Venous refocusing for volume estimation: VERVE functional magnetic resonance imaging

Breath-hold BOLD fMRI without CO2 sampling enables estimation of venous cerebral blood volume: potential use in normalization of stimulus-evoked BOLD fMRI data

BOLD fMRI signal has been used in conjunction with vasodilatory stimulation as a marker of cerebrovascular reactivity (CVR): the relative change in cerebral blood flow (CBF) arising from a unit change in the vasodilatory stimulus. Using numerical simulations, we demonstrate that the variability in the relative BOLD signal change induced by vasodilation is strongly influenced by the variability in deoxyhemoglobin-containing cerebral blood volume (CBV), as this source of variability is likely to be more prominent than that of CVR. It may, therefore, be more appropriate to describe the relative BOLD signal change induced by an isometabolic vasodilation as a proxy of deoxygenated CBV (CBVdHb) rather than CVR. With this in mind, a new method was implemented to map a marker of CBVdHb, termed BOLD-CBV, based on the normalization of voxel-wise BOLD signal variation by an estimate of the intravascular venous BOLD signal from voxels filled with venous blood. The intravascular venous BOLD signal variation, recorded during repeated breath-holding, was extracted from the superior sagittal sinus in a cohort of 27 healthy volunteers and used as a regressor across the whole brain, yielding maps of BOLD-CBV. In the same cohort, we demonstrated the potential use of BOLD-CBV for the normalization of stimulus-evoked BOLD fMRI by comparing group-level BOLD fMRI responses to a visuomotor learning task with and without the inclusion of voxel-wise vascular covariates of BOLD-CBV and the BOLD signal change per mmHg variation in end-tidal carbon dioxide (BOLD-CVR). The empirical measure of BOLD-CBV accounted for more between-subject variability in the motor task-induced BOLD responses than BOLD-CVR estimated from end-tidal carbon dioxide recordings. The new method can potentially increase the power of group fMRI studies by including a measure of vascular characteristics and has the strong practical advantage of not requiring experimental measurement of end-tidal carbon dioxide, unlike traditional methods to estimate BOLD-CVR. It also more closely represents a specific physiological characteristic of brain vasculature than BOLD-CVR, namely blood volume.

Magnetization transfer weighted laminar fMRI with multi-echo FLASH

Laminar functional magnetic resonance imaging (fMRI) using the gradient echo (GRE) blood oxygenation level dependent (BOLD) contrast is prone to signal changes arising from large unspecific venous vessels. Alternatives based on changes of cerebral blood volume (CBV) become more popular since it is expected that this hemodynamic response is dominant in microvasculature. One approach to sensitize the signal toward changes in CBV, and to simultaneously reduce unwanted extravascular (EV) BOLD blurring, is to selectively reduce gray matter (GM) signal via magnetization transfer (MT). In this work, we use off-resonant MT-pulses with a 3D FLASH readout to perform MT-prepared (MT-prep) laminar fMRI of the primary visual cortex (V1) at multiple echo times at 7 T. With a GRE-BOLD contrast without additional MT-weighting as reference, we investigated the influence of the MT-preparation on the shape and the echo time dependency of laminar profiles. Through numerical simulations, we optimized the sequence parameters to increase the sensitivity toward signal changes induced by changes in arterial CBV and to delineate the contributions of different compartments to the signal. We show that at 7 T, GM signals can be reduced by 30 %. Our laminar fMRI responses exhibit an increased signal change in the parenchyma at very short TE compared to a BOLD-only reference as a result of reduced EV signal intensity. By varying echo times, we could show that MT-prep results in less sensitivity toward unwanted signal changes based on changes in T₂*. We conclude that when accounting for nuclear overhauser enhancement effects in blood, off-resonant MT-prep combined with efficient short TE readouts can become a promising method to reduce unwanted EV venous contributions in GRE-BOLD and/or to allow scanning at much shorter echo times without incurring a sensitivity penalty in laminar fMRI.

Venous cerebral blood volume mapping in the whole brain using venous-spin-labeled 3D turbo spin echo

PURPOSE

Venous cerebral blood volume (CBVv ) is a major contributor to BOLD contrast, and therefore is an important parameter for understanding the underlying mechanism. Here, we propose a velocity-selective venous spin labeling (VS-VSL)-prepared 3D turbo spin echo pulse sequence for whole-brain baseline CBVv mapping.

METHODS

Unlike previous CBVv measurement techniques that exploit the interrelationship between BOLD signals and CBVv , in the proposed VS-VSL technique both arterial blood and cerebrospinal fluid (CSF) signals were suppressed before the VS pulse train for exclusive labeling of venous blood, while a single-slab 3D turbo spin echo readout was used because of its relative immunity to magnetic field variations. Furthermore, two approximations were made to the VS-VSL signal model for simplified derivation of CBVv . In vivo studies were performed at 3T field strength in 8 healthy subjects. The performance of the proposed VS-VSL method in baseline CBVv estimation was first evaluated in comparison to the existing, hyperoxia-based method. Then, data were also acquired using VS-VSL under hypercapnic and hyperoxic gas breathing challenges for further validation of the technique.

RESULTS

The proposed technique yielded physiologically plausible baseline CBVv values, and when compared with the hyperoxia-based method, showed no statistical difference. Furthermore, data acquired using VS-VSL yielded average CBVv of 2.89%/1.78%, 3.71%/2.29%, and 2.88%/1.76% for baseline, hypercapnia, and hyperoxia, respectively, in gray/white matter regions. As expected, hyperoxia had negligible effect (P > .8), whereas hypercapnia demonstrated vasodilation (P << .01).

CONCLUSION

Upon further validation of the quantification model, the method is expected to have merit for 3D CBVv measurements across the entire brain.

Static and dynamic functional connectivity analysis of cerebrovascular reactivity: An fMRI study

BACKGROUND

Cerebrovascular reactivity (CVR) is an important aspect of brain function, and as such it is important to understand relationship between CVR and functional connectivity.

