vascular contribution to AD, and provides critical perspective on the choice of CVR-mapping techniques amongst frail populations.
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Affiliation(s)
- J J Chen
- Rotman Research Institute, Baycrest, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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31
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Urback AL, Metcalfe AWS, Korczak DJ, MacIntosh BJ, Goldstein BI. Magnetic resonance imaging of cerebrovascular reactivity in healthy adolescents. J Neurosci Methods 2018; 306:1-9. [PMID: 29879447 DOI: 10.1016/j.jneumeth.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/24/2018] [Accepted: 06/02/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Cerebrovascular reactivity (CVR), an important measure of cerebrovascular health in adults, has not been examined in healthy adolescents. Beyond the direct importance of understanding CVR in healthy youth, studies on this topic can yield insights regarding brain disease. We set out to evaluate 3 different CVR modelling approaches. NEW METHOD Thirty-nine healthy adolescents (ages 13-19 years, 20 females) completed six blocks of 15-second breath-holds separated by 30-second blocks of free-breathing. CVR was measured using blood-oxygenation-level dependent functional magnetic resonance imaging at 3-Tesla; voxel-wise analyses were complemented by regional analyses in five major subdivisions of the brain. Hemodynamic response functions were modelled using: (1) an individualized delay term (double-gamma variate convolved with a boxcar function), (2) with a standard 9-second delay term, and (3) a sine-cosine regressor. RESULTS Individual-delay yielded superior model fit or larger cluster volumes. Regional analysis found differences in CVR and time-to-peak CVR. Males had higher brain-wide CVR in comparison to females (p = 0.025, η2part = 0.345). BMI and blood pressure were not significantly associated with CVR (all p > 0.4). COMPARISON WITH EXISTING METHODS This was the first study to compare these methods in youth. Regional differences were similar to adult studies. CONCLUSIONS These findings lend support to future breath-hold CVR studies in youth, and highlight the merit of applying individualized-delay estimates. Regional variability and sex-related differences in CVR suggest that these variables should be considered in future studies, particularly those that examine disease states with predilection for specific brain regions or those diseases characterized by sex differences.
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Affiliation(s)
- Adam L Urback
- Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., FG-53, Toronto, ON, M4N 3M5, Canada; Department of Pharmacology, University of Toronto, Medicine, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Arron W S Metcalfe
- Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., FG-53, Toronto, ON, M4N 3M5, Canada; Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room M6 180, Toronto, ON, M4N 3M5, Canada.
| | - Daphne J Korczak
- Department of Psychiatry, University of Toronto, Medicine, 250 College Street, Room 835, Toronto, ON, M5T 1R8, Canada; Department of Psychiatry, Hospital For Sick Children, 555 University Avenue, Room 1145, Elm Wing, Toronto, ON, M5G 1X8, Canada.
| | - Bradley J MacIntosh
- Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room M6 180, Toronto, ON, M4N 3M5, Canada; University of Toronto, Department of Medical Biophysics, 101 College Street Suite 15-701, Toronto, ON, M5G 1L7, Canada.
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., FG-53, Toronto, ON, M4N 3M5, Canada; Department of Pharmacology, University of Toronto, Medicine, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Department of Psychiatry, University of Toronto, Medicine, 250 College Street, Room 835, Toronto, ON, M5T 1R8, Canada.
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32
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van Niftrik CHB, Piccirelli M, Bozinov O, Maldaner N, Strittmatter C, Pangalu A, Valavanis A, Regli L, Fierstra J. Impact of baseline CO 2 on Blood-Oxygenation-Level-Dependent MRI measurements of cerebrovascular reactivity and task-evoked signal activation. Magn Reson Imaging 2018; 49:123-130. [DOI: 10.1016/j.mri.2018.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/30/2018] [Accepted: 02/12/2018] [Indexed: 12/25/2022]
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33
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Chen JJ. Functional MRI of brain physiology in aging and neurodegenerative diseases. Neuroimage 2018; 187:209-225. [PMID: 29793062 DOI: 10.1016/j.neuroimage.2018.05.050] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 05/16/2018] [Accepted: 05/20/2018] [Indexed: 12/14/2022] Open
Abstract
Brain aging and associated neurodegeneration constitute a major societal challenge as well as one for the neuroimaging community. A full understanding of the physiological mechanisms underlying neurodegeneration still eludes medical researchers, fuelling the development of in vivo neuroimaging markers. Hence it is increasingly recognized that our understanding of neurodegenerative processes likely will depend upon the available information provided by imaging techniques. At the same time, the imaging techniques are often developed in response to the desire to observe certain physiological processes. In this context, functional MRI (fMRI), which has for decades provided information on neuronal activity, has evolved into a large family of techniques well suited for in vivo observations of brain physiology. Given the rapid technical advances in fMRI in recent years, this review aims to summarize the physiological basis of fMRI observations in healthy aging as well as in age-related neurodegeneration. This review focuses on in-vivo human brain imaging studies in this review and on disease features that can be imaged using fMRI methods. In addition to providing detailed literature summaries, this review also discusses future directions in the study of brain physiology using fMRI in the clinical setting.
