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Jiang D, Lin Z, Liu P, Sur S, Xu C, Hazel K, Pottanat G, Yasar S, Rosenberg P, Albert M, Lu H. Normal variations in brain oxygen extraction fraction are partly attributed to differences in end-tidal CO 2. J Cereb Blood Flow Metab 2020; 40:1492-1500. [PMID: 31382788 PMCID: PMC7308520 DOI: 10.1177/0271678x19867154] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cerebral oxygen extraction fraction is an important physiological index of the brain's oxygen consumption and supply and has been suggested to be a potential biomarker for a number of diseases such as stroke, Alzheimer's disease, multiple sclerosis, sickle cell disease, and metabolic disorders. However, in order for oxygen extraction fraction to be a sensitive biomarker for personalized disease diagnosis, inter-subject variations in normal subjects must be minimized or accounted for, which will otherwise obscure its interpretation. Therefore, it is essential to investigate the physiological underpinnings of normal differences in oxygen extraction fraction. This work used two studies, one discovery study and one verification study, to examine the extent to which an individual's end-tidal CO2 can explain variations in oxygen extraction fraction. It was found that, across normal subjects, oxygen extraction fraction is inversely correlated with end-tidal CO2. Approximately 50% of the inter-subject variations in oxygen extraction fraction can be attributed to end-tidal CO2 differences. In addition, oxygen extraction fraction was found to be positively associated with age and systolic blood pressure. By accounting for end-tidal CO2, age, and systolic blood pressure of the subjects, normal variations in oxygen extraction fraction can be reduced by 73%, which is expected to substantially enhance the utility of oxygen extraction fraction as a disease biomarker.
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Affiliation(s)
- Dengrong Jiang
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zixuan Lin
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peiying Liu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sandeepa Sur
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cuimei Xu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kaisha Hazel
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George Pottanat
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
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Welker K, Boxerman J, Kalnin A, Kaufmann T, Shiroishi M, Wintermark M. ASFNR recommendations for clinical performance of MR dynamic susceptibility contrast perfusion imaging of the brain. AJNR Am J Neuroradiol 2015; 36:E41-51. [PMID: 25907520 DOI: 10.3174/ajnr.a4341] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/20/2015] [Indexed: 11/07/2022]
Abstract
MR perfusion imaging is becoming an increasingly common means of evaluating a variety of cerebral pathologies, including tumors and ischemia. In particular, there has been great interest in the use of MR perfusion imaging for both assessing brain tumor grade and for monitoring for tumor recurrence in previously treated patients. Of the various techniques devised for evaluating cerebral perfusion imaging, the dynamic susceptibility contrast method has been employed most widely among clinical MR imaging practitioners. However, when implementing DSC MR perfusion imaging in a contemporary radiology practice, a neuroradiologist is confronted with a large number of decisions. These include choices surrounding appropriate patient selection, scan-acquisition parameters, data-postprocessing methods, image interpretation, and reporting. Throughout the imaging literature, there is conflicting advice on these issues. In an effort to provide guidance to neuroradiologists struggling to implement DSC perfusion imaging in their MR imaging practice, the Clinical Practice Committee of the American Society of Functional Neuroradiology has provided the following recommendations. This guidance is based on review of the literature coupled with the practice experience of the authors. While the ASFNR acknowledges that alternate means of carrying out DSC perfusion imaging may yield clinically acceptable results, the following recommendations should provide a framework for achieving routine success in this complicated-but-rewarding aspect of neuroradiology MR imaging practice.
