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Rasti SD, Sugiarto AAR, Nuryandi APA, Arvianti MZ, Yomara RT, Nagasastra J, Julario R, Fagi RA, Windrati DMH. Revitalizing brain perfusion: Unveiling advancements through rhythm control strategies in atrial fibrillation-A systematic review. J Arrhythm 2024; 40:411-422. [PMID: 38939785 PMCID: PMC11199798 DOI: 10.1002/joa3.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/18/2024] [Accepted: 04/30/2024] [Indexed: 06/29/2024] Open
Abstract
Background Recent evidence suggests an elevated risk of cognitive impairment and dementia in individuals with atrial fibrillation (AF), irrespective of stroke occurrence. AF, known to reduce brain perfusion, particularly through silent cerebral ischemia, underscores the intricate relationship between cardiac and cerebral health. The heart plays a crucial role in supporting normal brain function, and rhythm control, a standard AF treatment, has demonstrated enhancements in brain perfusion. This systematic review aimed to examine published data concerning the influence of rhythm control on brain perfusion in patients with atrial fibrillation. Methods A systematic search for relevant studies was carried out in Scopus, PubMed, Cochrane Reviews, ProQuest, and EBSCOhost, spanning from their inception until April 30, 2023. Studies that specifically examined brain perfusion following any form of rhythm control in atrial fibrillation were included in the review. Results The review encompassed 10 studies involving 436 participants. Among these, six utilized electrical cardioversion for rhythm control. The majority (8 out of 10) demonstrated that restoring sinus rhythm markedly enhances brain perfusion. In one of the two remaining studies, notable improvement was observed specifically in a region closely linked to cognition. Additionally, both studies reporting data on the Mini-Mental State Examination (MMSE) showed a consistent and significant increase in scores following rhythm control. Conclusion Successful rhythm control in AF emerges as a significant contributor to enhanced brain perfusion, suggesting a potential therapeutic avenue for reducing cognitive impairment incidence. However, further validation through larger prospective studies and randomized trials is warranted.
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Affiliation(s)
| | | | | | | | | | | | - Rerdin Julario
- Department of Cardiology and Vascular MedicineDr. Soetomo General Hospital, Faculty of Medicine, University of AirlanggaSurabayaIndonesia
| | - Rosi Amrilla Fagi
- Department of Cardiology and Vascular MedicineDr. Soetomo General Hospital, Faculty of Medicine, University of AirlanggaSurabayaIndonesia
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2
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Iannotti GR, Nadin I, Ivanova V, Tourdot Q, Lascano AM, Momjian S, Schaller KL, Lovblad KO, Grouiller F. Specificity of Quantitative Functional Brain Mapping with Arterial Spin-Labeling for Preoperative Assessment. AJNR Am J Neuroradiol 2023; 44:1302-1308. [PMID: 37857448 PMCID: PMC10631521 DOI: 10.3174/ajnr.a8006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/28/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND AND PURPOSE Arterial spin-labeling is a noninvasive MR imaging technique allowing direct and quantitative measurement of brain perfusion. Arterial spin-labeling is well-established in clinics for investigating the overall cerebral perfusion, but it is still occasionally employed during tasks. The typical contrast for functional MR imaging is blood oxygen level-dependent (BOLD) imaging, whose specificity could be biased in neurologic patients due to altered neurovascular coupling. This work aimed to validate the use of functional ASL as a noninvasive tool for presurgical functional brain mapping. This is achieved by comparing the spatial accuracy of functional ASL with transcranial magnetic stimulation as the criterion standard. MATERIALS AND METHODS Twenty-eight healthy participants executed a motor task and received a somatosensory stimulation, while BOLD imaging and arterial spin-labeling were acquired simultaneously. Transcranial magnetic stimulation was subsequently used to define hand somatotopy. RESULTS Functional ASL was found more adjacent to transcranial magnetic stimulation than BOLD imaging, with a significant shift along the inferior-to-superior direction. With respect to BOLD imaging, functional ASL was localized significantly more laterally, anteriorly, and inferiorly during motor tasks and pneumatic stimulation. CONCLUSIONS Our results confirm the specificity of functional ASL in targeting the regional neuronal excitability. Functional ASL could be considered as a valid supplementary technique to BOLD imaging for presurgical mapping when spatial accuracy is crucial for delineating eloquent cortex.