METHODS

This research studied the role of CVR, or the brain's ability to react to vasoactive stimuli on brain functional connectivity by scanning subjects with blood-oxygenation-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) while they periodically inhale room air and a CO 2-enriched gas mixture. We developed a new metric to measure the effect of CVR on each intrinsic connectivity network (ICN), which contrasts to voxel-wise CVR. We also studied the changes in whole-brain connectivity patterns using both static functional network connectivity (sFNC) and dynamic FNC (dFNC).

RESULTS

We found that network connectivity is generally weaker during vascular dilation, which is supported by previous research. The dFNC analysis revealed that participants did not return to the pre-CO 2 inhalation state, suggesting that one-minute periods of room-air inhalation is not enough for the CO 2 effect to fully dissipate.

CONCLUSIONS

Cerebrovascular reactivity is one tool that the cerebrovascular system uses to ensure the constant, finely-tuned flow of oxygen to function properly. Understanding the relationship between CVR and brain dynamism can provide unique information about cerebrovascular diseases and general brain function. We observed that CVR has a wide, but consistent relationship to connectivity patterns between functional networks.

Coupling between cerebral blood flow and cerebral blood volume: Contributions of different vascular compartments

A better understanding of the coupling between changes in cerebral blood flow (CBF) and cerebral blood volume (CBV) is vital for furthering our understanding of the BOLD response. The aim of this study was to measure CBF-CBV coupling in different vascular compartments during neural activation. Three haemodynamic parameters were measured during a visual stimulus. Look-Locker flow-sensitive alternating inversion recovery was used to measure changes in CBF and arterial CBV (CBVa ) using sequence parameters optimized for each contrast. Changes in total CBV (CBVtot ) were measured using a gadolinium-based contrast agent technique. Haemodynamic changes were extracted from a region of interest based on voxels that were activated in the CBF experiments. The CBF-CBVtot coupling constant αtot was measured as 0.16 ± 0.14 and the CBF-CBVa coupling constant αa was measured as 0.65 ± 0.24. Using a two-compartment model of the vasculature (arterial and venous), the change in venous CBV (CBVv ) was predicted for an assumed value of baseline arterial and venous blood volume. These results will enhance the accuracy and reliability of applications that rely on models of the BOLD response, such as calibrated BOLD.

MRI techniques to measure arterial and venous cerebral blood volume

The measurement of cerebral blood volume (CBV) has been the topic of numerous neuroimaging studies. To date, however, most in vivo imaging approaches can only measure CBV summed over all types of blood vessels, including arterial, capillary and venous vessels in the microvasculature (i.e. total CBV or CBVtot). As different types of blood vessels have intrinsically different anatomy, function and physiology, the ability to quantify CBV in different segments of the microvascular tree may furnish information that is not obtainable from CBVtot, and may provide a more sensitive and specific measure for the underlying physiology. This review attempts to summarize major efforts in the development of MRI techniques to measure arterial (CBVa) and venous CBV (CBVv) separately. Advantages and disadvantages of each type of method are discussed. Applications of some of the methods in the investigation of flow-volume coupling in healthy brains, and in the detection of pathophysiological abnormalities in brain diseases such as arterial steno-occlusive disease, brain tumors, schizophrenia, Huntington's disease, Alzheimer's disease, and hypertension are demonstrated. We believe that the continual development of MRI approaches for the measurement of compartment-specific CBV will likely provide essential imaging tools for the advancement and refinement of our knowledge on the exquisite details of the microvasculature in healthy and diseased brains.

Cerebral blood volume changes during the BOLD post-stimulus undershoot measured with a combined normoxia/hyperoxia method

Cerebral blood flow (CBF) and blood oxygenation level dependent (BOLD) signal measurements make it possible to estimate steady-state changes in the cerebral metabolic rate of oxygen (CMRO2) with a calibrated BOLD method. However, extending this approach to measure the dynamics of CMRO2 requires an additional assumption: that deoxygenated cerebral blood volume (CBVdHb) follows CBF in a predictable way. A test-case for this assumption is the BOLD post-stimulus undershoot, for which one proposed explanation is a strong uncoupling of flow and blood volume with an elevated level of CBVdHb during the post-stimulus period compared to baseline due to slow blood volume recovery (Balloon Model). A challenge in testing this model is that CBVdHb differs from total blood volume, which can be measured with other techniques. In this study, the basic hypothesis of elevated CBVdHb during the undershoot was tested, based on the idea that the BOLD signal change when a subject switches from breathing a normoxic gas to breathing a hyperoxic gas is proportional to the absolute CBVdHb. In 19 subjects (8F), dual-echo BOLD responses were measured in primary visual cortex during a flickering radial checkerboard stimulus in normoxia, and the identical experiment was repeated in hyperoxia (50% O2/balance N2). The BOLD signal differences between normoxia and hyperoxia for the pre-stimulus baseline, stimulus, and post-stimulus periods were compared using an equivalent BOLD signal calculated from measured R2* changes to eliminate signal drifts. Relative to the pre-stimulus baseline, the average BOLD signal change from normoxia to hyperoxia was negative during the undershoot period (p = 0.0251), consistent with a reduction of CBVdHb and contrary to the prediction of the Balloon Model. Based on these results, the BOLD post-stimulus undershoot does not represent a case of strong uncoupling of CBVdHb and CBF, supporting the extension of current calibrated BOLD methods to estimate the dynamics of CMRO2.

Impulse response timing differences in BOLD and CBV weighted fMRI

Recent advances in BOLD fMRI scan techniques have substantially improved spatial and temporal resolution, currently reaching to sub-millimeter and sub-second levels respectively. Unfortunately, there remain physiological barriers that prevent achieving this resolution in practice. BOLD contrast relies on the hemodynamic response to neuronal activity, whose associated cerebral blood oxygenation (CBO) changes may spread over several millimeters and last several seconds. Recent reports have suggested that significant improvements may be possible with cerebral blood volume (CBV)-weighted fMRI, which highlights the CBV changes rather than the BOLD changes associated with the hemodynamic response. Nevertheless, quantitative comparisons between CBV and BOLD are sparse, in particular regarding their temporal characteristics in human brain. To address this, we studied a cohort of subjects that received injection of ferumoxytol, an intravascular iron-oxide based contrast agent that introduces strong CBV contrast. An event-related visual stimulus paradigm was used to compare the impulse response (IR) for CBV and BOLD contrast, obtained with and without ferumoxytol, respectively. Experiments performed at 7 T (n = 5) at 1.2-1.5 mm spatial and 1 s temporal resolution showed that the onset time and time-to-peak of the CBV IR averaged 0.8 and 3.5 s respectively, both 0.6 s shorter than the BOLD IR. While significant, these improvements are relatively small and not expected to lead to practical advantages for the extraction of temporal information about neural activity. Nonlinearities in the observed IR were also compared and found to be similar between the CBV and BOLD, indicating that these are likely not caused by a 'ceiling' effect in the CBO response, but rather support a previously proposed model of vascular compliance, in which changes in vascular tone elicited by a preceding stimulus affect the IR.