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Affiliation(s)
- J Jean Chen
- Rotman Research Institute at Baycrest Centre, Canada; Department of Medical Biophysics, University of Toronto, Canada.
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34
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Liu P, De Vis JB, Lu H. Cerebrovascular reactivity (CVR) MRI with CO2 challenge: A technical review. Neuroimage 2018; 187:104-115. [PMID: 29574034 DOI: 10.1016/j.neuroimage.2018.03.047] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/06/2018] [Accepted: 03/19/2018] [Indexed: 11/16/2022] Open
Abstract
Cerebrovascular reactivity (CVR) is an indicator of cerebrovascular reserve and provides important information about vascular health in a range of brain conditions and diseases. Unlike steady-state vascular parameters, such as cerebral blood flow (CBF) and cerebral blood volume (CBV), CVR measures the ability of cerebral vessels to dilate or constrict in response to challenges or maneuvers. Therefore, CVR mapping requires a physiological challenge while monitoring the corresponding hemodynamic changes in the brain. The present review primarily focuses on methods that use CO2 inhalation as a physiological challenge while monitoring changes in hemodynamic MRI signals. CO2 inhalation has been increasingly used in CVR mapping in recent literature due to its potency in causing vasodilation, rapid onset and cessation of the effect, as well as advances in MRI-compatible gas delivery apparatus. In this review, we first discuss the physiological basis of CVR mapping using CO2 inhalation. We then review the methodological aspects of CVR mapping, including gas delivery apparatus, the timing paradigm of the breathing challenge, the MRI imaging sequence, and data analysis. In addition, we review alternative approaches for CVR mapping that do not require CO2 inhalation.
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Affiliation(s)
- Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States.
| | - Jill B De Vis
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, 21287, United States; F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, 21205, United States
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35
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Fierstra J, van Niftrik C, Warnock G, Wegener S, Piccirelli M, Pangalu A, Esposito G, Valavanis A, Buck A, Luft A, Bozinov O, Regli L. Staging Hemodynamic Failure With Blood Oxygen-Level–Dependent Functional Magnetic Resonance Imaging Cerebrovascular Reactivity. Stroke 2018; 49:621-629. [DOI: 10.1161/strokeaha.117.020010] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/03/2017] [Accepted: 11/29/2017] [Indexed: 12/20/2022]
Abstract
Background and Purpose—
Increased stroke risk correlates with hemodynamic failure, which can be assessed with (
15
O-)H
2
O positron emission tomography (PET) cerebral blood flow (CBF) measurements. This gold standard technique, however, is not established for routine clinical imaging. Standardized blood oxygen-level–dependent (BOLD) functional magnetic resonance imaging+CO
2
is a noninvasive and potentially widely applicable tool to assess whole-brain quantitative cerebrovascular reactivity (CVR). We examined the agreement between the 2 imaging modalities and hypothesized that quantitative CVR can be a surrogate imaging marker to assess hemodynamic failure.
Methods—
Nineteen data sets of subjects with chronic cerebrovascular steno-occlusive disease (age, 60±11 years; 4 women) and unilaterally impaired perfusion reserve on Diamox-challenged (
15
O-)H
2
O PET were studied and compared with a standardized BOLD functional magnetic resonance imaging+CO
2
examination within 6 weeks (8±19 days). Agreement between quantitative CBF- and CVR-based perfusion reserve was assessed. Hemodynamic failure was staged according to PET findings: stage 0: normal CBF, normal perfusion reserve; stage I: normal CBF, decreased perfusion reserve; and stage II: decreased CBF, decreased perfusion reserve. The BOLD CVR data set of the same subjects was then matched to the corresponding stage of hemodynamic failure.