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Affiliation(s)
- Giannina R Iannotti
- From the Division of Neuroradiology, Diagnostic Department (G.R.I., K.O.L.), Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Department of Neurosurgery (G.R.I., I.N., V.I., S.M., K.L.S.), Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Isaure Nadin
- Department of Neurosurgery (G.R.I., I.N., V.I., S.M., K.L.S.), Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Vladimira Ivanova
- Department of Neurosurgery (G.R.I., I.N., V.I., S.M., K.L.S.), Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Quentin Tourdot
- Faculty of Pharmacy (Q.T.), University of Montpellier, Montpellier, France
| | - Agustina M Lascano
- Division of Neurology (A.M.L.), Department of Clinical Neuroscience, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Shahan Momjian
- Department of Neurosurgery (G.R.I., I.N., V.I., S.M., K.L.S.), Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Karl L Schaller
- Department of Neurosurgery (G.R.I., I.N., V.I., S.M., K.L.S.), Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Karl O Lovblad
- From the Division of Neuroradiology, Diagnostic Department (G.R.I., K.O.L.), Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Frederic Grouiller
- Swiss Centre for Affective Sciences (F.G.), University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging (F.G.), MRI University of Geneva Cognitive and Affective Neuroimaging Section, Geneva, Switzerland
- Laboratory of Neurology and Imaging of Cognition (F.G.), Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
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3
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Gouel P, Decazes P, Vera P, Gardin I, Thureau S, Bohn P. Advances in PET and MRI imaging of tumor hypoxia. Front Med (Lausanne) 2023; 10:1055062. [PMID: 36844199 PMCID: PMC9947663 DOI: 10.3389/fmed.2023.1055062] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Tumor hypoxia is a complex and evolving phenomenon both in time and space. Molecular imaging allows to approach these variations, but the tracers used have their own limitations. PET imaging has the disadvantage of low resolution and must take into account molecular biodistribution, but has the advantage of high targeting accuracy. The relationship between the signal in MRI imaging and oxygen is complex but hopefully it would lead to the detection of truly oxygen-depleted tissue. Different ways of imaging hypoxia are discussed in this review, with nuclear medicine tracers such as [18F]-FMISO, [18F]-FAZA, or [64Cu]-ATSM but also with MRI techniques such as perfusion imaging, diffusion MRI or oxygen-enhanced MRI. Hypoxia is a pejorative factor regarding aggressiveness, tumor dissemination and resistance to treatments. Therefore, having accurate tools is particularly important.
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Affiliation(s)
- Pierrick Gouel
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Pierre Decazes
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Pierre Vera
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Isabelle Gardin
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Sébastien Thureau
- QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France,Département de Radiothérapie, Centre Henri Becquerel, Rouen, France
| | - Pierre Bohn
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France,*Correspondence: Pierre Bohn,
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4
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Kpoda HB, Savadogo LG, Samadoulougou DR, Traoré IT, Somda SM, Lemogoum D, Sombié I, Millogo A, Dramaix M, Donnen P. Prognostic factors of the lethality of stroke at the Sourô Sanou University Teaching Hospital (CHUSS) of Burkina Faso. Cerebrovasc Dis Extra 2022; 12:36-46. [PMID: 35235929 PMCID: PMC9149345 DOI: 10.1159/000523888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/25/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Stroke is a major public health concern. It is a frequent pathology, 80% of which is of ischemic origin. Approximately 86% of all stroke deaths worldwide occur in low- and middle-income countries. The objective of this study was to investigate prognostic factors for in hospital lethality of stroke cases admitted in a public university hospital in Burkina Faso. Methods This was a retrospective cohort study with a descriptive and analytical aim on adults admitted for a stroke confirmed by a brain scan at the Sourô Sanou University Teaching Hospital (CHUSS) of Bobo-Dioulasso over the period from January 1, 2009, to December 31, 2013. Results The proportion of cases confirmed by the brain CT scan was 32% of all patients admitted for stroke in the CHUSS. The overall case fatality was 27.6%. This lethality was more pronounced in patients with hemorrhagic stroke (35.8%) compared to patients with ischemic stroke (22.4%). Median survival was higher in patients with ischemic stroke than those with hemorrhagic one (36 and 25 days, respectively) with a statistically significant difference (p value = 0.001). In multivariate analysis and hemorrhagic stroke (hazard ratio [HR]: 2.25; CI 95%: 1.41–3.61), an altered state of consciousness (HR: 1.90; CI 95%: 1.20–2.99) and the presence of central facial paralysis (HR: 1.67; CI 95%: 1.04–2.67) are factors that increased significantly the lethality. Conclusion The study has identified three prognostic factors of lethality that are the hemorrhagic stroke type, the altered state of consciousness, and the central facial paralysis. Given the high case fatality, it is important to develop and implement effective prevention and management strategies adapted to the resources for the optimal control of stroke in Africa.