Functional MRI of brain physiology in aging and neurodegenerative diseases

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.

Multiparametric measurement of cerebral physiology using calibrated fMRI

The ultimate goal of calibrated fMRI is the quantitative imaging of oxygen metabolism (CMRO₂), and this has been the focus of numerous methods and approaches. However, one underappreciated aspect of this quest is that in the drive to measure CMRO₂, many other physiological parameters of interest are often acquired along the way. This can significantly increase the value of the dataset, providing greater information that is clinically relevant, or detail that can disambiguate the cause of signal variations. This can also be somewhat of a double-edged sword: calibrated fMRI experiments combine multiple parameters into a physiological model that requires multiple steps, thereby providing more opportunity for error propagation and increasing the noise and error of the final derived values. As with all measurements, there is a trade-off between imaging time, spatial resolution, coverage, and accuracy. In this review, we provide a brief overview of the benefits and pitfalls of extracting multiparametric measurements of cerebral physiology through calibrated fMRI experiments.

A Hitchhiker's Guide to Functional Magnetic Resonance Imaging

Functional Magnetic Resonance Imaging (fMRI) studies have become increasingly popular both with clinicians and researchers as they are capable of providing unique insights into brain functions. However, multiple technical considerations (ranging from specifics of paradigm design to imaging artifacts, complex protocol definition, and multitude of processing and methods of analysis, as well as intrinsic methodological limitations) must be considered and addressed in order to optimize fMRI analysis and to arrive at the most accurate and grounded interpretation of the data. In practice, the researcher/clinician must choose, from many available options, the most suitable software tool for each stage of the fMRI analysis pipeline. Herein we provide a straightforward guide designed to address, for each of the major stages, the techniques, and tools involved in the process. We have developed this guide both to help those new to the technique to overcome the most critical difficulties in its use, as well as to serve as a resource for the neuroimaging community.

Hippocampal arterial cerebral blood volume in early psychosis

Recent studies of patients in the early stage of psychosis have revealed increased cerebral blood volume (CBV) in specific subfields of the anterior hippocampus. These studies required injection of a contrast agent to measure steady state CBV. Here we used a novel, non-invasive method, inflow-based-vascular-space-occupancy with dynamic subtraction (iVASO-DS), to measure the arterial component of CBV (aCBV) in a single slice of the hippocampus. Based on evidence from contrast-enhanced CBV studies, we hypothesized increased aCBV in the anterior hippocampus in early psychosis. We used 3T MRI to generate iVASO-derived aCBV maps in 17 medicated patients (average duration of illness = 7.6 months) and 25 matched controls. We did not find hemispheric or regional group differences in hippocampal aCBV. The limited spatial resolution of the iVASO-DS method did not allow us to test for aCBV differences in specific subfields of the hippocampus. Future studies should investigate venous and arterial CBV changes in the hippocampus of early psychosis patients.

Noise concerns and post-processing procedures in cerebral blood flow (CBF) and cerebral blood volume (CBV) functional magnetic resonance imaging

Functional neuroimaging with blood oxygenation level-dependent (BOLD) contrast has emerged as the most popular method for evaluating qualitative changes in brain function in humans. At typical human field strengths (1.5-3.0T), BOLD contrast provides a measure of changes in transverse water relaxation rates in and around capillary and venous blood, and as such provides only a surrogate marker of brain function that depends on dynamic changes in hemodynamics (e.g., cerebral blood flow and volume) and metabolism (e.g., oxygen extraction fraction and the cerebral metabolic rate of oxygen consumption). Alternative functional neuroimaging methods that are specifically sensitive to these constituents of the BOLD signal are being developed and applied in a growing number of clinical and neuroscience applications of quantitative cerebral physiology. These methods require additional considerations for interpreting and quantifying their contrast responsibly. Here, an overview of two popular methods, arterial spin labeling and vascular space occupancy, is presented specifically in the context of functional neuroimaging. Appropriate post-processing and experimental acquisition strategies are summarized with the motivation of reducing sensitivity to noise and unintended signal sources and improving quantitative accuracy of cerebral hemodynamics.

Non-invasive quantification of absolute cerebral blood volume during functional activation applicable to the whole human brain

PURPOSE

Cerebral blood volume (CBV) changes in many diverse pathologic conditions, and in response to functional challenges along with changes in blood flow, blood oxygenation, and the cerebral metabolic rate of oxygen. The feasibility of a new method for non-invasive quantification of absolute cerebral blood volume that can be applicable to the whole human brain was investigated.

METHODS

Multi-slice data were acquired at 3 T using a novel inversion recovery echo planar imaging (IR-EPI) pulse sequence with varying contrast weightings and an efficient rotating slice acquisition order, at rest and during visual activation. A biophysical model was used to estimate absolute cerebral blood volume at rest and during activation, and oxygenation during activation, on data from 13 normal human subjects.

RESULTS

Cerebral blood volume increased by 21.7% from 6.6 ± 0.8 mL/100 mL of brain parenchyma at rest to 8.0 ± 1.3 mL/100 mL of brain parenchyma in the occipital cortex during visual activation, with average blood oxygenation of 84 ± 2.1% during activation, comparing well with literature.

CONCLUSION

The method is feasible, and could foster improved understanding of the fundamental physiological relationship between neuronal activity, hemodynamic changes, and metabolism underlying brain activation; complement existing methods for estimating compartmental changes; and potentially find utility in evaluating vascular health.

