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Zvolanek KM, Moore JE, Jarvis K, Moum SJ, Bright MG. Macrovascular blood flow and microvascular cerebrovascular reactivity are regionally coupled in adolescence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.26.590312. [PMID: 38746187 PMCID: PMC11092525 DOI: 10.1101/2024.04.26.590312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Cerebrovascular imaging assessments are particularly challenging in adolescent cohorts, where not all modalities are appropriate, and rapid brain maturation alters hemodynamics at both macro- and microvascular scales. In a preliminary sample of healthy adolescents (n=12, 8-25 years), we investigated relationships between 4D flow MRI-derived blood velocity and blood flow in bilateral anterior, middle, and posterior cerebral arteries and BOLD cerebrovascular reactivity in associated vascular territories. As hypothesized, higher velocities in large arteries are associated with an earlier response to a vasodilatory stimulus (cerebrovascular reactivity delay) in the downstream territory. Higher blood flow through these arteries is associated with a larger BOLD response to a vasodilatory stimulus (cerebrovascular reactivity amplitude) in the associated territory. These trends are consistent in a case study of adult moyamoya disease. In our small adolescent cohort, macrovascular-microvascular relationships for velocity/delay and flow/CVR change with age, though underlying mechanisms are unclear. Our work emphasizes the need to better characterize this key stage of human brain development, when cerebrovascular hemodynamics are changing, and standard imaging methods offer limited insight into these processes. We provide important normative data for future comparisons in pathology, where combining macro- and microvascular assessments may better help us prevent, stratify, and treat cerebrovascular disease.
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Lee SB, Lee S, Cho YJ, Choi YH, Cheon JE, Kim WS. Monitoring Cerebral Perfusion Changes Using Arterial Spin-Labeling Perfusion MRI after Indirect Revascularization in Children with Moyamoya Disease. Korean J Radiol 2021; 22:1537-1546. [PMID: 34132076 PMCID: PMC8390823 DOI: 10.3348/kjr.2020.1464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/19/2021] [Accepted: 03/12/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the role of arterial spin-labeling (ASL) perfusion MRI in identifying cerebral perfusion changes after indirect revascularization in children with moyamoya disease. MATERIALS AND METHODS We included pre- and postoperative perfusion MRI data of 30 children with moyamoya disease (13 boys and 17 girls; mean age ± standard deviation, 6.3 ± 3.0 years) who underwent indirect revascularization between June 2016 and August 2017. Relative cerebral blood flow (rCBF) and qualitative perfusion scores for arterial transit time (ATT) effects were evaluated in the middle cerebral artery (MCA) territory on ASL perfusion MRI. The rCBF and relative time-to-peak (rTTP) values were also measured using dynamic susceptibility contrast (DSC) perfusion MRI. Each perfusion change on ASL and DSC perfusion MRI was analyzed using the paired t test. We analyzed the correlation between perfusion changes on ASL and DSC images using Spearman's correlation coefficient. RESULTS The ASL rCBF values improved at both the ganglionic and supraganglionic levels of the MCA territory after surgery (p = 0.040 and p = 0.003, respectively). The ATT perfusion scores also improved at both levels (p < 0.001 and p < 0.001, respectively). The rCBF and rTTP values on DSC MRI showed significant improvement at both levels of the MCA territory of the operated side (all p < 0.05). There was no significant correlation between the improvements in rCBF values on the two perfusion images (r = 0.195, p = 0.303); however, there was a correlation between the change in perfusion scores on ASL and rTTP on DSC MRI (r = 0.701, p < 0.001). CONCLUSION Recognizing the effects of ATT on ASL perfusion MRI may help monitor cerebral perfusion changes and complement quantitative rCBF assessment using ASL perfusion MRI in patients with moyamoya disease after indirect revascularization.