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Affiliation(s)
- Hervé B.N. Kpoda
- Centre MURAZ Research Institute/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
- *Hervé B.N. Kpoda,
| | - Léon G.B. Savadogo
- Sourô Sanou University Teaching Hospital, Bobo-Dioulasso, Burkina Faso
- Public Health Department, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
| | - Délwendé R.S. Samadoulougou
- Centre MURAZ Research Institute/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
- Sourô Sanou University Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Isidore T. Traoré
- Centre MURAZ Research Institute/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
- Public Health Department, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
| | - Serge M.A. Somda
- Centre MURAZ Research Institute/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
- Public Health Department, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
| | - Daniel Lemogoum
- Université Libre de Bruxelles-Erasme Hospital, Bruxelles, Belgium
| | - Issiaka Sombié
- Sourô Sanou University Teaching Hospital, Bobo-Dioulasso, Burkina Faso
- Public Health Department, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
| | - Athanase Millogo
- Sourô Sanou University Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Michèle Dramaix
- School of Public Health, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Philippe Donnen
- School of Public Health, Université Libre de Bruxelles, Bruxelles, Belgium
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5
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Impaired cerebrovascular reactivity is associated with recurrent stroke in patients with severe intracranial arterial stenosis: A C02 BOLD fMRI study. J Neuroradiol 2021; 48:339-345. [DOI: 10.1016/j.neurad.2020.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/08/2020] [Accepted: 04/28/2020] [Indexed: 11/20/2022]
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6
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Hoffmann AC, Ruel Y, Gnirs K, Papageorgiou S, Zilberstein L, Nahmani S, Boddaert N, Gaillot H. Brain perfusion magnetic resonance imaging using pseudocontinuous arterial spin labeling in 314 dogs and cats. J Vet Intern Med 2021; 35:2327-2341. [PMID: 34291497 PMCID: PMC8478041 DOI: 10.1111/jvim.16215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Arterial spin labeling (ASL) is a noninvasive brain perfusion magnetic resonance imaging (MRI) technique that has not been assessed in clinical veterinary medicine. Hypothesis/Objectives To test the feasibility of ASL using a 1.5 Tesla scanner and provide recommendations for optimal quantification of cerebral blood flow (CBF) in dogs and cats. Animals Three hundred fourteen prospectively selected client‐owned dogs and cats. Methods Each animal underwent brain MRI including morphological sequences and ≥1 ASL sequences using different sites of blood labeling and postlabeling delays (PLD). Calculated ASL success rates were compared. The CBF was quantified in animals that had morphologically normal brain MRI results and parameters of ASL optimization were investigated. Results Arterial spin labeling was easily implemented with an overall success rate of 95% in animals with normal brain MRI. Technical recommendations included (a) positioning of the imaging slab at the foramen magnum and (b) selected PLD of 1025 ms in cats and dogs <7 kg, 1525 ms in dogs 7 to 38 kg, and 2025 ms in dogs >38 kg. In 37 dogs, median optimal CBF in the cortex and thalamic nuclei were 114 and 95 mL/100 g/min, respectively. In 28 cats, median CBF in the cortex and thalamic nuclei were 113 and 114 mL/100 g/min, respectively. Conclusions and Clinical Importance Our survey of brain perfusion ASL‐MRI demonstrated the feasibility of ASL at 1.5 Tesla, suggested technical recommendations and provided CBF values that should be helpful in the characterization of various brain diseases in dogs and cats.
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Affiliation(s)
- Anne-Cécile Hoffmann
- Unit of Diagnostic Imaging, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Yannick Ruel
- Unit of Diagnostic Imaging, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Kirsten Gnirs
- Unit of Neurology, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Stella Papageorgiou
- Unit of Neurology, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Luca Zilberstein
- Unit of Anesthesiology-Analgesia, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Sarah Nahmani
- Paediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Nathalie Boddaert
- Paediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France.,Universié de Paris, Institut Imagine INSERM U1163, Paris, France
| | - Hugues Gaillot
- Unit of Diagnostic Imaging, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
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7
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Zhu L, Wu J, Niu H, Hao X, Yang C, Li X. Detection of age related differences in CBF with PCASL using 2 post label delays. Clin Imaging 2021; 79:36-42. [PMID: 33872914 DOI: 10.1016/j.clinimag.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/01/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The brain is reliant on an abundant and uninterrupted CBF for normal neural function because it is an organ with high metabolic activity and limited ability to store energy. PURPOSE This study aimed to compare age-related variations in CBF measured with PCASL. METHODS This prospective study included healthy volunteers at the Radiology Department of Shanxi Cardiovascular Hospital between October 2018 and July 2019. The volunteers were divided into three groups (n = 30 per group): young (≤44 years), middle-aged (45-59 years) and elderly (≥60 years). CBF was measured by PCASL using 2 post label delays (PLD) (PLD = 1.5 s, 2.5 s), and compared between PLDs and groups. The relation between CBF value and age was assessed by Pearson correlation analysis. RESULTS For PLD = 1.5 s, CBF differed significantly between groups for all brain regions (P < 0.05), with higher values in the young group and lower values in the elderly group. For PLD = 2.5 s, the young and middle-aged groups had broadly comparable CBF values, whereas the elderly group had higher CBF values (P < 0.05) for most brain regions. For both PLDs, no brain regions showed significant differences in CBF values between males and females. The CBF of all brain regions was negatively correlated with age for PLD = 1.5 s (P < 0.05) but not PLD = 2.5 s. Compared with PLD = 1.5 s, PLD = 2.5 s yielded lower CBF values for the young group and higher CBF values for the elderly group. CONCLUSION 3D-pCASL with dual PLDs can non-invasively evaluate age-related changes in CBF in healthy people.