Reduced CMRO₂ and cerebrovascular reserve in patients with severe intracranial arterial stenosis: a combined multiparametric qBOLD oxygenation and BOLD fMRI study

Multiparametric quantitative blood oxygenation level dependent (mqBOLD) magnetic resonance Imaging (MRI) approach allows mapping tissular oxygen saturation (StO2 ) and cerebral metabolic rate of oxygen (CMRO2 ). To identify hemodynamic alteration related to severe intracranial arterial stenosis (SIAS), functional MRI of cerebrovascular reserve (CVR BOLD fMRI) to hypercapnia has been proposed. Diffusion imaging suggests chronic low grade ischemia in patients with impaired CVR. The aim of the present study was to evaluate how oxygen parameters (StO2 and CMRO2 ), assessed with mqBOLD approach, correlate with CVR in patients (n = 12) with SIAS and without arterial occlusion. The perfusion (dynamic susceptibility contrast), oxygenation, and CVR were compared. The MRI protocol conducted at 3T lasted approximately 1 h. Regions of interest measures on maps were delineated on segmented gray matter (GM) of middle cerebral artery territories. We have shown that decreased CVR is spatially associated with decreased CMRO2 in GM of patients with SIAS. Further, the degree of ipsilateral CVR reduction was well-correlated with the amplitude of the CMRO2 deficit. The altered CMRO2 suggests the presence of a moderate ischemia explained by both a decrease in perfusion and in CVR. CVR and mqBOLD method may be helpful in the selection of patients with SIAS to advocate for medical therapy or percutaneous transluminal angioplasty-stenting.

Investigation of the neurovascular coupling in positive and negative BOLD responses in human brain at 7 T

Decreases in stimulus-dependent blood oxygenation level dependent (BOLD) signal and their underlying neurovascular origins have recently gained considerable interest. In this study a multi-echo, BOLD-corrected vascular space occupancy (VASO) functional magnetic resonance imaging (fMRI) technique was used to investigate neurovascular responses during stimuli that elicit positive and negative BOLD responses in human brain at 7 T. Stimulus-induced BOLD, cerebral blood volume (CBV), and cerebral blood flow (CBF) changes were measured and analyzed in 'arterial' and 'venous' blood compartments in macro- and microvasculature. We found that the overall interplay of mean CBV, CBF and BOLD responses is similar for tasks inducing positive and negative BOLD responses. Some aspects of the neurovascular coupling however, such as the temporal response, cortical depth dependence, and the weighting between 'arterial' and 'venous' contributions, are significantly different for the different task conditions. Namely, while for excitatory tasks the BOLD response peaks at the cortical surface, and the CBV change is similar in cortex and pial vasculature, inhibitory tasks are associated with a maximum negative BOLD response in deeper layers, with CBV showing strong constriction of surface arteries and a faster return to baseline. The different interplays of CBV, CBF and BOLD during excitatory and inhibitory responses suggests different underlying hemodynamic mechanisms.

Cerebral blood volume changes during brain activation

Cerebral blood volume (CBV) changes significantly with brain activation, whether measured using positron emission tomography, functional magnetic resonance imaging (fMRI), or optical microscopy. If cerebral vessels are considered to be impermeable, the contents of the skull incompressible, and the skull itself inextensible, task- and hypercapnia-related changes of CBV could produce intolerable changes of intracranial pressure. Because it is becoming clear that CBV may be useful as a well-localized marker of neural activity changes, a resolution of this apparent paradox is needed. We have explored the idea that much of the change in CBV is facilitated by exchange of water between capillaries and surrounding tissue. To this end, we developed a novel hemodynamic boundary-value model and found approximate solutions using a numerical algorithm. We also constructed a macroscopic experimental model of a single capillary to provide biophysical insight. Both experiment and theory model capillary membranes as elastic and permeable. For a realistic change of input pressure, a relative pipe volume change of 21±5% was observed when using the experimental setup, compared with the value of approximately 17±1% when this quantity was calculated from the mathematical model. Volume, axial flow, and pressure changes are in the expected range.

Biophysical and physiological origins of blood oxygenation level-dependent fMRI signals

After its discovery in 1990, blood oxygenation level-dependent (BOLD) contrast in functional magnetic resonance imaging (fMRI) has been widely used to map brain activation in humans and animals. Since fMRI relies on signal changes induced by neural activity, its signal source can be complex and is also dependent on imaging parameters and techniques. In this review, we identify and describe the origins of BOLD fMRI signals, including the topics of (1) effects of spin density, volume fraction, inflow, perfusion, and susceptibility as potential contributors to BOLD fMRI, (2) intravascular and extravascular contributions to conventional gradient-echo and spin-echo BOLD fMRI, (3) spatial specificity of hemodynamic-based fMRI related to vascular architecture and intrinsic hemodynamic responses, (4) BOLD signal contributions from functional changes in cerebral blood flow (CBF), cerebral blood volume (CBV), and cerebral metabolic rate of O(2) utilization (CMRO(2)), (5) dynamic responses of BOLD, CBF, CMRO(2), and arterial and venous CBV, (6) potential sources of initial BOLD dips, poststimulus BOLD undershoots, and prolonged negative BOLD fMRI signals, (7) dependence of stimulus-evoked BOLD signals on baseline physiology, and (8) basis of resting-state BOLD fluctuations. These discussions are highly relevant to interpreting BOLD fMRI signals as physiological means.

Novel MRI approaches for assessing cerebral hemodynamics in ischemic cerebrovascular disease

Changes in cerebral hemodynamics underlie a broad spectrum of ischemic cerebrovascular disorders. An ability to accurately and quantitatively measure hemodynamic (cerebral blood flow and cerebral blood volume) and related metabolic (cerebral metabolic rate of oxygen) parameters is important for understanding healthy brain function and comparative dysfunction in ischemia. Although positron emission tomography, single-photon emission tomography, and gadolinium-MRI approaches are common, more recently MRI approaches that do not require exogenous contrast have been introduced with variable sensitivity for hemodynamic parameters. The ability to obtain hemodynamic measurements with these new approaches is particularly appealing in clinical and research scenarios in which follow-up and longitudinal studies are necessary. The purpose of this review is to outline current state-of-the-art MRI methods for measuring cerebral blood flow, cerebral blood volume, and cerebral metabolic rate of oxygen and provide practical tips to avoid imaging pitfalls. MRI studies of cerebrovascular disease performed without exogenous contrast are synopsized in the context of clinical relevance and methodological strengths and limitations.