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Affiliation(s)
- Seul Bi Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Kawadler JM, Hales PW, Barker S, Cox TCS, Kirkham FJ, Clark CA. Cerebral perfusion characteristics show differences in younger versus older children with sickle cell anaemia: Results from a multiple-inflow-time arterial spin labelling study. NMR IN BIOMEDICINE 2018; 31:e3915. [PMID: 29601112 DOI: 10.1002/nbm.3915] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 02/07/2018] [Accepted: 02/11/2018] [Indexed: 06/08/2023]
Abstract
Sickle cell anaemia (SCA) is associated with chronic anaemia and oxygen desaturation, which elevate cerebral blood flow (CBF) and increase the risk of neurocognitive complications. Arterial spin labelling (ASL) provides a methodology for measuring CBF non-invasively; however, ASL techniques using only a single inflow time are not sufficient to fully characterize abnormal haemodynamic behaviour in SCA. This study investigated haemodynamic parameters from a multi-inflow-time ASL acquisition in younger (8-12 years) and older (13-18 years) children with SCA with and without silent cerebral infarction (SCI+/-) (n = 20 and 19 respectively, 6 and 4 SCI+ respectively) and healthy controls (n = 9 and 7 respectively). Compared with controls, CBF was elevated globally in both groups of patients. In the younger SCA patients, blood oxygen content was negatively correlated with CBF in the middle and posterior cerebral artery territories and significantly positively correlated with bolus arrival time (BAT) in the anterior and middle cerebral artery territories. In older children, SCA patients had significantly shorter BAT than healthy controls and there was a significant negative correlation between CBF and oxygen content only in the territory of the posterior cerebral artery, with a trend for a correlation in the anterior cerebral artery but no relationship for the middle cerebral artery territory. In the younger group, SCI+ patients had significantly higher CBF in the posterior cerebral artery territory (SCI+ mean = 92.78 ml/100 g/min; SCI- mean = 72.71 ml/100 g/min; F = 4.28, p = 0.04), but this no longer reached significance when two children with abnormal transcranial Doppler and one with haemoglobin SC disease were excluded, and there were no significant differences between patients with and without SCI in the older children. With age, there appears to be increasing disparity between patients and controls in terms of the relationship between CBF and oxygen content in the anterior circulation, potentially predicting the risk of acute and chronic compromise of brain tissue.
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Affiliation(s)
- Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Patrick W Hales
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Simon Barker
- Wessex Neurological Centre and Child Health, University Hospital Southampton, Southampton, UK
| | - Timothy C S Cox
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
- Wessex Neurological Centre and Child Health, University Hospital Southampton, Southampton, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Chris A Clark
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
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Croal PL, Leung J, Kosinski P, Shroff M, Odame I, Kassner A. Assessment of cerebral blood flow with magnetic resonance imaging in children with sickle cell disease: A quantitative comparison with transcranial Doppler ultrasonography. Brain Behav 2017; 7:e00811. [PMID: 29201539 PMCID: PMC5698856 DOI: 10.1002/brb3.811] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/01/2017] [Accepted: 08/05/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Transcranial Doppler ultrasonography (TCD) is a clinical tool for stratifying ischemic stroke risk by identifying abnormal elevations in blood flow velocity (BFV) in the middle cerebral artery (MCA). However, TCD is not effective at screening for subtle neurologic injury such as silent cerebral infarcts. To better understand this disparity, we compared TCD measures of BFV with tissue-level cerebral blood flow (CBF) using arterial spin-labeling MRI in children with and without sickle cell disease, and correlated these measurements against clinical hematologic measures of disease severity. METHODS TCD and MRI assessment were performed in 13 pediatric sickle cell disease patients and eight age-matched controls. Using MRI measures of MCA diameter and territory weight, TCD measures of BFV in the MCA [cm/s] were converted into units of CBF [ml min-1100 g-1] for comparison. RESULTS There was no significant association between TCD measures of BFV in the MCA and corresponding MRI measures of CBF in patients (r = .28, p = .39) or controls (r = .10, p = .81). After conversion from BFV into units of CBF, a strong association was observed between TCD and MRI measures (r = .67, p = .017 in patients, r = .86, p = .006 in controls). While BFV in the MCA showed a lack of correlation with arterial oxygen content, an inverse association was observed for CBF measurements. CONCLUSIONS This study demonstrates that BFV in the MCA cannot be used as a surrogate marker for tissue-level CBF in children with sickle cell disease. Therefore, TCD alone may not be sufficient for understanding and predicting subtle pathophysiology in this population, highlighting the potential clinical value of tissue-level CBF.