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Affiliation(s)
- Lina Zhu
- Department of Magnetic Resonance, Shanxi Cardiovascular Hospital, Taiyuan, China
| | - Jiang Wu
- Department of Magnetic Resonance, Shanxi Cardiovascular Hospital, Taiyuan, China.
| | - Heng Niu
- Department of Magnetic Resonance, Shanxi Cardiovascular Hospital, Taiyuan, China
| | - Xiaoyong Hao
- Department of Magnetic Resonance, Shanxi Cardiovascular Hospital, Taiyuan, China
| | - Chaohui Yang
- Department of Magnetic Resonance, Shanxi Cardiovascular Hospital, Taiyuan, China
| | - Xuan Li
- Department of Magnetic Resonance, Shanxi Cardiovascular Hospital, Taiyuan, China
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8
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Courtie E, Veenith T, Logan A, Denniston AK, Blanch RJ. Retinal blood flow in critical illness and systemic disease: a review. Ann Intensive Care 2020; 10:152. [PMID: 33184724 PMCID: PMC7661622 DOI: 10.1186/s13613-020-00768-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Assessment and maintenance of end-organ perfusion are key to resuscitation in critical illness, although there are limited direct methods or proxy measures to assess cerebral perfusion. Novel non-invasive methods of monitoring microcirculation in critically ill patients offer the potential for real-time updates to improve patient outcomes. MAIN BODY Parallel mechanisms autoregulate retinal and cerebral microcirculation to maintain blood flow to meet metabolic demands across a range of perfusion pressures. Cerebral blood flow (CBF) is reduced and autoregulation impaired in sepsis, but current methods to image CBF do not reproducibly assess the microcirculation. Peripheral microcirculatory blood flow may be imaged in sublingual and conjunctival mucosa and is impaired in sepsis. Retinal microcirculation can be directly imaged by optical coherence tomography angiography (OCTA) during perfusion-deficit states such as sepsis, and other systemic haemodynamic disturbances such as acute coronary syndrome, and systemic inflammatory conditions such as inflammatory bowel disease. CONCLUSION Monitoring microcirculatory flow offers the potential to enhance monitoring in the care of critically ill patients, and imaging retinal blood flow during critical illness offers a potential biomarker for cerebral microcirculatory perfusion.
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Affiliation(s)
- E Courtie
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T Veenith
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Logan
- Axolotl Consulting Ltd, Droitwich, WR9 0JS, Worcestershire, UK
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - A K Denniston
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK
| | - R J Blanch
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
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9
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Soldozy S, Akyeampong DK, Barquin DL, Norat P, Yağmurlu K, Sokolowski JD, Sharifi KA, Tvrdik P, Park MS, Kalani MYS. Systematic Review of Functional Mapping and Cortical Reorganization in the Setting of Arteriovenous Malformations, Redefining Anatomical Eloquence. Front Surg 2020; 7:514247. [PMID: 33195382 PMCID: PMC7555608 DOI: 10.3389/fsurg.2020.514247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: The goal of this study was to systematically review functional mapping and reorganization that takes place in the setting of arteriovenous malformations (AVMs) and its potential impact on grading and surgical decision making. Methods: A systematic literature review was performed using the PubMed database for studies published between 1986 and 2019. Studies assessing brain mapping and functional reorganization in AVMs were included. Results: Of the total 84 articles identified in the original literature search, 12 studies were ultimately selected. This includes studies evaluating the impact of cortical reorganization on patient outcomes and factors impacting and triggering cortical reorganization in AVM. Conclusion: These studies demonstrate the utility of preoperative brain mapping and acknowledgment of functional reorganization in the setting of AVMs. While these findings led to alterations in Spetzler–Martin grading and subsequent surgical decision making, it remains unclear the clinical utility of this information when assessing patient outcomes. While promising, more research is required before recommendations can be made regarding functional brain mapping and cortical reorganization with respect to AVM surgery involving eloquent brain tissue.