IRON fMRI measurements of CBV and implications for BOLD signal

Changes in cerebral blood volume (CBV) and blood magnetization each induce changes in the transverse relaxation rate of MRI signal that are associated with changes in cerebral activity. BOLD signal, the preeminent method for non-invasive localization of task-induced brain function in human subjects, reflects a combination of changes in CBV and blood magnetization. Intravenous injection of paramagnetic contrast media, usually iron oxide particles surrounded by larger macromolecules, can overwhelm the BOLD response and sensitize signal to blood plasma volume, a method we have deemed "IRON" fMRI. The practical advantage of this technique is the ability to optimize blood magnetization at any echo time, enabling high detection power and the use of short echo times; for these reasons, IRON fMRI has become a valuable imaging tool in animal models. The temporal response of blood plasma volume is quite different from blood flow and BOLD signal; thus, CBV has been identified as a prominent source of transient features of the BOLD response. This article reviews the methodological advantages of the IRON method and how CBV measurements have informed our understanding of the BOLD response.

The BOLD post-stimulus undershoot, one of the most debated issues in fMRI

This paper provides a brief overview of how we got involved in fMRI work and of our efforts to elucidate the mechanisms underlying BOLD signal changes. The phenomenon discussed here in particular is the post-stimulus undershoot (PSU), the interpretation of which has captivated many fMRI scientists and is still under debate to date. This controversy is caused both by the convoluted physiological origin of the BOLD effect, which allows many possible explanations, and the lack of comprehensive data in the early years. BOLD effects reflect changes in cerebral blood flow (CBF), volume (CBV), metabolic rate of oxygen (CMRO(2)), and hematocrit fraction (Hct). However, the size of such effects is modulated by vascular origin such as intravascular, extravascular, macro and microvascular, venular and capillary, the relative contributions of which depend not only on the spatial resolution of the measurements, but also on stimulus duration, on magnetic field strength and on whether spin echo (SE) or gradient echo (GRE) detection is used. The two most dominant explanations of the PSU have been delayed vascular compliance (first venular, later arteriolar, and recently capillary) and sustained increases in CMRO(2), while post-activation reduction in CBF is a distant third. MRI has the capability to independently measure CBF and arteriolar, venous, and total CBV contributions in humans and animals, which has been of great assistance in improving the understanding of BOLD phenomena. Using currently available MRI and optical data, we conclude that the predominant PSU origin is a sustained increase in CMRO(2). However, some contributions from delayed vascular compliance are likely, and small CBF undershoot contributions that are difficult to detect with current arterial spin labeling technology can also not be excluded. The relative contribution of these different processes, which are not mutually exclusive and can act together, is likely to vary with stimulus duration and type.

A review of the development of Vascular-Space-Occupancy (VASO) fMRI

Vascular-Space-Occupancy (VASO) fMRI is a non-invasive technique to detect brain activation based on changes in Cerebral Blood Volume (CBV), as opposed to conventional BOLD fMRI, which is based on changes in blood oxygenation. This technique takes advantage of the T1 difference between blood and surrounding tissue, and uses an inversion recovery pulse sequence to null blood signal while maintaining part of the tissue signal. The VASO signal intensity can thus be considered proportional to 1-CBV. When neural activation causes CBV to increase, the VASO signal will show a decrease, allowing the detection of activated regions in the brain. Activation-induced changes in VASO signal, ∆S/S, are in the order of -1%. Absolute quantification of ∆CBV requires additional assumptions on baseline CBV and water contents of the parenchyma and blood. The first VASO experiment was conducted approximately 10 years ago. The original goal of nulling the blood signal was to isolate and measure extravascular BOLD effects, thus a long TE of 50 ms was used in the inversion recovery experiment. Instead of a positive signal change, a slight decrease in signal was observed, which became more pronounced when TE was shortened to 10 ms. These findings led to the hypothesis of a CBV signal mechanism and the development of VASO fMRI. Since its discovery, VASO has been validated by comparison with MION-CBV studies in animals and has been used in humans and animals to understand metabolic and hemodynamic changes during brain activation and physiologic challenges. With recent development of more sensitive VASO acquisitions, the availability of arterial-based VASO sequences, and improvement in spatial coverage, this technique is finding its place in neuroscience and clinical studies.

Measurement of absolute arterial cerebral blood volume in human brain without using a contrast agent

Arterial cerebral blood volume (CBV(a) ) is a vital indicator of tissue perfusion and vascular reactivity. We extended the recently developed inflow vascular-space-occupancy (iVASO) MRI technique, which uses spatially selective inversion to suppress the signal from blood flowing into a slice, with a control scan to measure absolute CBV(a) using cerebrospinal fluid (CSF) for signal normalization. Images were acquired at multiple blood nulling times to account for the heterogeneity of arterial transit times across the brain, from which both CBV(a) and arterial transit times were quantified. Arteriolar CBV(a) was determined separately by incorporating velocity-dependent bipolar crusher gradients. Gray matter (GM) CBV(a) values (n=11) were 2.04 ± 0.27 and 0.76 ± 0.17 ml blood/100 ml tissue without and with crusher gradients (b=1.8 s/mm(2) ), respectively. Arterial transit times were 671 ± 43 and 785 ± 69 ms, respectively. The arterial origin of the signal was validated by measuring its T(2) , which was within the arterial range. The proposed approach does not require exogenous contrast agent administration, and provides a non-invasive alternative to existing blood volume techniques for mapping absolute CBV(a) in studies of brain physiology and neurovascular diseases.

