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Zvolanek KM, Moore JE, Jarvis K, Moum SJ, Bright MG. Macrovascular blood flow and microvascular cerebrovascular reactivity are regionally coupled in adolescence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.26.590312. [PMID: 38746187 PMCID: PMC11092525 DOI: 10.1101/2024.04.26.590312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Cerebrovascular imaging assessments are particularly challenging in adolescent cohorts, where not all modalities are appropriate, and rapid brain maturation alters hemodynamics at both macro- and microvascular scales. In a preliminary sample of healthy adolescents (n=12, 8-25 years), we investigated relationships between 4D flow MRI-derived blood velocity and blood flow in bilateral anterior, middle, and posterior cerebral arteries and BOLD cerebrovascular reactivity in associated vascular territories. As hypothesized, higher velocities in large arteries are associated with an earlier response to a vasodilatory stimulus (cerebrovascular reactivity delay) in the downstream territory. Higher blood flow through these arteries is associated with a larger BOLD response to a vasodilatory stimulus (cerebrovascular reactivity amplitude) in the associated territory. These trends are consistent in a case study of adult moyamoya disease. In our small adolescent cohort, macrovascular-microvascular relationships for velocity/delay and flow/CVR change with age, though underlying mechanisms are unclear. Our work emphasizes the need to better characterize this key stage of human brain development, when cerebrovascular hemodynamics are changing, and standard imaging methods offer limited insight into these processes. We provide important normative data for future comparisons in pathology, where combining macro- and microvascular assessments may better help us prevent, stratify, and treat cerebrovascular disease.
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Sayin ES, Duffin J, Poublanc J, Venkatraghavan L, Mikulis DJ, Fisher JA, Sobczyk O. Determining the effects of elevated partial pressure of oxygen on hypercapnia-induced cerebrovascular reactivity. J Cereb Blood Flow Metab 2023; 43:2085-2095. [PMID: 37632334 PMCID: PMC10925865 DOI: 10.1177/0271678x231197000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/28/2023]
Abstract
Evaluation of cerebrovascular reactivity (CVR) to hypo- and hypercapnia is a valuable test for the assessment of vasodilatory reserve. While hypercapnia-induced CVR testing is usually performed at normoxia, mild hyperoxia may increase tolerability of hypercapnia by reducing the ventilatory distress. However, the effects of mild hyperoxia on CVR was unknown. We therefore recruited 21 patients with a range of steno-occlusive diseases and 12 healthy participants who underwent a standardized 13-minute step plus ramp CVR test with a carbon dioxide gas challenge at the subject's resting end-tidal partial pressure of oxygen or at mild hyperoxia (PetO2 = 150 mmHg) depending on to which group they were assigned. In 11 patients, the second CVR test was at normoxia to examine test-retest differences. CVR was defined as % Δ Signal/ΔPetCO2. We found that there was no significant difference between CVR test results conducted at normoxia and at mild hyperoxia for participants in Groups 1 and 2 for the step and ramp portion. We also found no difference between test and retest CVR at normoxia for patients with cerebrovascular pathology (Group 3) for step and ramp portion. We concluded normoxic CVR is repeatable, and that mild hyperoxia does not affect CVR.
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Affiliation(s)
- Ece Su Sayin
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
| | - Lashmikumar Venkatraghavan
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David John Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
| | - Joseph Arnold Fisher
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Olivia Sobczyk
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Lab, University Health Network, Toronto, ON, Canada
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Cowdrick KR, Akbar M, Boodooram T, Harris LH, Bai S, Brothers RO, Arrington M, Lee SY, Khemani K, Gee B, Buckley EM. Impaired cerebrovascular reactivity in pediatric sickle cell disease using diffuse correlation spectroscopy. BIOMEDICAL OPTICS EXPRESS 2023; 14:5696-5708. [PMID: 38021121 PMCID: PMC10659811 DOI: 10.1364/boe.499274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023]
Abstract
Cerebrovascular reactivity (CVR), defined as the ability of cerebral vasculature to dilate in response to a vasodilatory stimulus, is an integral mechanism in brain homeostasis that is thought to be impaired in sickle cell disease (SCD). This study used diffuse correlation spectroscopy and a simple breath-hold stimulus to quantify CVR non-invasively in a cohort of 12 children with SCD and 14 controls. Median [interquartile range] CVR was significantly decreased in SCD compared to controls (2.03 [1.31, 2.44] versus 3.49 [3.00, 4.11] %/mmHg, p = 0.028). These results suggest DCS may provide a feasible means to routinely monitor CVR impairments in pediatric SCD.