Results—
PET-based stage I versus stage II could also be clearly separated with BOLD CVR measurements (CVR for stage I 0.11 versus CVR for stage II −0.03;
P
<0.01). Hemispheric and middle cerebral artery territory difference analyses (ie, affected versus unaffected side) showed a significant correlation for CVR impairment in the affected hemisphere and middle cerebral artery territory (
P
<0.01,
R
2
=0.47 and
P
=0.02,
R
2
= 0.25, respectively).
Conclusions—
BOLD CVR corresponded well to CBF perfusion reserve measurements obtained with (
15
O-)H
2
O-PET, especially for detecting hemodynamic failure in the affected hemisphere and middle cerebral artery territory and for identifying hemodynamic failure stage II. BOLD CVR may, therefore, be considered for prospective studies assessing stroke risk in patients with chronic cerebrovascular steno-occlusive disease, in particular because it can potentially be implemented in routine clinical imaging.
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Affiliation(s)
- Jorn Fierstra
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Christiaan van Niftrik
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Geoffrey Warnock
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Susanne Wegener
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Marco Piccirelli
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Athina Pangalu
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Giuseppe Esposito
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Antonios Valavanis
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Alfred Buck
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Andreas Luft
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Oliver Bozinov
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Luca Regli
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
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Thrippleton MJ, Shi Y, Blair G, Hamilton I, Waiter G, Schwarzbauer C, Pernet C, Andrews PJD, Marshall I, Doubal F, Wardlaw JM. Cerebrovascular reactivity measurement in cerebral small vessel disease: Rationale and reproducibility of a protocol for MRI acquisition and image processing. Int J Stroke 2017; 13:195-206. [DOI: 10.1177/1747493017730740] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Impaired autoregulation may contribute to the pathogenesis of cerebral small vessel disease. Reliable protocols for measuring microvascular reactivity are required to test this hypothesis and for providing secondary endpoints in clinical trials. Aims To develop and assess a protocol for acquisition and processing of cerebrovascular reactivity by MRI, in subcortical tissue of patients with small vessel disease and minor stroke. Methods We recruited 15 healthy volunteers, testing paradigms using 1- and 3-min 6% CO2 challenges with repeat scanning, and 15 patients with history of minor stroke. We developed a protocol to measure cerebrovascular reactivity and delay times, assessing tolerability and reproducibility in grey and white matter areas. Results The 3-min paradigm yielded more reproducible data than the 1-min paradigm (CV respectively: 7.9–15.4% and 11.7–70.2% for cerebrovascular reactivity in grey matter), and was less reproducible in white matter (16.1–24.4% and 27.5–141.0%). Tolerability was similar for the two paradigms, but mean cerebrovascular reactivity and cerebrovascular reactivity delay were significantly higher for the 3-min paradigm in most regions. Patient tolerability was high with no evidence of greater failure rate (1/15 patients vs. 2/15 volunteers withdrew at the first visit). Grey matter cerebrovascular reactivity was lower in patients than in volunteers (0.110–0.234 vs. 0.172–0.313%/mmHg; p < 0.05 in 6/8 regions), as was the white matter cerebrovascular reactivity delay (16.2–43.9 vs. 31.1–47.9 s; p < 0.05 in 4/8 regions). Conclusions An effective and well-tolerated protocol for measurement of cerebrovascular reactivity was developed for use in ongoing and future trials to investigate small vessel disease pathophysiology and to measure treatment effects.
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Affiliation(s)
- Michael J Thrippleton
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Yulu Shi
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Gordon Blair
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Iona Hamilton
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Gordon Waiter
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, UK
| | - Christian Schwarzbauer
- Faculty of Applied Sciences & Mechatronics, Munich University of Applied Sciences, Munich, Germany
| | - Cyril Pernet
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Peter JD Andrews
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ian Marshall
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Fergus Doubal
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute at the University of Edinburgh
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37
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Verbree J, Bronzwaer A, van Buchem MA, Daemen M, van Lieshout JJ, van Osch M. Middle cerebral artery diameter changes during rhythmic handgrip exercise in humans. J Cereb Blood Flow Metab 2017; 37:2921-2927. [PMID: 27837189 PMCID: PMC5536799 DOI: 10.1177/0271678x16679419] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transcranial Doppler (TCD) sonography is a frequently employed technique for quantifying cerebral blood flow by assuming a constant arterial diameter. Given that exercise increases arterial pressure by sympathetic activation, we hypothesized that exercise might induce a change in the diameter of large cerebral arteries. Middle cerebral artery (MCA) cross-sectional area was assessed in response to handgrip exercise by direct magnetic resonance imaging (MRI) observations. Twenty healthy subjects (11 female) performed three 5 min bouts of rhythmic handgrip exercise at 60% maximum voluntary contraction, alternated with 5 min of rest. High-resolution 7 T MRI scans were acquired perpendicular to the MCA. Two blinded observers manually determined the MCA cross-sectional area. Sufficient image quality was obtained in 101 MCA-scans of 19 subjects (age-range 20-59 years). Mixed effects modelling showed that the MCA cross-sectional area decreased by 2.1 ± 0.8% (p = 0.01) during handgrip, while the heart rate increased by 11 ± 2% (p < 0.001) at constant end-tidal CO2 (p = 0.10). In conclusion, the present study showed a 2% decrease in MCA cross-sectional area during rhythmic handgrip exercise. This further strengthens the current concept of sympathetic control of large cerebral arteries, showing in vivo vasoconstriction during exercise-induced sympathetic activation. Moreover, care must be taken when interpreting TCD exercise studies as diameter constancy cannot be assumed.