Quantitative functional MRI: concepts, issues and future challenges

Since its inception 20 years ago, functional magnetic resonance imaging (fMRI) of the human brain based on the blood oxygenation level dependent (BOLD) contrast phenomenon has proliferated and matured. Today it is the predominant functional brain imaging modality with the majority of applications being in basic cognitive neuroscience where it has primarily been used as a tool to localize brain activity. While the magnitude of the BOLD response is often used in these studies as a surrogate for the level of neuronal activity, the link between the two is, in fact, quite indirect. The BOLD response is dependent upon hemodynamic (blood flow and volume) and metabolic (oxygen consumption) responses as well as acquisition details. Furthermore, the relationship between neuronal activity and the hemodynamic response, termed neurovascular coupling, is itself complex and incompletely understood. Quantitative fMRI techniques have therefore been developed to measure the hemodynamic and metabolic responses to modulations in brain activity. These methods have not only helped clarify the behaviour and origins of the BOLD signal under normal physiological conditions but they have also provided a potentially valuable set of tools for exploring pathophysiological conditions. Such quantitative methods will be critical to realize the potential of fMRI in a clinical context, where simple BOLD measurements cannot be uniquely interpreted, and to enhance the power of fMRI in basic neuroscience research. In this article, recent advances in human quantitative fMRI methods are reviewed, outstanding issues discussed and future challenges and opportunities highlighted.

Temporal dynamics and spatial specificity of arterial and venous blood volume changes during visual stimulation: implication for BOLD quantification

Determination of compartment-specific cerebral blood volume (CBV) changes is important for understanding neurovascular physiology and quantifying blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI). In isoflurane-anesthetized cats, we measured the spatiotemporal responses of arterial CBV (CBV(a)) and total CBV (CBV(t)) induced by a 40-second visual stimulation, using magnetization transfer (MT)-varied BOLD and contrast-agent fMRI techniques at 9.4 T. To determine the venous CBV (CBV(v)) change, we calculated the difference between CBV(t) and CBV(a) changes. The dynamic response of CBV(a) was an order of magnitude faster than that of CBV(v), while the magnitude of change under steady-state conditions was similar between the two. Following stimulation offset, ΔCBV(a) showed small poststimulus undershoots, while ΔCBV(v) slowly returned to baseline. The largest CBV(a) and CBV(t) response occurred after 10 seconds of simulation in cortical layer 4, which we identified as the stripe of Gennari by T(1)-weighted MRI. The CBV(v) response, however, was not specific across the cortical layers during the entire stimulation period. Our data indicate that rapid, more-specific arterial vasodilation is followed by slow, less-specific venous dilation. Our finding implies that the contribution of CBV(v) changes to BOLD signals is significant for long, but not short, stimulation periods.

Neurovascular and Neurometabolic Couplings in Dynamic Calibrated fMRI: Transient Oxidative Neuroenergetics for Block-Design and Event-Related Paradigms

Functional magnetic resonance imaging (fMRI) with blood-oxygenation level dependent (BOLD) contrast is an important tool for mapping brain activity. Interest in quantitative fMRI has renewed awareness in importance of oxidative neuroenergetics, as reflected by cerebral metabolic rate of oxygen consumption(CMRO2), for supporting brain function. Relationships between BOLD signal and the underlying neurophysiological parameters have been elucidated to allow determination of dynamic changes inCMRO2 by "calibrated fMRI," which require multi-modal measurements of BOLD signal along with cerebral blood flow (CBF) and volume (CBV). But how doCMRO2 changes, steady-state or transient, derived from calibrated fMRI compare with neural activity recordings of local field potential (LFP) and/or multi-unit activity (MUA)? Here we discuss recent findings primarily from animal studies which allow high magnetic fields studies for superior BOLD sensitivity as well as multi-modal CBV and CBF measurements in conjunction with LFP and MUA recordings from activated sites. A key observation is that while relationships between neural activity and sensory stimulus features range from linear to non-linear, associations between hyperemic components (BOLD, CBF, CBV) and neural activity (LFP, MUA) are almost always linear. More importantly, the results demonstrate good agreement between the changes inCMRO2 and independent measures of LFP or MUA. The tight neurovascular and neurometabolic couplings, observed from steady-state conditions to events separated by <200 ms, suggest rapid oxygen equilibration between blood and tissue pools and thus calibrated fMRI at high magnetic fields can provide high spatiotemporal mapping ofCMRO2 changes.

Absolute arterial cerebral blood volume quantification using inflow vascular-space-occupancy with dynamic subtraction magnetic resonance imaging

In patients with steno-occlusive disease of the internal carotid artery (ICA), cerebral blood flow may be maintained by autoregulatory increases in arterial cerebral blood volume (aCBV). Therefore, characterizing aCBV may be useful for understanding hemodynamic compensation strategies. A new 'inflow vascular-space-occupancy with dynamic subtraction (iVASO-DS)' MRI approach is presented where aCBV (mL blood/100 mL parenchyma) is quantified without contrast agents using the difference between images with and without inflowing blood water signal. The iVASO-DS contrast mechanism is investigated (3.0 T, spatial resolution=2.4 x 2.4 x 5 mm(3)) in healthy volunteers (n=8; age=29+/-5 years), and patients with mild (n=7; age=72+/-8 years) and severe (n=10; age=73+/-8 years) ICA stenoses. aCBV was quantified in right and left hemispheres in controls, and, alongside industry standard dynamic susceptibility contrast (DSC), contralateral (cont), and ipsilateral (ips) to maximum stenosis in patients. iVASO contrast significantly correlated (R=0.67, P<0.01) with DSC-CBV after accounting for transit time discrepancies. Gray matter aCBV (mL/100 mL) was 1.60+/-0.10 (right) versus 1.61+/-0.20 (left) in controls, 1.59+/-0.38 (cont) and 1.65+/-0.37 (ips) in mild stenosis patients, and 1.72+/-0.18 (cont) and 1.58+/-0.20 (ips) in severe stenosis patients. aCBV was asymmetric (P<0.01) in 41% of patients whereas no asymmetry was found in any control. The potential of iVASO-DS for autoregulation studies is discussed in the context of existing hemodynamic literature.