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Affiliation(s)
- Sauson Soldozy
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Daniel K Akyeampong
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - David L Barquin
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Pedro Norat
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Kaan Yağmurlu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Jennifer D Sokolowski
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Khadijeh A Sharifi
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Petr Tvrdik
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Min S Park
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - M Yashar S Kalani
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
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10
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Thiel S, Lettau F, Rejmer P, Rossi C, Haile S, Schwarz EI, Stöberl AS, Sievi NA, Boss A, Becker AS, Winklhofer S, Stradling JR, Kohler M. Effects of short-term continuous positive airway pressure withdrawal on cerebral vascular reactivity measured by blood oxygen level-dependent magnetic resonance imaging in obstructive sleep apnoea: a randomised controlled trial. Eur Respir J 2019; 53:13993003.01854-2018. [DOI: 10.1183/13993003.01854-2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022]
Abstract
Impaired cerebral vascular reactivity (CVR) increases long-term stroke risk. Obstructive sleep apnoea (OSA) is associated with peripheral vascular dysfunction and vascular events. The aim of this trial was to evaluate the effect of continuous positive airway pressure (CPAP) withdrawal on CVR.41 OSA patients (88% male, mean age 57±10 years) were randomised to either subtherapeutic or continuation of therapeutic CPAP. At baseline and after 2 weeks, patients underwent a sleep study and magnetic resonance imaging (MRI). CVR was estimated by quantifying the blood oxygen level-dependent (BOLD) MRI response to breathing stimuli.OSA did recur in the subtherapeutic CPAP group (mean treatment effect apnoea–hypopnoea index +38.0 events·h−1, 95% CI 24.2–52.0; p<0.001) but remained controlled in the therapeutic group. Although there was a significant increase in blood pressure upon CPAP withdrawal (mean treatment effect +9.37 mmHg, 95% CI 1.36–17.39; p=0.023), there was no significant effect of CPAP withdrawal on CVR assessedviaBOLD MRI under either hyperoxic or hypercapnic conditions.Short-term CPAP withdrawal did not result in statistically significant changes in CVR as assessed by functional MRI, despite the recurrence of OSA. We thus conclude that, unlike peripheral endothelial function, CVR is not affected by short-term CPAP withdrawal.
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11
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Fuhrer H, Reinhard M, Niesen WD. Paradigm Change? Cardiac Output Better Associates with Cerebral Perfusion than Blood Pressure in Ischemic Stroke. Front Neurol 2017; 8:706. [PMID: 29312128 PMCID: PMC5743655 DOI: 10.3389/fneur.2017.00706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/07/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction In patients with acute ischemic stroke, penumbral perfusion is maintained by collateral flow and so far is maintained by normal mean arterial pressure (MAP) levels. Since MAP is dependent on cardiac function, optimization of cardiac output might be a valuable hemodynamic goal in order to optimize cerebral perfusion (CP). Methods Cerebral perfusion was assessed by transcranial color-coded duplex and transcranial perfusion sonography in 10 patients with acute large hemispheric stroke. Time-to-peak (TTP) values of defined regions of interest (ROI) within the middle cerebral artery (MCA) territory were assessed bilaterally in addition to mean flow velocities of the MCA. Via semi-invasive advanced hemodynamic monitoring systemic hemodynamic parameters were assessed, including MAP and cardiac index (CI). Patients received sonographic follow-up after optimizing CI. Results TTP values of the deeply located ROIs of the non-affected as well as the affected hemisphere correlated highly significantly with CI (in affected side r = −0.827, p = 0.002; and in non-affected side r = −0.908, p < 0.0001). This demonstrates dependence of CP on CI, while correlation with MAP was not detected. Neither CI nor MAP revealed significant correlation with MCA velocity.