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Affiliation(s)
- Kyle R. Cowdrick
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Drive NE, Atlanta, GA 30322, USA
| | - Mariam Akbar
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Drive NE, Atlanta, GA 30322, USA
| | - Tisha Boodooram
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Drive NE, Atlanta, GA 30322, USA
| | - LaBeausha H. Harris
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Drive NE, Atlanta, GA 30322, USA
| | - Shasha Bai
- Pediatric Biostatistics Core, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA 30322, USA
| | - Rowan O. Brothers
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Drive NE, Atlanta, GA 30322, USA
| | - Michael Arrington
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Drive NE, Atlanta, GA 30322, USA
| | - Seung Yup Lee
- Department of Electrical and Computer Engineering, Kennesaw State University, 840 Polytechnic Lane, Marietta, GA 30060, USA
| | - Kirsma Khemani
- Aflac Cancer and Blood Disorders Center, Division of Pediatric Hematology/Oncology, Children's Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Beatrice Gee
- Aflac Cancer and Blood Disorders Center, Division of Pediatric Hematology/Oncology, Children's Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Erin M. Buckley
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Drive NE, Atlanta, GA 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Children's Research Scholar, Children's Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA 30322, USA
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Marchena-Romero KJ, Ji X, Sommer R, Centen A, Ramirez J, Poulin JM, Mikulis D, Thrippleton M, Wardlaw J, Lim A, Black SE, MacIntosh BJ. Examining temporal features of BOLD-based cerebrovascular reactivity in clinical populations. Front Neurol 2023; 14:1199805. [PMID: 37396759 PMCID: PMC10310960 DOI: 10.3389/fneur.2023.1199805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Background Conventional cerebrovascular reactivity (CVR) estimation has demonstrated that many brain diseases and/or conditions are associated with altered CVR. Despite the clinical potential of CVR, characterization of temporal features of a CVR challenge remains uncommon. This work is motivated by the need to develop CVR parameters that characterize individual temporal features of a CVR challenge. Methods Data were collected from 54 adults and recruited based on these criteria: (1) Alzheimer's disease diagnosis or subcortical Vascular Cognitive Impairment, (2) sleep apnea, and (3) subjective cognitive impairment concerns. We investigated signal changes in blood oxygenation level dependent (BOLD) contrast images with respect to hypercapnic and normocapnic CVR transition periods during a gas manipulation paradigm. We developed a model-free, non-parametric CVR metric after considering a range of responses through simulations to characterize BOLD signal changes that occur when transitioning from normocapnia to hypercapnia. The non-parametric CVR measure was used to examine regional differences across the insula, hippocampus, thalamus, and centrum semiovale. We also examined the BOLD signal transition from hypercapnia back to normocapnia. Results We found a linear association between isolated temporal features of successive CO2 challenges. Our study concluded that the transition rate from hypercapnia to normocapnia was significantly associated with the second CVR response across all regions of interest (p < 0.001), and this association was highest in the hippocampus (R2 = 0.57, p < 0.0125). Conclusion This study demonstrates that it is feasible to examine individual responses associated with normocapnic and hypercapnic transition periods of a BOLD-based CVR experiment. Studying these features can provide insight on between-subject differences in CVR.