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Affiliation(s)
- K Welker
- From the Department of Radiology (K.W., T.K.), Mayo Clinic, Rochester, Minnesota
| | - J Boxerman
- Department of Diagnostic Imaging (J.B.), Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
| | - A Kalnin
- Department of Radiology (A.K.), Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - T Kaufmann
- From the Department of Radiology (K.W., T.K.), Mayo Clinic, Rochester, Minnesota
| | - M Shiroishi
- Division of Neuroradiology, Department of Radiology (M.S.), Keck School of Medicine, University of Southern California, Los Angeles, California
| | - M Wintermark
- Department of Radiology, Neuroradiology Section (M.W.), Stanford University, Stanford, California
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Jahanian H, Peltier S, Noll DC, Hernandez Garcia L. Arterial cerebral blood volume-weighted functional MRI using pseudocontinuous arterial spin tagging (AVAST). Magn Reson Med 2015; 73:1053-64. [PMID: 24753198 DOI: 10.1002/mrm.25220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/14/2014] [Accepted: 02/25/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE Neurovascular regulation, including responses to neural activation that give rise to the blood oxygenation level-dependent (BOLD) effect, occurs mainly at the arterial and arteriolar level. The purpose of this study is to develop a framework for fast imaging of arterial cerebral blood volume (aCBV) signal suitable for functional imaging studies. METHODS A variant of the pseudocontinuous arterial spin tagging technique was developed in order to achieve a contrast that depends on aCBV with little contamination from perfusion signal by taking advantage of the kinetics of the tag through the vasculature. This technique tailors the tagging duration and repetition time for each subject. The proposed technique, called AVAST, is compared empirically with BOLD imaging and standard (perfusion-weighted) arterial spin labeling (ASL) technique, in a motor-visual activation paradigm. RESULTS The average Z-scores in the activated area obtained over all the subjects were 4.25, 5.52, and 7.87 for standard ASL, AVAST, and BOLD techniques, respectively. The aCBV contrast obtained from AVAST provided 80% higher average signal-to-noise ratio and 95% higher average contrast-to-noise ratio compared with that of the standard ASL measurements. CONCLUSION AVAST exhibits improved activation detection sensitivity and temporal resolution over the standard ASL technique, in functional MRI experiments, while preserving its quantitative nature and statistical advantages. AVAST particularly could be useful in clinical studies of pathological conditions, longitudinal studies of cognitive function, and studies requiring sustained periods of the condition.
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Comparing cerebrovascular reactivity measured using BOLD and cerebral blood flow MRI: The effect of basal vascular tension on vasodilatory and vasoconstrictive reactivity. Neuroimage 2015; 110:110-23. [PMID: 25655446 DOI: 10.1016/j.neuroimage.2015.01.050] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/15/2015] [Accepted: 01/26/2015] [Indexed: 11/23/2022] Open
Abstract
Cerebrovascular reactivity (CVR) is an important metric of cerebrovascular health. While the BOLD fMRI method in conjunction with carbon-dioxide (CO2) based vascular manipulation has been the most commonly used, the BOLD signal is not a direct measure of vascular changes, and the use of arterial-spin labeling (ASL) cerebral blood flow (CBF) imaging is increasingly advocated. Nonetheless, given the differing dependencies of BOLD and CBF on vascular baseline conditions and the diverse CO2 manipulation types currently used in the literature, knowledge of potential biases introduced by each technique is critical for the interpretation of CVR measurements. In this work, we use simultaneous BOLD-CBF acquisitions during both vasodilatory (hypercapnic) and vasoconstrictive (hypocapnic) stimuli to measure CVR. We further imposed different levels of baseline vascular tension by inducing hypercapnic and hypocapnic baselines, separately from normocapnia by 4mmHg. We saw significant and diverse dependencies on vascular stimulus and baseline condition in both BOLD and CBF CVR measurements: (i) BOLD-based CVR is more sensitive to basal vascular tension than CBF-based CVR; (ii) the use of a combination of vasodilatory and vasoconstrictive stimuli maximizes the sensitivity of CBF-based CVR to vascular tension changes; (iii) the BOLD and CBF vascular response delays are both significantly lengthened at predilated baseline. As vascular tension can often be altered by potential pathology, our findings are important considerations when interpreting CVR measurements in health and disease.