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Affiliation(s)
- J Verbree
- 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Agt Bronzwaer
- 2 Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.,3 Laboratory for Clinical Cardiovascular Physiology, Academic Medical Center, Amsterdam, The Netherlands
| | - M A van Buchem
- 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mjap Daemen
- 4 Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - J J van Lieshout
- 2 Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.,3 Laboratory for Clinical Cardiovascular Physiology, Academic Medical Center, Amsterdam, The Netherlands.,5 MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham Medical School, Nottingham, UK
| | - Mjp van Osch
- 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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38
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Rane S, Koh N, Boord P, Askren K, Madhyashtha TM, Grabowski TJ. [P4–217]: CEREBROVASCULAR RESERVE DEPLETION OCCURS FASTER THAN PERFUSION REDUCTION NEAR WHITE MATTER HYPERINTENSITIES. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Swati Rane
- University of Washington Medical CenterSeattleWAUSA
| | - Natalie Koh
- University of Washington Medical CenterSeattleWAUSA
| | - Peter Boord
- University of Washington Medical CenterSeattleWAUSA
| | - Katie Askren
- University of Washington Medical CenterSeattleWAUSA
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Domi T, Vossough A, Stence NV, Felling RJ, Leung J, Krishnan P, Watson CG, Grant PE, Kassner A. The Potential for Advanced Magnetic Resonance Neuroimaging Techniques in Pediatric Stroke Research. Pediatr Neurol 2017; 69:24-36. [PMID: 28237248 DOI: 10.1016/j.pediatrneurol.2016.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND This article was written to provide clinicians and researchers with an overview of a number of advanced neuroimaging techniques in an effort to promote increased utility and the design of future studies using advanced neuroimaging in childhood stroke. The current capabilities of advanced magnetic resonance imaging techniques provide the opportunity to build on our knowledge of the consequences of stroke on the developing brain. These capabilities include providing information about the physiology, metabolism, structure, and function of the brain that are not routinely evaluated in the clinical setting. METHODS During the Proceedings of the Stroke Imaging Laboratory for Children Workshop in Toronto in June 2015, a subgroup of clinicians and imaging researchers discussed how the application of advanced neuroimaging techniques could further our understanding of the mechanisms of stroke injury and repair in the pediatric population. This subgroup was established based on their interest and commitment to design collaborative, advanced neuroimaging studies in the pediatric stroke population. RESULTS In working toward this goal, we first sought to describe here the magnetic resonance imaging techniques that are currently available for use, and how they have been applied in other stroke populations (e.g., adult and perinatal stroke). CONCLUSIONS With the continued improvement in advanced neuroimaging techniques, including shorter acquisition times, there is an opportunity to apply these techniques to their full potential in the research setting and learn more about the effects of stroke in the developing brain.