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Affiliation(s)
- Kayley-Jasmin Marchena-Romero
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Xiang Ji
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Toronto, ON, Canada
| | - Rosa Sommer
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Andrew Centen
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Joel Ramirez
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Toronto, ON, Canada
| | - Joshua M. Poulin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Toronto, ON, Canada
| | - David Mikulis
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Michael Thrippleton
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre, The University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna Wardlaw
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre, The University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Lim
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Sandra E. Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Toronto, ON, Canada
| | - Bradley J. MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Toronto, ON, Canada
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Domi T, Robertson A, Lee W, Wintle RF, Stence N, Bernard T, Kirton A, Carlson H, Andrade A, Rafay MF, Bjornson B, Kim D, Dowling M, Bonnett W, Rivkin M, Krishnan P, Shroff M, Ertl-Wagner B, Strother S, Arnott S, Wintermark M, Kassner A, deVeber G, Dlamini N. The development of the pediatric stroke neuroimaging platform (PEDSNIP). Neuroimage Clin 2023; 39:103438. [PMID: 37354865 PMCID: PMC10331307 DOI: 10.1016/j.nicl.2023.103438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/15/2023] [Indexed: 06/26/2023]
Abstract
Childhood stroke occurs from birth to 18 years of age, ranks among the top ten childhood causes of death, and leaves lifelong neurological impairments. Arterial ischemic stroke in infancy and childhood occurs due to arterial occlusion in the brain, resulting in a focal lesion. Our understanding of mechanisms of injury and repair associated with focal injury in the developing brain remains rudimentary. Neuroimaging can reveal important insights into these mechanisms. In adult stroke population, multi-center neuroimaging studies are common and have accelerated the translation process leading to improvements in treatment and outcome. These studies are centered on the growing evidence that neuroimaging measures and other biomarkers (e.g., from blood and cerebrospinal fluid) can enhance our understanding of mechanisms of risk and injury and be used as complementary outcome markers. These factors have yet to be studied in pediatric stroke because most neuroimaging studies in this population have been conducted in single-centred, small cohorts. By pooling neuroimaging data across multiple sites, larger cohorts of patients can significantly boost study feasibility and power in elucidating mechanisms of brain injury, repair and outcomes. These aims are particularly relevant in pediatric stroke because of the decreased incidence rates and the lack of mechanism-targeted trials. Toward these aims, we developed the Pediatric Stroke Neuroimaging Platform (PEDSNIP) in 2015, funded by The Brain Canada Platform Support Grant, to focus on three identified neuroimaging priorities. These were: developing and harmonizing multisite clinical protocols, creating the infrastructure and methods to import, store and organize the large clinical neuroimaging dataset from multiple sites through the International Pediatric Stroke Study (IPSS), and enabling central searchability. To do this, developed a two-pronged approach that included building 1) A Clinical-MRI Data Repository (standard of care imaging) linked to clinical data and longitudinal outcomes and 2) A Research-MRI neuroimaging data set acquired through our extensive collaborative, multi-center, multidisciplinary network. This dataset was collected prospectively in eight North American centers to test the feasibility and implementation of harmonized advanced Research-MRI, with the addition of clinical information, genetic and proteomic studies, in a cohort of children presenting with acute ischemic stroke. Here we describe the process that enabled the development of PEDSNIP built to provide the infrastructure to support neuroimaging research priorities in pediatric stroke. Having built this Platform, we are now able to utilize the largest neuroimaging and clinical data pool on pediatric stroke data worldwide to conduct hypothesis-driven research. We are actively working on a bioinformatics approach to develop predictive models of risk, injury and repair and accelerate breakthrough discoveries leading to mechanism-targeted treatments that improve outcomes and minimize the burden following childhood stroke. This unique transformational resource for scientists and researchers has the potential to result in a paradigm shift in the management, outcomes and quality of life in children with stroke and their families, with far-reaching benefits for other brain conditions of people across the lifespan.