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Driver ID, Wharton SJ, Croal PL, Bowtell R, Francis ST, Gowland PA. Global intravascular and local hyperoxia contrast phase-based blood oxygenation measurements. Neuroimage 2014; 101:458-65. [PMID: 25091128 PMCID: PMC4176654 DOI: 10.1016/j.neuroimage.2014.07.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/22/2014] [Accepted: 07/24/2014] [Indexed: 12/12/2022] Open
Abstract
The measurement of venous cerebral blood oxygenation (Yv) has potential applications in the study of patient groups where oxygen extraction and/or metabolism are compromised. It is also useful for fMRI studies to assess the stimulus-induced changes in Yv, particularly since basal Yv partially accounts for inter-subject variation in the haemodynamic response to a stimulus. A range of MRI-based methods of measuring Yv have been developed recently. Here, we use a method based on the change in phase in the MR image arising from the field perturbation caused by deoxygenated haemoglobin in veins. We build on the existing phase based approach (Method I), where Yv is measured in a large vein (such as the superior sagittal sinus) based on the field shift inside the vein with assumptions as to the vein's shape and orientation. We demonstrate two novel modifications which address limitations of this method. The first modification (Method II), maps the actual form of the vein, rather than assume a given shape and orientation. The second modification (Method III) uses the intra and perivascular phase change in response to a known change in Yv on hyperoxia to measure normoxic Yv in smaller veins. Method III can be applied to veins whose shape, size and orientation are not accurately known, thus allowing more localised measures of venous oxygenation. Results demonstrate that the use of an overly fine spatial filter caused an overestimation in Yv for Method I, whilst the measurement of Yv using Method II was less sensitive to this bias, giving Yv = 0.62 ± 0.03. Method III was applied to mapping of Yv in local veins across the brain, yielding a distribution of values with a mode of Yv = 0.661 ± 0.008.
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Affiliation(s)
- Ian D Driver
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK; Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
| | - Samuel J Wharton
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Paula L Croal
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Richard Bowtell
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Susan T Francis
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Penny A Gowland
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.
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Yu L, Xie S, Xiao J, Wang Z, Zhang X. Quantitative measurement of cerebral oxygen extraction fraction using MRI in patients with MELAS. PLoS One 2013; 8:e79859. [PMID: 24260310 PMCID: PMC3832652 DOI: 10.1371/journal.pone.0079859] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/25/2013] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To quantify the cerebral OEF at different phases of stroke-like episodes in patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) by using MRI. METHODS We recruited 32 patients with MELAS confirmed by gene analysis. Conventional MRI scanning, as well as functional MRI including arterial spin labeling and oxygen extraction fraction imaging, was undertaken to obtain the pathological and metabolic information of the brains at different stages of stroke-like episodes in patients. A total of 16 MRI examinations at the acute and subacute phase and 19 examinations at the interictal phase were performed. In addition, 24 healthy volunteers were recruited for control subjects. Six regions of interest were placed in the anterior, middle, and posterior parts of the bilateral hemispheres to measure the OEF of the brain or the lesions. RESULTS OEF was reduced significantly in brains of patients at both the acute and subacute phase (0.266 ± 0.026) and at the interictal phase (0.295 ± 0.009), compared with normal controls (0.316 ± 0.025). In the brains at the acute and subacute phase of the episode, 13 ROIs were prescribed on the stroke-like lesions, which showed decreased OEF compared with the contralateral spared brain regions. Increased blood flow was revealed in the stroke-like lesions at the acute and subacute phase, which was confined to the lesions. CONCLUSION MRI can quantitatively show changes in OEF at different phases of stroke-like episodes. The utilization of oxygen in the brain seems to be reduced more severely after the onset of episodes in MELAS, especially for those brain tissues involved in the episodes.
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Affiliation(s)
- Lei Yu
- Department of Radiology, Peking University First Hospital, BeiJing, China
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, BeiJing, China
- * E-mail: (SX); (JX)
| | - Jiangxi Xiao
- Department of Radiology, Peking University First Hospital, BeiJing, China
- * E-mail: (SX); (JX)
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, BeiJing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, BeiJing, China
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Metabolic Imaging in Translational Stroke Research. Transl Stroke Res 2012. [DOI: 10.1007/978-1-4419-9530-8_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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The effect of basal vasodilation on hypercapnic and hypocapnic reactivity measured using magnetic resonance imaging. J Cereb Blood Flow Metab 2011; 31:426-38. [PMID: 20959855 PMCID: PMC3049535 DOI: 10.1038/jcbfm.2010.187] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cerebrovascular reactivity to vasodilatory hypercapnic and vasoconstrictive hypocapnic challenges is known to be altered in several hemodynamic disorders, which is often attributable to changes in smooth muscle-mediated vascular compliance. Recently, attenuated reactivity to hypercapnia but enhanced reactivity to hypocapnia was observed in patients with chronic stroke. We hypothesize that the latter observation could be explained by a change in the basal vascular tone. In particular, reduced cerebral perfusion pressure, as is prevalent in these patients, may cause vasodilation through autoregulatory mechanisms, and this compensatory baseline condition may alter reactivity to vasoconstrictive hypocapnic challenges. To test this hypothesis, a predilated vascular condition was created in young, healthy subjects (n=11; age=23 to 36 years) using inhalation of 4% CO(2). Using blood oxygenation level-dependent functional magnetic resonance imaging at 3 T, breath holding and cued deep breathing respiratory challenges were administered to assess hypercapnia and hypocapnia reactivity, respectively. During the predilated condition, vasoconstrictive reactivity to hypocapnia was significantly (21.1%, P=0.016) enhanced throughout the gray matter, whereas there was no significant change (6.4%, P=0.459) in hypercapnic vasodilatory reactivity. This suggests that baseline vasodilation may explain the enhanced hypocapnia reactivity observed in some stroke patients, and that hypocapnia challenges may help identify the level of vascular compliance in patients with reduced cerebral perfusion pressure.