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Affiliation(s)
- Trish Domi
- Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arastoo Vossough
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas V Stence
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ryan J Felling
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jackie Leung
- Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- Department of Neuroradiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher G Watson
- Department of Computational Neuroscience, Division of Graduate Medical Sciences, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - P Ellen Grant
- Division of Newborn Medicine, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrea Kassner
- Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
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Kosinski PD, Croal PL, Leung J, Williams S, Odame I, Hare GMT, Shroff M, Kassner A. The severity of anaemia depletes cerebrovascular dilatory reserve in children with sickle cell disease: a quantitative magnetic resonance imaging study. Br J Haematol 2016; 176:280-287. [DOI: 10.1111/bjh.14424] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Przemyslaw D. Kosinski
- Institute of Medical Science; University of Toronto; Toronto ON Canada
- Physiology and Experimental Medicine; The Hospital for Sick Children; Toronto ON Canada
| | - Paula L. Croal
- Physiology and Experimental Medicine; The Hospital for Sick Children; Toronto ON Canada
| | - Jackie Leung
- Physiology and Experimental Medicine; The Hospital for Sick Children; Toronto ON Canada
| | - Suzan Williams
- Division of Haematology/Oncology; The Hospital for Sick Children; Toronto ON Canada
| | - Isaac Odame
- Division of Haematology/Oncology; The Hospital for Sick Children; Toronto ON Canada
| | | | - Manohar Shroff
- Department of Diagnostic Imaging; The Hospital for Sick Children; Toronto ON Canada
| | - Andrea Kassner
- Physiology and Experimental Medicine; The Hospital for Sick Children; Toronto ON Canada
- Department of Diagnostic Imaging; The Hospital for Sick Children; Toronto ON Canada
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Leung J, Duffin J, Fisher JA, Kassner A. MRI-based cerebrovascular reactivity using transfer function analysis reveals temporal group differences between patients with sickle cell disease and healthy controls. Neuroimage Clin 2016; 12:624-630. [PMID: 27722086 PMCID: PMC5048082 DOI: 10.1016/j.nicl.2016.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Cerebrovascular reactivity (CVR) measures the ability of cerebral blood vessels to change their diameter and, hence, their capacity to regulate regional blood flow in the brain. High resolution quantitative maps of CVR can be produced using blood-oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) in combination with a carbon dioxide stimulus, and these maps have become a useful tool in the clinical evaluation of cerebrovascular disorders. However, conventional CVR analysis does not fully characterize the BOLD response to a stimulus as certain regions of the brain are slower to react to the stimulus than others, especially in disease. Transfer function analysis (TFA) is an alternative technique that can account for dynamic temporal relations between signals and has recently been adapted for CVR computation. We investigated the application of TFA in data on children with sickle cell disease (SCD) and healthy controls, and compared them to results derived from conventional CVR analysis. MATERIALS AND METHODS Data from 62 pediatric patients with SCD and 34 age-matched healthy controls were processed using conventional CVR analysis and TFA. BOLD data were acquired on a 3 Tesla MRI scanner while a carbon dioxide stimulus was quantified by sampling the end-tidal partial pressures of each exhaled breath. In addition, T1 weighted structural imaging was performed to identify grey and white matter regions for analysis. The TFA method generated maps representing both the relative magnitude change of the BOLD signal in response to the stimulus (Gain), as well as the BOLD signal speed of response (Phase) for each subject. These were compared to CVR maps calculated from conventional analysis. The effect of applying TFA on data from SCD patients versus controls was also examined. RESULTS The Gain measures derived from TFA were significantly higher than CVR values based on conventional analysis in both SCD patients and healthy controls, but the difference was greater in the SCD data. Moreover, while these differences were uniform across the grey and white matter regions of controls, they were greater in white matter than grey matter in the SCD group. Phase was also shown to be significantly correlated with the amount that TFA increases CVR estimates in both the grey and white matter. CONCLUSIONS We demonstrated that conventional CVR analysis underestimates vessel reactivity and this effect is more prominent in patients with SCD. By using TFA, the resulting Gain and Phase measures more accurately characterize the BOLD response as it accounts for the temporal dynamics responsible for the CVR underestimation. We suggest that the additional information offered through TFA can provide insight into the mechanisms underlying CVR compromise in cerebrovascular diseases.
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Affiliation(s)
- Jackie Leung
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Duffin
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Joseph A. Fisher
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Kassner
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Mutch WAC, Ellis MJ, Ryner LN, Ruth Graham M, Dufault B, Gregson B, Hall T, Bunge M, Essig M. Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome. J Neurosurg 2016; 125:648-60. [DOI: 10.3171/2015.6.jns15972] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
A neuroimaging assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls.
METHODS
This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level–dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1).
RESULTS
Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p < 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model.
CONCLUSIONS
Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS.