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Affiliation(s)
- Paula L Croal
- Physiology & Experimental Medicine The Hospital for Sick Children Toronto ON Canada
| | - Jackie Leung
- Physiology & Experimental Medicine The Hospital for Sick Children Toronto ON Canada
| | | | - Manohar Shroff
- Department of Diagnostic Imaging The Hospital for Sick Children Toronto ON Canada
| | - Isaac Odame
- Division of Haematology/Oncology The Hospital for Sick Children Toronto ON Canada
| | - Andrea Kassner
- Physiology & Experimental Medicine The Hospital for Sick Children Toronto ON Canada.,Institute of Medical Science University of Toronto Toronto ON Canada
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Juttukonda MR, Jordan LC, Gindville MC, Davis LT, Watchmaker JM, Pruthi S, Donahue MJ. Cerebral hemodynamics and pseudo-continuous arterial spin labeling considerations in adults with sickle cell anemia. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3681. [PMID: 28052565 PMCID: PMC5351809 DOI: 10.1002/nbm.3681] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 10/11/2016] [Accepted: 11/12/2016] [Indexed: 05/28/2023]
Abstract
Sickle cell anemia (SCA) is a genetic disorder resulting in reduced oxygen carrying capacity and elevated stroke risk. Pseudo-continuous arterial spin labeling (pCASL) measures of cerebral blood flow (CBF) may have relevance for stroke risk assessment; however, the effects of elevated flow velocity and reduced bolus arrival time (BAT) on CBF quantification in SCA patients have not been thoroughly characterized, and pCASL model parameters used in healthy adults are often applied to patients with SCA. Here, cervical arterial flow velocities and pCASL labeling efficiencies were computed in adults with SCA (n = 19) and age- and race-matched controls without sickle trait (n = 7) using pCASL in sequence with phase contrast MR angiography (MRA). Controls (n = 7) and a subgroup of patients (n = 8) also underwent multi-post-labeling-delay pCASL for BAT assessment. Mean flow velocities were elevated in SCA adults (velocity = 28.3 ± 4.1 cm/s) compared with controls (velocity = 24.5 ± 3.8 cm/s), and mean pCASL labeling efficiency (α) was reduced in SCA adults (α = 0.72) relative to controls (α = 0.91). In patients, mean whole-brain CBF from phase contrast MRA was 91.8 ± 18.1 ml/100 g/min, while mean pCASL CBF when assuming a constant labeling efficiency of 0.86 was 75.2 ± 17.3 ml/100 g/min (p < 0.01), resulting in a mean absolute quantification error of 23% when a labeling efficiency appropriate for controls was assumed. This difference cannot be accounted for by BAT (whole-brain BAT: control, 1.13 ± 0.06 s; SCA, 1.02 ± 0.09 s) or tissue T1 variation. In conclusion, BAT variation influences pCASL quantification less than elevated cervical arterial velocity and labeling efficiency variation in SCA adults; thus, a lower labeling efficiency (α = 0.72) or subject-specific labeling efficiency should be incorporated for SCA patients.
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Affiliation(s)
- Meher R. Juttukonda
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee USA
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee USA
| | - Lori C. Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt Medical Center, Nashville, Tennessee USA
| | - Melissa C. Gindville
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt Medical Center, Nashville, Tennessee USA
| | - Larry T. Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee USA
| | | | - Sumit Pruthi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee USA
| | - Manus J. Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee USA
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee USA
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee USA
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Enhanced Long-Term Brain Magnetic Resonance Imaging Evaluation of Children with Sickle Cell Disease after Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2017; 23:670-676. [PMID: 28089760 DOI: 10.1016/j.bbmt.2017.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/03/2017] [Indexed: 11/23/2022]
Abstract
Progressive neurovasculopathy in children with sickle cell disease (SCD) results in decreased cognitive function and quality of life (QoL). Hematopoietic cell transplantation (HCT) is believed to halt progression of neurovasculopathy. Quantitative analysis of T2-weighted fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) for white matter hyperintensity (WMH) burden provides a meaningful estimate of small vessel cerebrovascular disease. We asked if quantitative analysis of WMH could complement standardized clinical assessment of MRI/magnetic resonance angiography (MRA) for assessing SCD central nervous system vasculopathy before and after HCT. Retrospective longitudinal clinical examination of scheduled annual MRI/MRA and quantitative analysis of WMH were performed before and 1 to 7 years after HCT at scheduled annual intervals, along with QoL measurements, in children who had engrafted after HCT. Of 18 patients alive and persistently engrafted (median age, 9.1 years), pretransplantation MRI demonstrated that 9 and 5 had sickle-related stroke and/or small infarcts, respectively. Patients were divided into WMH severity tertiles based on pretransplantation WMH volumes. MRI and WMH were assessed 1 to 7 years after HCT. MRI/MRA and WMH volume were stable or slightly better in 17 of 18 patients. By parent- and self-report, post-HCT QoL improved for children in the lowest WMH tertile significantly more than in the other groups. Based on this single-institution retrospective sample, we report that WMH appears to quantitatively support MRI-based findings that HCT stabilizes long-term small and large vessel cerebrovascular changes and is associated with the degree of improved QoL. While confirmation in larger prospective studies and evaluation by neurocognitive testing are needed, these findings suggest that WMH is a useful biomarker of neurovasculopathy after transplantation for SCD.