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Affiliation(s)
- Hannah Fuhrer
- Department of Neurology, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Reinhard
- Department of Neurology, University Medical Center, University of Freiburg, Freiburg, Germany.,Department of Neurology, Medical Center Esslingen, Teaching Hospital of the University of Tuebingen, Esslingen, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology, University Medical Center, University of Freiburg, Freiburg, Germany
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Fuhrer H, Günther A, Zinke J, Niesen WD. Optimizing Cardiac Out-Put to Increase Cerebral Penumbral Perfusion in Large Middle Cerebral Artery Ischemic Lesion-OPTIMAL Study. Front Neurol 2017; 8:402. [PMID: 28848494 PMCID: PMC5554127 DOI: 10.3389/fneur.2017.00402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/26/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION In unsuccessful vessel recanalization, clinical outcome of acute stroke patients depends on early improvement of penumbral perfusion. So far, mean arterial blood pressure (MAP) is the target hemodynamic parameter. However, the correlations of MAP to cardiac output (CO) and cerebral perfusion are volume state dependent. In severe subarachnoid hemorrhage, optimizing CO leads to a reduction of delayed ischemic neurological deficits and improvement of clinical outcome. This study aims to investigate the effect of standard versus advanced cardiac monitoring with optimization of CO on the clinical outcome in patients with large ischemic stroke. METHODS AND ANALYSIS The OPTIMAL study is a prospective, multicenter, open, into two arms (1:1) randomized, controlled trial. Sample size estimate: sample sizes of 150 for each treatment group (300 in total) ensure an 80% power to detect a difference of 16% of a dichotomized level of functional clinical outcome at 3 months at a significance level of 0.05. Study outcomes: the primary endpoint is the functional outcome at 3 months. The secondary endpoints include functional outcome at 6 months follow-up, and complications related to hemodynamic monitoring and therapies. DISCUSSION The results of this trial will provide data on the safety and efficacy of advanced hemodynamic monitoring on clinical outcome. ETHICS AND DISSEMINATION The trial was approved by the leading ethics committee of Freiburg University, Germany (438/14, 2015) and the local ethics committees of the participating centers. The study is performed in accordance with the Declaration of Helsinki and the guidelines of Good Clinical Practice. It is registered in the German Clinical Trial register (DRKS; DRKS00007805). Dissemination will include submission to peer-reviewed professional journals and presentation at congresses. Hemodynamic monitoring may be altered in a specific stroke patient cohort if the study shows that advanced monitoring is safe and improves the functional outcome.
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Affiliation(s)
- Hannah Fuhrer
- Department of Neurology, Albert Ludwig University of Freiburg, Freiburg, Germany
| | - Albrecht Günther
- Department of Neurology, Friedrich Schiller University Jena, Jena, Germany
| | - Jan Zinke
- Department of Neurology, Friedrich Schiller University Jena, Jena, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology, Albert Ludwig University of Freiburg, Freiburg, Germany
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Bellot E, Coizet V, Warnking J, Knoblauch K, Moro E, Dojat M. Effects of aging on low luminance contrast processing in humans. Neuroimage 2016; 139:415-426. [DOI: 10.1016/j.neuroimage.2016.06.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/02/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022] Open
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Influence of Vascular Variant of the Posterior Cerebral Artery (PCA) on Cerebral Blood Flow, Vascular Response to CO2 and Static Functional Connectivity. PLoS One 2016; 11:e0161121. [PMID: 27532633 PMCID: PMC4988665 DOI: 10.1371/journal.pone.0161121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/30/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction The fetal origin of the posterior cerebral artery (fPCA) is a frequent vascular variant in 11–29% of the population. For the fPCA, blood flow in the PCA originates from the anterior instead of the posterior circulation. We tested whether this blood supply variant impacts the cerebral blood flow assessed by arterial spin labeling (ASL), cerebrovascular reserve as well as resting-state static functional connectivity (sFC) in the sense of a systematic confound. Methods The study included 385 healthy, elderly subjects (mean age: 74.18 years [range: 68.9–90.4]; 243 female). Participants were classified into normal vascular supply (n = 296, 76.88%), right fetal origin (n = 23, 5.97%), left fetal origin (n = 16, 4.16%), bilateral fetal origin (n = 4, 1.04%), and intermediate (n = 46, 11.95%, excluded from further analysis) groups. ASL-derived relative cerebral blood flow (relCBF) maps and cerebrovascular reserve (CVR) maps derived from a CO2 challenge with blocks of 7% CO2 were compared. Additionally, sFC between 90 regions of interest (ROIs) was compared between the groups. Results CVR was significantly reduced in subjects with ipsilateral fPCA, most prominently in the temporal lobe. ASL yielded a non-significant trend towards reduced relCBF in bilateral posterior watershed areas. In contrast, conventional atlas-based sFC did not differ between groups. Conclusions In conclusion, fPCA presence may bias the assessment of cerebrovascular reserve by reducing the response to CO2. In contrast, its effect on ASL-assessed baseline perfusion was marginal. Moreover, fPCA presence did not systematically impact resting-state sFC. Taken together, this data implies that perfusion variables should take into account the vascularization patterns.