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Affiliation(s)
- Trish Domi
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amanda Robertson
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wayne Lee
- Research Operations, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Richard F Wintle
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas Stence
- Pediatric Neuroradiology, Children's Hospital Colorado, Aurora, CO, United States; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timothy Bernard
- Child Neurology and Hemophilia and Thrombosis Center, University of Colorado, Aurora, CO, United States; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam Kirton
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Helen Carlson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea Andrade
- London Health Sciences Centre, London, United Kingdom; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mubeen F Rafay
- Health Sciences Centre Winnipeg, Winnipeg, Manitoba, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bruce Bjornson
- The University of British Columbia, Vancouver, British Columbia, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Danny Kim
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Dowling
- The University of Texas, Southwestern Austin, TX, United States; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wilmot Bonnett
- The University of Texas, Southwestern Austin, TX, United States; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Rivkin
- Department of Neurology, Boston, MA, United States; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manohar Shroff
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen Strother
- Department of Medical Biophysics Rotman Research Institute, Baycrest Hospital, Toronto, Ontario, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven Arnott
- Department of Medical Biophysics Rotman Research Institute, Baycrest Hospital, Toronto, Ontario, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson, Houston, TX (M.W.), United States; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea Kassner
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gabrielle deVeber
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada,.
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Gong J, Stickland RC, Bright MG. Hemodynamic timing in resting-state and breathing-task BOLD fMRI. Neuroimage 2023; 274:120120. [PMID: 37072074 DOI: 10.1016/j.neuroimage.2023.120120] [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: 11/14/2022] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 04/20/2023] Open
Abstract
The blood flow response to a vasoactive stimulus demonstrates regional heterogeneity across both the healthy brain and in cerebrovascular pathology. The timing of a regional hemodynamic response is emerging as an important biomarker of cerebrovascular dysfunction, as well as a confound within fMRI analyses. Previous research demonstrated that hemodynamic timing is more robustly characterized when a larger systemic vascular response is evoked by a breathing challenge, compared to when only spontaneous fluctuations in vascular physiology are present (i.e., in resting-state data). However, it is not clear whether hemodynamic delays in these two conditions are physiologically interchangeable, and how methodological signal-to-noise factors may limit their agreement. To address this, we generated whole-brain maps of hemodynamic delays in nine healthy adults. We assessed the agreement of voxel-wise gray matter (GM) hemodynamic delays between two conditions: resting-state and breath-holding. We found that delay values demonstrated poor agreement when considering all GM voxels, but increasingly greater agreement when limiting analyses to voxels showing strong correlation with the GM mean time-series. Voxels showing the strongest agreement with the GM mean time-series were primarily located near large venous vessels, however these voxels explain some, but not all, of the observed agreement in timing. Increasing the degree of spatial smoothing of the fMRI data enhanced the correlation between individual voxel time-series and the GM mean time-series. These results suggest that signal-to-noise factors may be limiting the accuracy of voxel-wise timing estimates and hence their agreement between the two data segments. In conclusion, caution must be taken when using voxel-wise delay estimates from resting-state and breathing-task data interchangeably, and additional work is needed to evaluate their relative sensitivity and specificity to aspects of vascular physiology and pathology.