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Václavů L, van der Land V, Heijtel DFR, van Osch MJP, Cnossen MH, Majoie CBLM, Bush A, Wood JC, Fijnvandraat KJ, Mutsaerts HJMM, Nederveen AJ. In Vivo T1 of Blood Measurements in Children with Sickle Cell Disease Improve Cerebral Blood Flow Quantification from Arterial Spin-Labeling MRI. AJNR Am J Neuroradiol 2016; 37:1727-32. [PMID: 27231223 DOI: 10.3174/ajnr.a4793] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/24/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Children with sickle cell disease have low hematocrit and elevated CBF, the latter of which can be assessed with arterial spin-labeling MR imaging. Quantitative CBF values are obtained by using an estimation of the longitudinal relaxation time of blood (T1blood). Because T1blood depends on hematocrit in healthy individuals, we investigated the importance of measuring T1blood in vivo with MR imaging versus calculating it from hematocrit or assuming an adult fixed value recommended by the literature, hypothesizing that measured T1blood would be the most suited for CBF quantification in children with sickle cell disease. MATERIALS AND METHODS Four approaches for T1blood estimation were investigated in 39 patients with sickle cell disease and subsequently used in the CBF quantification from arterial spin-labeling MR imaging. First, we used 1650 ms as recommended by the literature (T1blood-fixed); second, T1blood calculated from hematocrit measured in patients (T1blood-hematocrit); third, T1blood measured in vivo with a Look-Locker MR imaging sequence (T1blood-measured); and finally, a mean value from T1blood measured in this study in children with sickle cell disease (T1blood-sickle cell disease). Quantitative flow measurements acquired with phase-contrast MR imaging served as reference values for CBF. RESULTS T1blood-measured (1818 ± 107 ms) was higher than the literature recommended value of 1650 ms, was significantly lower than T1blood-hematocrit (2058 ± 123 ms, P < .001), and, most interesting, did not correlate with hematocrit measurements. Use of either T1blood-measured or T1blood-sickle cell disease provided the best agreement on CBF between arterial-spin labeling and phase-contrast MR imaging reference values. CONCLUSIONS This work advocates the use of patient-specific measured T1blood or a standardized value (1818 ms) in the quantification of CBF from arterial spin-labeling in children with SCD.
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Affiliation(s)
- L Václavů
- From the Department of Radiology (L.V., D.F.R.H., C.B.L.M.M., H.J.M.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands
| | - V van der Land
- Department of Pediatric Hematology (V.v.d.L., K.J.F.), Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - D F R Heijtel
- From the Department of Radiology (L.V., D.F.R.H., C.B.L.M.M., H.J.M.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands
| | - M J P van Osch
- C.J. Gorter Center for High Field MRI (M.J.P.v.O.), Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - M H Cnossen
- Department of Pediatric Hematology (M.H.C.), Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - C B L M Majoie
- From the Department of Radiology (L.V., D.F.R.H., C.B.L.M.M., H.J.M.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands
| | - A Bush
- Department of Biomedical Engineering (A.B.), Viterbi School of Engineering, University of Southern California, Los Angeles, California
| | - J C Wood
- Department of Pediatrics (J.C.W.), Children's Hospital Los Angeles, Los Angeles, California
| | - K J Fijnvandraat
- Department of Pediatric Hematology (V.v.d.L., K.J.F.), Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - H J M M Mutsaerts
- From the Department of Radiology (L.V., D.F.R.H., C.B.L.M.M., H.J.M.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands Sunnybrook Research Institute (H.J.M.M.M.), Toronto, Ontario, Canada
| | - A J Nederveen
- From the Department of Radiology (L.V., D.F.R.H., C.B.L.M.M., H.J.M.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands
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