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Respiratory challenge MRI: Practical aspects. NEUROIMAGE-CLINICAL 2016; 11:667-677. [PMID: 27330967 PMCID: PMC4901170 DOI: 10.1016/j.nicl.2016.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/11/2016] [Accepted: 05/03/2016] [Indexed: 11/24/2022]
Abstract
Respiratory challenge MRI is the modification of arterial oxygen (PaO2) and/or carbon dioxide (PaCO2) concentration to induce a change in cerebral function or metabolism which is then measured by MRI. Alterations in arterial gas concentrations can lead to profound changes in cerebral haemodynamics which can be studied using a variety of MRI sequences. Whilst such experiments may provide a wealth of information, conducting them can be complex and challenging. In this paper we review the rationale for respiratory challenge MRI including the effects of oxygen and carbon dioxide on the cerebral circulation. We also discuss the planning, equipment, monitoring and techniques that have been used to undertake these experiments. We finally propose some recommendations in this evolving area for conducting these experiments to enhance data quality and comparison between techniques. Oxygen and carbon dioxide affect cerebral blood flow and metabolism. This can be imaged with various MRI sequences. The practicalities of these techniques are reviewed. Examples of how this has been used to understand disease mechanisms.
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Fuhrer H, Weiller C, Niesen WD. Is mean arterial pressure the best parameter in ischemic stroke? Clin Case Rep 2016; 4:236-9. [PMID: 27014441 PMCID: PMC4771867 DOI: 10.1002/ccr3.491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 10/11/2015] [Accepted: 12/17/2015] [Indexed: 01/01/2023] Open
Abstract
This case series of 27 patients with large stroke challenges the current state of the art guiding hemodynamic management by blood pressure levels. The results show that assumed correlations of blood pressure, cardiac output, and systemic vascular resistance do not exist. Therefore, hemodynamic therapy may better be guided by cardiac output.
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Affiliation(s)
- Hannah Fuhrer
- Department of Neurology University of Freiburg Breisacher Straße 64 79106 Freiburg Germany
| | - Cornelius Weiller
- Department of Neurology University of Freiburg Breisacher Straße 64 79106 Freiburg Germany
| | - Wolf-Dirk Niesen
- Department of Neurology University of Freiburg Breisacher Straße 64 79106 Freiburg Germany
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Yao Y, Lu Q, Jin LR, Zhou XQ, Huang Y, Xu WH. Real-time TCD-vEEG monitoring for neurovascular coupling in epilepsy. Seizure 2015; 29:1-3. [PMID: 26076836 DOI: 10.1016/j.seizure.2015.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/01/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Recently, a novel multi-model monitor has been available, which integrates real-time signals of transcranial Doppler (TCD) and video-EEG (vEEG) into one workstation. We sought to test the feasibility of this device in detecting neurovascular coupling in patients with epilepsy. METHOD Cerebral blood flow velocity (CBFV) of bilateral middle cerebral arteries and vEEG during seizure episodes were recorded simultaneously in 12 patients (age 17-58 years) with partial epilepsies. The correlations between vEEG and CBFV findings were analyzed. RESULTS Eleven seizure episodes were detected in 5 patients. Of them, bilateral CBFV increase with interhemispheric asymmetry was observed in 4 seizure episodes of 3 patients. EEG abnormalities preceded CBFV increase by 1-3s at the onset of a seizure. In a patient with bilateral middle cerebral artery stenosis, no apparent CBFV changes were detected during 2 of 3 seizure episodes. Another patient with previous frontal hemorrhage displayed CBFV increase without interhemispheric asymmetry during 4 seizure episodes. CONCLUSION It is feasible to evaluate neurovascular coupling with good temporal correlation in patients with frequent seizure episodes by real-time TCD-vEEG monitoring.
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Affiliation(s)
- Yuan Yao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1, Dong Cheng District, Beijing 100730, China.
| | - Qiang Lu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1, Dong Cheng District, Beijing 100730, China.
| | - Li-Ri Jin
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1, Dong Cheng District, Beijing 100730, China.
| | - Xiang-Qin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1, Dong Cheng District, Beijing 100730, China.
| | - Yan Huang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1, Dong Cheng District, Beijing 100730, China.
| | - Wei-Hai Xu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1, Dong Cheng District, Beijing 100730, China.