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Affiliation(s)
- Jingxuan Gong
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA
| | - Rachael C Stickland
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Molly G Bright
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Zvolanek KM, Moia S, Dean JN, Stickland RC, Caballero-Gaudes C, Bright MG. Comparing end-tidal CO 2, respiration volume per time (RVT), and average gray matter signal for mapping cerebrovascular reactivity amplitude and delay with breath-hold task BOLD fMRI. Neuroimage 2023; 272:120038. [PMID: 36958618 DOI: 10.1016/j.neuroimage.2023.120038] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023] Open
Abstract
Cerebrovascular reactivity (CVR), defined as the cerebral blood flow response to a vasoactive stimulus, is an imaging biomarker with demonstrated utility in a range of diseases and in typical development and aging processes. A robust and widely implemented method to map CVR involves using a breath-hold task during a BOLD fMRI scan. Recording end-tidal CO2 (PETCO2) changes during the breath-hold task is recommended to be used as a reference signal for modeling CVR amplitude in standard units (%BOLD/mmHg) and CVR delay in seconds. However, obtaining reliable PETCO2 recordings requires equipment and task compliance that may not be achievable in all settings. To address this challenge, we investigated two alternative reference signals to map CVR amplitude and delay in a lagged general linear model (lagged-GLM) framework: respiration volume per time (RVT) and average gray matter BOLD response (GM-BOLD). In 8 healthy adults with multiple scan sessions, we compare spatial agreement of CVR maps from RVT and GM-BOLD to those generated with PETCO2. We define a threshold to determine whether a PETCO2 recording has "sufficient" quality for CVR mapping and perform these comparisons in 16 datasets with sufficient PETCO2 and 6 datasets with insufficient PETCO2. When PETCO2 quality is sufficient, both RVT and GM-BOLD produce CVR amplitude maps that are nearly identical to those from PETCO2 (after accounting for differences in scale), with the caveat they are not in standard units to facilitate between-group comparisons. CVR delays are comparable to PETCO2 with an RVT regressor but may be underestimated with the average GM-BOLD regressor. Importantly, when PETCO2 quality is insufficient, RVT and GM-BOLD CVR recover reasonable CVR amplitude and delay maps, provided the participant attempted the breath-hold task. Therefore, our framework offers a solution for achieving high quality CVR maps in both retrospective and prospective studies where sufficient PETCO2 recordings are not available and especially in populations where obtaining reliable measurements is a known challenge (e.g., children). Our results have the potential to improve the accessibility of CVR mapping and to increase the prevalence of this promising metric of vascular health.
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Affiliation(s)
- Kristina M Zvolanek
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA.
| | - Stefano Moia
- Basque Center on Cognition, Brain and Language, Donostia, Gipuzkoa, Spain; Medical Imaging Processing Lab (MIP:Lab), Neuro-X institute, EPFL, Geneva, Switzerland
| | - Joshua N Dean
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA
| | - Rachael C Stickland
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Molly G Bright
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA
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8
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Sayin ES, Sobczyk O, Poublanc J, Mikulis DJ, Fisher JA, Kuo KHM, Duffin J. Assessment of cerebrovascular function in patients with sickle cell disease using transfer function analysis. Physiol Rep 2022; 10:e15472. [PMID: 36200271 PMCID: PMC9535348 DOI: 10.14814/phy2.15472] [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: 07/04/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
In patients with sickle cell disease (SCD), the delivery of oxygen to the brain is compromised by anemia, abnormal rheology, and steno‐occlusive vascular disease. Successful compensation depends on an increase in oxygen supply such as that provided by an increase in cerebral blood flow (CBF). We used magnetic resonance imaging to provide a high‐resolution assessment of the ability of SCD patients to respond to a vasoactive stimulus in middle, anterior, and posterior cerebral artery territories for both white and gray matter. Cerebrovascular reactivity (CVR) was measured as the blood oxygen level dependent signal (a surrogate for CBF) response to an increase in the end tidal partial pressure of CO2 (PETCO2). The dynamic aspect of the response was measured as the time constant of the first order response kinetics (tau). To confirm and support these findings we used an alternative examination of the response, transfer function analysis (TFA), to measure the responsiveness (gain), the speed of response (phase), and the consistency of the response over time (coherence). We tested 34 patients with SCD and compared the results to those of 24 healthy controls participants. The results from a three‐way ANOVA showed that patients with SCD have reduced CVR (p < 0.001) and lower coherence (p < 0.001) in gray matter and white matter and reduced gain in gray matter only (p < 0.001). In terms of the speed of the response to CO2, tau (p < 0.001) and TFA phase (p < 0.001) were increased in SCD patients compared to healthy control subjects. These findings show that the cerebrovascular responsiveness to CO2 in patients with SCD is both decreased and slowed compared to healthy controls.