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Rane S, Koh N, Boord P, Askren MK, Gatenby JC, Madhyashtha TM, Mestre Z, Grabowski TJ. P1‐248: Cerebrovascular Reserve as a Marker of Vascular Pathology and Cognitive Status in Older ADULTS. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Swati Rane
- University of Washington Medical CenterSeattleWA USA
| | - Natalie Koh
- University of Washington Medical CenterSeattleWA USA
| | - Peter Boord
- University of Washington Medical CenterSeattleWA USA
| | | | | | | | - Zoe Mestre
- University of Washington Medical CenterSeattleWA USA
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Geijer JR, Evanoff NG, Kelly AS, Chernin MA, Stoltman MG, Dengel DR. Reproducibility of Brachial Vascular Changes with Alterations in End-Tidal Carbon Dioxide. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1450-1456. [PMID: 27061149 DOI: 10.1016/j.ultrasmedbio.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 12/19/2015] [Accepted: 02/05/2016] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to examine the reproducibility of the peripheral vascular response to hypercapnia. Healthy college-aged men (n = 7) and women (n = 10) underwent an iso-oxic 10-mm Hg increase in PetCO2 for 12 min. Brachial artery diameter changes were measured using ultrasound imaging. Two tests were completed on day 1 with 15 min of rest between tests. Tests were repeated on day 2. Paired t-tests, Bland-Altman plots and intra-class correlations (ICCs) determined reproducibility. There were no significant differences in peak dilation within day (5.33 ± 3.73% vs. 4.52 ± 2.49%, p = 0.378). The within-day ICC was poor (0.213). Within-day time-to-peak dilation did not significantly differ (660.0 ± 231.8 s vs. 602.7 ± 259.9 s, p = 0.379), and the ICC was fair (0.416, p = 0.113). Between-day peak dilation did not significantly differ (5.24 ± 3.84% vs. 4.71 ± 3.17%, p = 0.123), and the ICC was fair (0.419). Hypercapnia-induced brachial artery dilation is similar within day and between days. The ICC for peak dilation suggests the methodology is not reproducible.
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Affiliation(s)
- Justin R Geijer
- Department of Health and Exercise Rehabilitation Sciences, Winona State University, Winona, Minnesota, USA
| | - Nicholas G Evanoff
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron S Kelly
- Department of Pediatrics, University of Minnesota, and University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA; Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael A Chernin
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Matthew G Stoltman
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Donald R Dengel
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA; Department of Pediatrics, University of Minnesota, and University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA.
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Dubois J, Adolphs R. Building a Science of Individual Differences from fMRI. Trends Cogn Sci 2016; 20:425-443. [PMID: 27138646 DOI: 10.1016/j.tics.2016.03.014] [Citation(s) in RCA: 382] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 11/19/2022]
Abstract
To date, fMRI research has been concerned primarily with evincing generic principles of brain function through averaging data from multiple subjects. Given rapid developments in both hardware and analysis tools, the field is now poised to study fMRI-derived measures in individual subjects, and to relate these to psychological traits or genetic variations. We discuss issues of validity, reliability and statistical assessment that arise when the focus shifts to individual subjects and that are applicable also to other imaging modalities. We emphasize that individual assessment of neural function with fMRI presents specific challenges and necessitates careful consideration of anatomical and vascular between-subject variability as well as sources of within-subject variability.
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Affiliation(s)
- Julien Dubois
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA 91125, USA.
| | - Ralph Adolphs
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA 91125, USA
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Ellis MJ, Ryner LN, Sobczyk O, Fierstra J, Mikulis DJ, Fisher JA, Duffin J, Mutch WAC. Neuroimaging Assessment of Cerebrovascular Reactivity in Concussion: Current Concepts, Methodological Considerations, and Review of the Literature. Front Neurol 2016; 7:61. [PMID: 27199885 PMCID: PMC4850165 DOI: 10.3389/fneur.2016.00061] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/11/2016] [Indexed: 01/07/2023] Open
Abstract
Concussion is a form of traumatic brain injury (TBI) that presents with a wide spectrum of subjective symptoms and few objective clinical findings. Emerging research suggests that one of the processes that may contribute to concussion pathophysiology is dysregulation of cerebral blood flow (CBF) leading to a mismatch between CBF delivery and the metabolic needs of the injured brain. Cerebrovascular reactivity (CVR) is defined as the change in CBF in response to a measured vasoactive stimulus. Several magnetic resonance imaging (MRI) techniques can be used as a surrogate measure of CBF in clinical and laboratory studies. In order to provide an accurate assessment of CVR, these sequences must be combined with a reliable, reproducible vasoactive stimulus that can manipulate CBF. Although CVR imaging currently plays a crucial role in the diagnosis and management of many cerebrovascular diseases, only recently have studies begun to apply this assessment tool in patients with concussion. In order to evaluate the quality, reliability, and relevance of CVR studies in concussion, it is important that clinicians and researchers have a strong foundational understanding of the role of CBF regulation in health, concussion, and more severe forms of TBI, and an awareness of the advantages and limitations of currently available CVR measurement techniques. Accordingly, in this review, we (1) discuss the role of CVR in TBI and concussion, (2) examine methodological considerations for MRI-based measurement of CVR, and (3) provide an overview of published CVR studies in concussion patients.