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Boudiaf N, Attyé A, Warnking JM, Troprès I, Lamalle L, Pietras J, Krainik A. BOLD fMRI of cerebrovascular reactivity in the middle cerebral artery territory: A 100 volunteers' study. J Neuroradiol 2015; 42:338-44. [PMID: 26031884 DOI: 10.1016/j.neurad.2015.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/26/2015] [Accepted: 04/05/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE The assessment of cerebrovascular reactivity (CVR) has shown promising results for its use in medical diagnosis and prognosis, especially in patients suffering from severe intracranial arterial stenosis. However, its quantification remains uncertain because of a large variability inherent in brain anatomy and in methodological settings. To overcome this variability, we provide lateralization index (LI) values for CVR within the middle cerebral artery territory to detect CVR impairment. MATERIALS AND METHODS We assessed CVR in 100 volunteers (41 females; 47.52 ± 21.58 years) without cervico-encephalic arterial stenosis using BOLD-fMRI contrast with a block-design hypercapnic challenge. Averaged end-tidal CO2 was used as a physiological regressor for statistical analyses with a general linear model. We measured %BOLD signal-change in segmented gray matter regions of interest in the middle cerebral artery territory (MCA). We calculated a laterality index according to the following formula: LI=(CVRleft-CVRright)/(CVRleft+CVRright). We tested the effects of methodological settings (i.e. hypercapnic gas, gas administration means, MR acquisition and sex) on %BOLD signal change and LI values with analysis of variance. RESULTS No adverse effects of the hypercapnic challenge were reported. LI values were independent of experimental conditions. Mean LI calculated in MCA territories was 0.016 ± 0.031, giving the lower and upper limits of 95% (m ± 2SD) of this population distribution at]-0.05; 0.08[. CONCLUSION LI can effectively help us to overcome measurement variabilities. Therefore, it can be used to detect abnormal asymmetries in CVR and identify patients at higher risk of ischemic stroke.
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Affiliation(s)
- Naïla Boudiaf
- Université Grenoble Alpes 3bis, CNRS, LPNC, 38000 Grenoble, France; Université Savoie 3, LPNC, 73000 Chambéry, France.
| | - Arnaud Attyé
- Inserm, université Grenoble Alpes, GIN, CHU de Grenoble, 38000 Grenoble, France; Department of Neuroradiology and MRI, University Hospital of Grenoble-IFR1, Grenoble, France
| | - Jan M Warnking
- Inserm, université Grenoble Alpes, GIN, CHU de Grenoble, 38000 Grenoble, France
| | - Irène Troprès
- Inserm, université Grenoble Alpes, GIN, CHU de Grenoble, 38000 Grenoble, France; Inserm, université Grenoble Alpes, CNRS, IRMaGe, CHU de Grenoble, 38000 Grenoble, France
| | - Laurent Lamalle
- Inserm, université Grenoble Alpes, CNRS, IRMaGe, CHU de Grenoble, 38000 Grenoble, France
| | - Johan Pietras
- Inserm, université Grenoble Alpes, CNRS, IRMaGe, CHU de Grenoble, 38000 Grenoble, France
| | - Alexandre Krainik
- Inserm, université Grenoble Alpes, GIN, CHU de Grenoble, 38000 Grenoble, France; Inserm, université Grenoble Alpes, CNRS, IRMaGe, CHU de Grenoble, 38000 Grenoble, France; Department of Neuroradiology and MRI, University Hospital of Grenoble-IFR1, Grenoble, France
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Bouvier J, Detante O, Tahon F, Attye A, Perret T, Chechin D, Barbieux M, Boubagra K, Garambois K, Tropres I, Grand S, Barbier EL, Krainik A. Reduced CMRO₂ and cerebrovascular reserve in patients with severe intracranial arterial stenosis: a combined multiparametric qBOLD oxygenation and BOLD fMRI study. Hum Brain Mapp 2014; 36:695-706. [PMID: 25307948 DOI: 10.1002/hbm.22657] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/23/2014] [Accepted: 10/01/2014] [Indexed: 11/08/2022] Open
Abstract
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.
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Affiliation(s)
- Julien Bouvier
- Inserm, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France; Philips France (Healthcare Activity), Suresnes, France
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Williams M, Lee JK. Intraoperative blood pressure and cerebral perfusion: strategies to clarify hemodynamic goals. Paediatr Anaesth 2014; 24:657-67. [PMID: 24725244 PMCID: PMC4154320 DOI: 10.1111/pan.12401] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2014] [Indexed: 01/24/2023]
Abstract
Blood pressure can vary considerably during anesthesia. If blood pressure falls outside the limits of cerebrovascular autoregulation, children can become at risk of cerebral ischemic or hyperemic injury. However, the blood pressure limits of autoregulation are unclear in infants and children, and these limits can shift after brain injury. This article will review autoregulation, considerations for the hemodynamic management of children with brain injuries, and research on autoregulation monitoring techniques.
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Affiliation(s)
- Monica Williams
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, USA
| | - Jennifer K. Lee
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, USA
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