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Affiliation(s)
- Ece Su Sayin
- Department of PhysiologyUniversity of TorontoTorontoCanada,Departments of Anaesthesia and Pain ManagementUniversity Health NetworkTorontoCanada
| | - Olivia Sobczyk
- Department of PhysiologyUniversity of TorontoTorontoCanada,Departments of Anaesthesia and Pain ManagementUniversity Health NetworkTorontoCanada,Joint Department of Medical Imaging and the Functional Neuroimaging LaboratoryUniversity Health NetworkTorontoCanada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging LaboratoryUniversity Health NetworkTorontoCanada
| | - David J. Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging LaboratoryUniversity Health NetworkTorontoCanada,Institute of Medical SciencesUniversity of TorontoTorontoCanada
| | - Joseph A. Fisher
- Department of PhysiologyUniversity of TorontoTorontoCanada,Departments of Anaesthesia and Pain ManagementUniversity Health NetworkTorontoCanada
| | - Kevin H. M. Kuo
- Division of Medical Oncology and Hematology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - James Duffin
- Department of PhysiologyUniversity of TorontoTorontoCanada,Departments of Anaesthesia and Pain ManagementUniversity Health NetworkTorontoCanada
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9
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Forté S, Sobczyk O, Poublanc J, Duffin J, Hare GMT, Fisher JA, Mikulis D, Kuo KHM. Sickle cell cerebrovascular reactivity to a CO2 stimulus: Too little, too slow. Front Physiol 2022; 13:886807. [PMID: 36060689 PMCID: PMC9437621 DOI: 10.3389/fphys.2022.886807] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Despite increased cerebral blood flow (CBF), cerebral infarcts occur in patients with sickle cell disease (SCD). This suggests increased CBF does not meet metabolic demand possibly due to compromised cerebral vasodilatory response. Hypothesis: In adult SCD patients, cerebrovascular reactivity (CVR) and speed of vasodilatory response (tau) to a standardized vasodilatory stimulus, are reduced compared to normal subjects. Methods: Functional brain imaging performed as part of routine care in adult SCD patients without known large vessel cerebral vasculopathy was reviewed retrospectively. CVR was calculated as the change in CBF measured as the blood-oxygenation-level-dependent (BOLD)-magnetic resonance imaging signal, in response to a standard vasoactive stimulus of carbon dioxide (CO2). The tau corresponding to the best fit between the convolved end-tidal partial pressures of CO2 and BOLD signal was defined as the speed of vascular response. CVR and tau were normalized using a previously generated atlas of 42 healthy controls. Results: Fifteen patients were included. CVR was reduced in grey and white matter (mean Z-score for CVR −0.5 [−1.8 to 0.3] and −0.6 [−2.3 to 0.7], respectively). Tau Z-scores were lengthened in grey and white matter (+0.9 [−0.5 to 3.3] and +0.8 [−0.7 to 2.7], respectively). Hematocrit was the only significant independent predictor of CVR on multivariable regression. Conclusion: Both measures of cerebrovascular health (CVR and tau) in SCD patients were attenuated compared to normal controls. These findings show that CVR represents a promising tool to assess disease state, stroke risk, and therapeutic efficacy of treatments in SCD and merits further investigation.
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Affiliation(s)
- Stéphanie Forté
- Division of Medical Oncology and Hematology, Departement of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, ON, Canada
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Olivia Sobczyk
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
- Department of Anaesthesia and Pain Medicine, University Health Network, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - James Duffin
- The Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Gregory M. T. Hare
- The Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael’s Hospital, Toronto, ON, Canada
| | - Joseph Arnold Fisher
- Department of Anaesthesia and Pain Medicine, University Health Network, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - David Mikulis
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Kevin H. M. Kuo
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, ON, Canada
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- *Correspondence: Kevin H. M. Kuo,
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10
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Zhao MY, Woodward A, Fan AP, Chen KT, Yu Y, Chen DY, Moseley ME, Zaharchuk G. Reproducibility of cerebrovascular reactivity measurements: A systematic review of neuroimaging techniques . J Cereb Blood Flow Metab 2022; 42:700-717. [PMID: 34806918 PMCID: PMC9254040 DOI: 10.1177/0271678x211056702] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cerebrovascular reactivity (CVR), the capacity of the brain to increase cerebral blood flow (CBF) to meet changes in physiological demand, is an important biomarker to evaluate brain health. Typically, this brain "stress test" is performed by using a medical imaging modality to measure the CBF change between two states: at baseline and after vasodilation. However, since there are many imaging modalities and many ways to augment CBF, a wide range of CVR values have been reported. An understanding of CVR reproducibility is critical to determine the most reliable methods to measure CVR as a clinical biomarker. This review focuses on CVR reproducibility studies using neuroimaging techniques in 32 articles comprising 427 total subjects. The literature search was performed in PubMed, Embase, and Scopus. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We identified 5 factors of the experimental subjects (such as sex, blood characteristics, and smoking) and 9 factors of the measuring technique (such as the imaging modality, the type of the vasodilator, and the quantification method) that have strong effects on CVR reproducibility. Based on this review, we recommend several best practices to improve the reproducibility of CVR quantification in neuroimaging studies.