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Affiliation(s)
- Michael J Ellis
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; Section of Neurosurgery, University of Manitoba, Winnipeg, MB, Canada; Pan Am Concussion Program, University of Manitoba, Winnipeg, MB, Canada; Childrens Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada; Canada North Concussion Network, University of Manitoba, Winnipeg, MB, Canada; University of Manitoba, Winnipeg, MB, Canada
| | - Lawrence N Ryner
- Canada North Concussion Network, University of Manitoba, Winnipeg, MB, Canada; Department of Radiology, University of Manitoba, Winnipeg, MB, Canada; Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Olivia Sobczyk
- Institute of Medical Sciences, University of Toronto , Toronto, ON , Canada
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich , Zurich , Switzerland
| | - David J Mikulis
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University Health Network Cerebrovascular Reactivity Research Group, Toronto, ON, Canada
| | - Joseph A Fisher
- University of Toronto, Toronto, ON, Canada; University Health Network Cerebrovascular Reactivity Research Group, Toronto, ON, Canada; Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - James Duffin
- University of Toronto, Toronto, ON, Canada; University Health Network Cerebrovascular Reactivity Research Group, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - W Alan C Mutch
- Canada North Concussion Network, University of Manitoba, Winnipeg, MB, Canada; University of Manitoba, Winnipeg, MB, Canada; Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada; Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada
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Abstract
Effective methods of monitoring the status of patients with neurological injuries began with non-invasive observations and evolved during the past several decades to include more invasive monitoring tools and physiologic measures. The monitoring paradigm continues to evolve, this time back toward the use of less invasive tools. In parallel, the science of monitoring began with the global assessment of the patient's neurological condition, evolved to focus on regional monitoring techniques, and with the advent of enhanced computing capabilities is now moving back to focus on global monitoring. The purpose of this session of the Second Neurocritical Care Research Conference was to collaboratively develop a comprehensive understanding of the state of the science for global brain monitoring and to identify research priorities for intracranial pressure monitoring, neuroimaging, and neuro-electrophysiology monitoring.
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Leung J, Kosinski PD, Croal PL, Kassner A. Developmental trajectories of cerebrovascular reactivity in healthy children and young adults assessed with magnetic resonance imaging. J Physiol 2016; 594:2681-9. [PMID: 26847953 DOI: 10.1113/jp271056] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/28/2016] [Indexed: 01/13/2023] Open
Abstract
KEY POINTS Cerebrovascular reactivity (CVR) reflects the vasodilatory reserve of cerebral resistance vessels. Normal development in children is associated with significant changes in blood pressure, cerebral blood flow (CBF) and cerebral oxygen metabolism. Therefore, it stands to reason that CVR will also undergo changes during this period. The study acquired magnetic resonance imaging measures of CVR and CBF in healthy children and young adults to trace their changes with age. We found that CVR changes in two phases, increasing with age until the mid-teens, followed by a decrease. Baseline CBF declined steadily with age. We conclude that CVR varies with age during childhood, which prompts future CVR studies involving children to take into account the effect of development. ABSTRACT Cerebrovascular reactivity (CVR) reflects the vasculature's ability to accommodate changes in blood flow demand thereby serving as a critical imaging tool for mapping vascular reserve. Normal development is associated with extensive physiological changes in blood pressure, cerebral blood flow and cerebral metabolic rate of oxygen, all of which can affect CVR. Moreover, the evolution of these physiological parameters is most prominent during childhood. Therefore, the aim of this study was to use non-invasive magnetic resonance imaging (MRI) to characterize the developmental trajectories of CVR in healthy children and young adults, and relate them to changes in cerebral blood flow (CBF). Thirty-four healthy subjects (17 males, 17 females; age 9-30 years) underwent CVR assessment using blood oxygen level-dependent MRI in combination with a computer controlled CO2 stimulus. In addition, baseline CBF was measured with a pulsed arterial spin labelling sequence. CVR exhibited a gradual increase with age in both grey and white matter up to 14.7 years. After this break point, a negative correlation with age was detected. Baseline CBF maintained a consistent negative linear correlation across the entire age range. The significant age-dependent changes in CVR and CBF demonstrate the evolution of cerebral haemodynamics in children and should be taken into consideration. The shift in developmental trajectory of CVR from increasing to decreasing suggests that physiological factors beyond baseline CBF also influence CVR.