BOLD-specific cerebral blood volume and blood flow changes during neuronal activation in humans

To understand and predict the blood-oxygenation level-dependent (BOLD) fMRI signal, an accurate knowledge of the relationship between cerebral blood flow (DeltaCBF) and volume (DeltaCBV) changes is critical. Currently, this relationship is widely assumed to be characterized by Grubb's power-law, derived from primate data, where the power coefficient (alpha) was found to be 0.38. The validity of this general formulation has been examined previously, and an alpha of 0.38 has been frequently cited when calculating the cerebral oxygen metabolism change (DeltaCMRo(2)) using calibrated BOLD. However, the direct use of this relationship has been the subject of some debate, since it is well established that the BOLD signal is primarily modulated by changes in 'venous' CBV (DeltaCBV(v), comprising deoxygenated blood in the capillary, venular, and to a lesser extent, in the arteriolar compartments) instead of total CBV, and yet DeltaCBV(v) measurements in humans have been extremely scarce. In this work, we demonstrate reproducible DeltaCBV(v) measurements at 3 T using venous refocusing for the volume estimation (VERVE) technique, and report on steady-state DeltaCBV(v) and DeltaCBF measurements in human subjects undergoing graded visual and sensorimotor stimulation. We found that: (1) a BOLD-specific flow-volume power-law relationship is described by alpha = 0.23 +/- 0.05, significantly lower than Grubb's constant of 0.38 for total CBV; (2) this power-law constant was not found to vary significantly between the visual and sensorimotor areas; and (3) the use of Grubb's value of 0.38 in gradient-echo BOLD modeling results in an underestimation of DeltaCMRo(2).

Origins of the BOLD post-stimulus undershoot

The interpretation of the blood-oxygenation level-dependent (BOLD) post-stimulus undershoot has been a topic of considerable interest, as the mechanisms behind this prominent BOLD transient may provide valuable clues on the neurovascular response process and energy supply routes of the brain. Biomechanical theories explain the origin of the BOLD undershoot through the passive ballooning of post-capillary vessels which leads to an increase in venous blood volume (CBV(v), comprising deoxygenated blood in capillary, venular and arteriolar compartments), resulting in susceptibility-induced signal decrease. While there has been substantial evidence supporting a role for venous ballooning, there have also been reports arguing for a prolonged post-stimulus elevation in cerebral oxygenation consumption (CMRo(2)) as the primary cause. Furthermore, a contribution of post-stimulus cerebral blood flow (CBF) undershoots has also been demonstrated. To clarify the role of the venous compartment in causing the BOLD undershoot, we performed in vivo fMRI measurements of the transient DeltaCBV(v), DeltaCBF and DeltaBOLD responses in healthy humans. We observed a slow post-stimulus return to baseline in venous CBV which supports the existence of a passive "balloon" effect, implying that previous observations of a quicker recovery of the total CBV response may be dominated by arterial CBV change. Our findings also support a significant contribution from the CBF undershoots, which, combined with a slow venous CBV response, would account for much of the BOLD undershoot.

Current trends and challenges in MRI acquisitions to investigate brain function

Functional magnetic resonance imaging (fMRI) studies using the blood oxygenation level dependent (BOLD) response have become a widely used tool for noninvasive assessment of functional organization of the brain. Yet the technique is still fairly new, with many significant challenges remaining. Capitalizing on additional contrast mechanisms available with MRI, several other functional imaging techniques have been developed that potentially provide improved quantification or specificity of neuronal function. This article reviews the challenges and the current state of the art in MRI-based methods of imaging cognitive function.

Vascular space occupancy-dependent functional MRI by tissue suppression

PURPOSE

To measure the cerebral blood volume (CBV) dynamics during neural activation, a novel technique named vascular space occupancy (VASO)-based functional MRI (fMRI) was recently introduced for noninvasive CBV detection. However, its application is limited because of its low contrast-to-noise ratio (CNR) due to small signal change from the inverted blood.

MATERIALS AND METHODS

In this study a new approach-VASO with tissue suppression (VAST)-is proposed to enhance CNR. This technique is compared with VASO and blood oxygenation level-dependent (BOLD) fMRI in block-design and event-related visual experiments.

RESULTS

Based on acquired T(1) maps, 75.3% of the activated pixels detected by VAST are located in the cortical gray matter. Temporal characteristics of functional responses obtained by VAST were consistent with that of VASO. Although the baseline signal was decreased by the tissue suppression, the CNR of VAST was about 43% higher than VASO.

CONCLUSION

With the improved sensitivity, VAST fMRI provides a useful alternative for mapping the spatial/temporal features of regional CBV changes during brain activation. However, the technical imperfectness of VAST, such as the nonideal inversion efficiency and physiological contaminations, limits its application to precise CBV quantification.

Spin-echo MRI underestimates functional changes in microvascular cerebral blood plasma volume using exogenous contrast agent

While most functional MRI studies using exogenous contrast agent employ gradient-echo (GE) signal, spin echo (SE) imaging would represent an attractive alternative if its detection power were more comparable with GE imaging. This study demonstrates that SE methods systematically underestimate functional changes in microvascular cerebral blood plasma volume (CBV), so that SE detection power in brain tissue cannot match that provided by GE signal. Empirically, the in vivo response of SE-CBV was about 40% smaller than that of GE-CBV in rat brain at low basal values of CBV, a result that is consistent with physics predictions under the simplifying assumption of uniform vessel dilation. However, increasing values of basal CBV were associated with monotonically increasing mean vessel sizes and monotonically decreasing GE to SE ratios of functional changes in CBV (fCBV). This result suggests the presence of large but weakly reactive conduit vessels at high basal values of CBV. Hence, we conclude that GE imaging is the method of choice for functional MRI (fMRI) using exogenous contrast agent in most cases, although SE methods may represent a more spatially linear representation of underlying neural activity that becomes most apparent in regions with high basal CBV, such as the cortical surface.