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Affiliation(s)
- Moss Y Zhao
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Amanda Woodward
- Lane Medical Library, Stanford University, Stanford, CA, USA
| | - Audrey P Fan
- Department of Biomedical Engineering, University of California Davis, Davis, CA, USA.,Department of Neurology, University of California Davis, Davis, CA, USA
| | - Kevin T Chen
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Yannan Yu
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - David Y Chen
- Department of Medical Imaging, Taipei Medical University - Shuan-Ho Hospital, New Taipei City.,Department of Radiology, School of Medicine, Taipei Medical University, Taipei *Research materials supporting this publication can be accessed at https://doi.org/10.25740/hd852bg4538
| | | | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA, USA
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11
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Sayin ES, Sobczyk O, Poublanc J, Mikulis DJ, Fisher JA, Kuo KHM, Duffin J. Assessing Cerebrovascular Resistance in Patients With Sickle Cell Disease. Front Physiol 2022; 13:847969. [PMID: 35422710 PMCID: PMC9002264 DOI: 10.3389/fphys.2022.847969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/08/2022] [Indexed: 02/05/2023] Open
Abstract
In patients with sickle cell disease (SCD) the delivery of oxygen to the brain is compromised by anemia, abnormal rheology, and steno-occlusive vascular disease. Meeting demands for oxygen delivery requires compensatory features of brain perfusion. The cerebral vasculature’s regulatory function and reserves can be assessed by observing the flow response to a vasoactive stimulus. In a traditional approach we measured voxel-wise change in Blood Oxygen-Level Dependent (BOLD) MRI signal as a surrogate of cerebral blood flow (CBF) in response to a linear progressive ramping of end-tidal partial pressure of carbon dioxide (PETCO2). Cerebrovascular reactivity (CVR) was defined as ΔBOLD/ΔPETCO2. We used a computer model to fit a virtual sigmoid resistance curve to the progressive CBF response to the stimulus, enabling the calculation of resistance parameters: amplitude, midpoint, range response, resistance sensitivity and vasodilatory reserve. The quality of the resistance sigmoid fit was expressed as the r2 of the fit. We tested 35 patients with SCD, as well as 24 healthy subjects to provide an indication of the normal ranges of the resistance parameters. We found that gray matter CVR and resistance amplitude, range, reserve, and sensitivity are reduced in patients with SCD compared to healthy controls, while resistance midpoint was increased. This study is the first to document resistance measures in adult patients with SCD. It is also the first to score these vascular resistance measures in comparison to the normal range. We anticipate these data will complement the current understanding of the cerebral vascular pathophysiology of SCD, identify paths for therapeutic interventions, and provide biomarkers for monitoring the progress of the disease.