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Affiliation(s)
- Jackie Leung
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8
| | - Przemyslaw D Kosinski
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada, M5S 3E2
| | - Paula L Croal
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8
| | - Andrea Kassner
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada, M5S 3E2
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49
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Dengel DR, Evanoff NG, Marlatt KL, Geijer JR, Mueller BA, Lim KO. Reproducibility of blood oxygen level-dependent signal changes with end-tidal carbon dioxide alterations. Clin Physiol Funct Imaging 2016; 37:794-798. [PMID: 26934185 DOI: 10.1111/cpf.12358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/05/2016] [Indexed: 11/29/2022]
Abstract
Hypercapnia has been utilized as a stimulus to elicit changes in cerebral blood flow (CBF). However, in many instances it has been delivered in a non-controlled method that is often difficult to reproduce. The purpose of this study was to examine the within- and between-visit reproducibility of blood oxygen level-dependent (BOLD) signal changes to an iso-oxic square wave alteration in end-tidal carbon dioxide partial pressure (Pet CO2 ). Two 3-Tesla (3T) MRI scans were performed on the same visit, with two square wave alterations administered per scan. The protocol was repeated on a separate visit with minimum of 3 days between scanning sessions. Pet CO2 was altered to stimulate changes in cerebral vascular reactivity (CVR), while Pet O2 was held constant. Eleven subjects (six females; mean age 26·5 ± 5·7 years) completed the full testing protocol. Excellent within-visit square wave reproducibility (ICC > 0·75) was observed. Similarly, square waves were reproducible between scanning sessions (ICC > 0·7). This study demonstrates BOLD signal changes in response to alterations in Pet CO2 are reproducible both within- and between-visit MRI scans.
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Affiliation(s)
- Donald R Dengel
- School of Kinesiology, University of Minnesota, Minneapolis, MN, USA.,Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | | | - Kara L Marlatt
- School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Justin R Geijer
- Department of Health, Exercise and Rehabilitative Sciences, Winona State University, Winona, MN, USA
| | - Bryon A Mueller
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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Geijer JR, Hultgren NE, Evanoff NG, Kelly AS, Chernin MA, Stoltman MG, Dengel DR. Comparison of brachial dilatory responses to hypercapnia and reactive hyperemia. Physiol Meas 2016; 37:380-6. [PMID: 26862786 DOI: 10.1088/0967-3334/37/3/380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Flow-mediated dilation (FMD) relies on reactive hyperemia to stimulate the endothelium to release nitric oxide, causing smooth muscle relaxation. Hypercapnia also produces vasodilation, which is thought to be nitric oxide-independent. The purpose of this study was to compare and contrast the effects of hypercapnia and reactive hyperemia as stimuli for brachial artery dilation. On separate days, twenty-five participants underwent vasodilation studies via reactive hyperemia or hypercapnia (i.e. 10 mmHg increase in end-tidal carbon dioxide [PetCO2)]). During both studies changes in brachial artery diameter were recorded using continuous ultrasound imaging. Heart rate (HR) was measured throughout both tests. Resting HR (63 ± 11 versus 68 ± 14 beats min(-1), p = 0.0027) and baseline brachial artery diameter measurements (4.57 ± 1.51 versus 5.28 ± 1.86 mm, p = 0.022) were significantly different between reactive hyperemia and hypercapnia, respectively. HR at peak dilation (65 ± 11 versus 76 ± 14 beats min(-1), p < 0.0001), peak vessel dilation (8.68 ± 4.50 versus 5.28 ± 1.86%, p = 0.002), and time to peak dilation (90.8 ± 120.1 versus 658.3 ± 226.6 s, p < 0.0001) were also significantly different between reactive hyperemia and hypercapnia. The dynamics by which reactive hyperemia and hypercapnia stimulate vasodilation appear to differ. Hypercapnia produces a smaller and slower vasodilatory effect than reactive hyperemia. Further research is necessary to better understand the mechanisms of vasodilation under hypercapnic conditions.
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Affiliation(s)
- Justin R Geijer
- Department of Health, Exercise, and Rehabilitation Sciences, Winona State University, Winona, MN 55987, USA
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