Arterial versus total blood volume changes during neural activity-induced cerebral blood flow change: implication for BOLD fMRI

Quantifying both arterial cerebral blood volume (CBV(a)) changes and total cerebral blood volume (CBV(t)) changes during neural activation can provide critical information about vascular control mechanisms, and help to identify the origins of neurovascular responses in conventional blood oxygenation level dependent (BOLD) magnetic resonance imaging (MRI). Cerebral blood flow (CBF), CBV(a), and CBV(t) were quantified by MRI at 9.4 T in isoflurane-anesthetized rats during 15-s duration forepaw stimulation. Cerebral blood flow and CBV(a) were simultaneously determined by modulation of tissue and vessel signals using arterial spin labeling, while CBV(t) was measured with a susceptibility-based contrast agent. Baseline versus stimulation values in a region centered over the somatosensory cortex were: CBF=150+/-18 versus 182+/-20 mL/100 g/min, CBV(a)=0.83+/-0.21 versus 1.17+/-0.30 mL/100 g, CBV(t)=3.10+/-0.55 versus 3.41+/-0.61 mL/100 g, and CBV(a)/CBV(t)=0.27+/-0.05 versus 0.34+/-0.06 (n=7, mean+/-s.d.). Neural activity-induced absolute changes in CBV(a) and CBV(t) are statistically equivalent and independent of the spatial extent of regional analysis. Under our conditions, increased CBV(t) during neural activation originates mainly from arterial rather than venous blood volume changes, and therefore a critical implication is that venous blood volume changes may be negligible in BOLD fMRI.

Dynamics of changes in blood flow, volume, and oxygenation: implications for dynamic functional magnetic resonance imaging calibration

Changes in cerebral blood flow (CBF), volume (CBV), and oxygenation (blood-oxygenation level dependent (BOLD)) during functional activation are important for calculating changes in cerebral metabolic rate of oxygen consumption (CMRo2) from calibrated functional MRI (fMRI). An important part of this process is the CBF/CBV relationship, which is signified by a power-law parameter: gamma=ln (1+DeltaCBV/CBV)/ln (1+DeltaCBF/CBF). Because of difficulty in measuring CBF and CBV with MRI, the value of gamma is therefore assumed to be approximately 0.4 from a prior primate study under hypercapnia. For dynamic fMRI calibration, it is important to know if the value of gamma varies after stimulation onset. We measured transient relationships between DeltaCBF, DeltaCBV, and DeltaBOLD by multimodal MRI with temporal resolution of 500 ms (at 7.0 T) from the rat somatosensory cortex during forepaw stimulation, where the stimulus duration ranged from 4 to 32 secs. Changes in CBF and BOLD were measured before the administration of the contrast agent for CBV measurements in the same subjects. We observed that the relationship between DeltaCBF and DeltaCBV varied dynamically from stimulation onset for all stimulus durations. Typically after stimulation onset and at the peak or plateau of the DeltaCBF, the value of gamma ranged between 0.1 and 0.2. However, after stimulation offset, the value of gamma increased to 0.4 primarily because of rapid and slow decays in DeltaCBF and DeltaCBV, respectively. These results suggest caution in using dynamic measurements of DeltaCBF and DeltaBOLD required for calculating DeltaCMRo2 for functional stimulation, when either DeltaCBV has not been accurately measured or a fixed value of gamma during hypercapnia perturbation is used.

Fast spin echo sequences for BOLD functional MRI

At higher field strengths, spin echo (SE) functional MRI (fMRI) is an attractive alternative to gradient echo (GE) as the increased weighting towards the microvasculature results in intrinsically better localization of the BOLD signal. Images are free of signal voids but the commonly used echo planar imaging (EPI) sampling scheme causes geometric distortions, and T₂* effects often contribute considerably to the signal changes measured upon brain activation. Multiply refocused SE sequences such as fast spin echo (FSE) are essentially artifact free but their application to fast fMRI is usually hindered due to high energy deposition, and long sampling times. In the work presented here, a combination of parallel imaging and partial Fourier acquisition is used to shorten FSE acquisition times to near those of conventional SE-EPI, permitting sampling of eight slices (matrix 64  ×  64) per second. Signal acquisition is preceded by a preparation experiment that aims at increasing the relative contribution of extravascular dynamic averaging to the BOLD signal. Comparisons are made with conventional SE-EPI using a visual stimulation paradigm. While the observed signal changes are approximately 30% lower, most likely due to the absence of T₂* contamination, activation size and t-scores are comparable for both methods, suggesting that HASTE fMRI is a viable alternative, particularly if distortion free images are required. Our data also indicate that the BOLD post-stimulus undershoot is most probably attributable to persistent elevated oxygen metabolism rather than to delayed vascular compliance.

Principles of magnetic resonance assessment of brain function

MRI has advanced to being one of the major tools for the assessment of brain function. This review article examines the basic principles that underpin these measurements. The main emphasis is on the characteristics and detection of blood oxygen level dependent (BOLD) contrast. In the first part of the article the relationship between BOLD, blood flow, blood oxygen, and the rate of metabolic consumption of oxygen is described. The four contrast mechanisms that contribute to the BOLD signal change, namely extravascular static and dynamic dephasing, intravascular T2-like changes, and the intravascular frequency offset effect are described in terms of their spatial localization and relative contributions to the BOLD signal. The current model of changes in blood flow being an indirect consequence of synaptic input to a region is presented. The second section of the article deals with the imaging characteristics of BOLD in terms of the attainable spatial resolution and linear system characteristics. In the third section, practical BOLD imaging is examined for choice of pulse sequence, resolution, echo time (TE), repetition time (TR), and flip angle. The final section touches on other MRI approaches that are relevant to cognitive neuroimaging, in particular the measurement of blood flow, blood volume, resting state fluctuations in the BOLD signal, and measures of connectivity using diffusion tensor imaging and fiber-tracking.

Frontiers of brain mapping using MRI

Over the past dozen years, the use of MRI techniques to map brain function (fMRI) has sparked a great deal of research. The ability of fMRI to image several different physiological processes concurrently (i.e., blood oxygenation, blood flow, metabolism) and noninvasively over large volumes make it the ideal choice for many different areas of neuroscience research in addition to countless applications in clinical settings. Furthermore, with the advent of high magnetic fields (and other hardware advancements, i.e., parallel imaging) for both human and animal research, spatial and temporal resolutions continue to be pushed to higher levels because of increases in the sensitivity as well as specificity of MR-detectable functional signals. fMRI methodology continues to grow and has the ability to cater to many different research applications. There seems to be no foreseeable end in sight to the advancement of fMRI techniques and its subsequent use in basic research as well as in clinical settings. In this work, fMRI techniques and the ongoing development of existing techniques are discussed with implications for the future of fMRI.