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Uh J, Lewis-Amezcua K, Varghese R, Lu H. On the measurement of absolute cerebral blood volume (CBV) using vascular-space-occupancy (VASO) MRI. Magn Reson Med 2009; 61:659-67. [PMID: 19097238 DOI: 10.1002/mrm.21872] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recently, a vascular-space-occupancy (VASO) MRI technique was developed for quantitative assessment of cerebral blood volume (CBV). This method uses the T(1)-shortening effect of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) with imaging parameters chosen that null the precontrast blood magnetization but allow the postcontrast blood magnetization to recover to equilibrium. A key advantage of VASO CBV estimation is that it provides a straightforward procedure for converting MR signals to absolute physiologic values. However, as with other T(1)-based steady-state approaches, several important factors need to be considered that influence the accuracy of CBV values obtained with VASO MRI. Here, the transverse relaxation (T(2)/T(2) (*)) effect in VASO MRI was investigated using multiecho spin-echo and gradient-echo experiments, resulting in underestimation of CBV by 14.9% +/- 1.1% and 16.0% +/- 2.5% for spin echo (TE = 10 ms) and gradient echo (TE = 6 ms), respectively. In addition, the influence of contrast agent clearance was studied by acquiring multiple postcontrast VASO images at 2.2-min intervals, which showed that the concentration of Gd-DTPA in the first 14 min (single dose) was sufficient for the blood magnetization to fully recover to equilibrium. Finally, the effect of vascular Gd-DTPA leakage was assessed for scalp tissue, and signal extrapolation as a function of postinjection time was demonstrated to be useful in minimizing the associated errors. Specific recommendations for VASO MRI acquisition and processing strategies are provided.
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Affiliation(s)
- Jinsoo Uh
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
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Kosior JC, Kosior RK, Frayne R. Robust dynamic susceptibility contrast MR perfusion using 4D nonlinear noise filters. J Magn Reson Imaging 2007; 26:1514-22. [DOI: 10.1002/jmri.21219] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Anderson CM, Kaufman MJ, Lowen SB, Rohan M, Renshaw PF, Teicher MH. Brain T2 relaxation times correlate with regional cerebral blood volume. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2004; 18:3-6. [PMID: 15592693 DOI: 10.1007/s10334-004-0076-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2004] [Revised: 10/01/2004] [Accepted: 10/07/2004] [Indexed: 11/30/2022]
Abstract
We previously reported cerebellar and putaminal transverse relaxation time (T2) differences in children with ADHD and in adults with childhood trauma. As brain T2 can be altered by deoxyhemoglobin concentration ([dHb]) and because [dHb] is proportional to regional cerebral blood volume (rCBV), at steady state we attributed those differences to rCBV changes. Studies in other species have established a correlation between T2 and rCBV; however this has yet to be demonstrated in human brain. Echo planar imaging (EPI) T2 relaxometry and dynamic susceptibility-contrast (DSC) MRI were used to measure T2 and rCBV in 11 healthy adults. Significant T2-rCBV correlations were observed in both cerebellar vermis and putamen (r = 0.759,p = 0.007;r = 0.782,p = 0.004, respectively). These correlations predict 9 +/- 3% and 10 +/- 3% rCBV changes, respectively, for each 1-msec change in T2. Consequently, brain T2 measurements may be useful for estimating steady-state rCBV.
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Affiliation(s)
- C M Anderson
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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