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Affiliation(s)
- Ece Su Sayin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Olivia Sobczyk
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - David J. Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Joseph A. Fisher
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Kevin H. M. Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- *Correspondence: James Duffin,
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12
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Lin Z, McIntyre T, Jiang D, Cannon A, Liu P, Tekes A, Casella JF, Slifer K, Lu H, Lance E. Brain Oxygen Extraction and Metabolism in Pediatric Patients With Sickle Cell Disease: Comparison of Four Calibration Models. Front Physiol 2022; 13:814979. [PMID: 35222083 PMCID: PMC8874251 DOI: 10.3389/fphys.2022.814979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/21/2022] [Indexed: 12/11/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy with an increased risk of neurological complications. Due to anemia and other factors related to the underlying hemoglobinopathy, cerebral blood flow (CBF) increases as compensation; however, the nature of alterations in oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) in SCD remains controversial, largely attributed to the different calibration models. In addition, limited studies have been done to investigate oxygen metabolism in pediatric patients. Thus, this study used a non-invasive T2-based MR oximetry, T2-Relaxation-Under-Spin-Tagging (TRUST) MRI, to measure oxygen homeostasis in pediatric patients with SCD using four different calibration models and examined its relationship to hematological measures. It was found that, compared with controls, SCD patients showed an increased CBF, unchanged total oxygen delivery and increased venous blood T2. The results of OEF and CMRO2 were dependent on the calibration models used. When using sickle-specific, hemoglobin S (HbS) level-dependent calibration, there was a decreased OEF and CMRO2, while the bovine model showed an opposite result. OEF and CMRO2 were also associated with hemoglobin and HbS level; the direction of the relationship was again dependent on the model. Future studies with in vivo calibration are needed to provide more accurate information on the T2-Yv relationship.
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Affiliation(s)
- Zixuan Lin
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tiffany McIntyre
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Dengrong Jiang
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alicia Cannon
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Peiying Liu
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aylin Tekes
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - James F. Casella
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Keith Slifer
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Eboni Lance
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Eboni Lance,
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13
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Santana JERS, Baptista AF, Lucena R, Lopes TDS, do Rosário RS, Xavier MR, Fonseca A, Miranda JGV. Altered Dynamic Brain Connectivity in Individuals With Sickle Cell Disease and Chronic Pain Secondary to Hip Osteonecrosis. Clin EEG Neurosci 2021; 54:333-342. [PMID: 34779267 DOI: 10.1177/15500594211054297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Individuals with sickle cell disease (SCD) exhibit changes in static brain connectivity in rest. However, little known as chronic pain associated with hip osteonecrosis affects dynamic brain connectivity during rest and the motor imagery task. The aim of this study was to investigate the characteristics of the dynamic functional brain connectivity of individuals with SCD and chronic pain secondary to hip osteonecrosis. This is a cross-sectional study comparing the dynamic brain connectivity of healthy individuals (n = 18) with the dynamic brain connectivity of individuals with SCD and chronic pain (n = 22). Individuals with SCD and chronic pain were stratified into high- or low-intensity pain groups based on pain intensity at the time of assessment. Dynamic brain connectivity was assessed through electroencephalography in 3 stages, resting state with eyes closed, and during hip (painful for the SCD individuals) and hand (control, nonpainful) motor imagery. Average weight of the edges and full synchronization time (FST)-time required for 95% of the possible edges to appear over time during a given task-were evaluated. Regarding the average weight of the edges, individuals with SCD and high-intensity pain presented higher edge weight during hip motor imagery. The average weight of the edges correlated positively with pain intensity and depression symptoms. Individuals with SCD and chronic pain complete the cerebral network at rest more quickly (lower FST). Individuals with SCD and chronic pain/hip osteonecrosis have impaired dynamic brain network with shorter FST in rest network and more pronounced diffuse connectivity in individuals with high-intensity pain. The dynamic brain network evaluated by time-varying graphs and motif synchronization was able to identify differences between groups.
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Affiliation(s)
- Jamille Evelyn R S Santana
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, 28111Federal University of Bahia, Salvador, Brazil
| | - Abrahão F Baptista
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, 28111Federal University of Bahia, Salvador, Brazil.,Center for Mathematics, Computation and Cognition, 488583Federal University of ABC, Santo Andre, Brazil
| | - Rita Lucena
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, 28111Federal University of Bahia, Salvador, Brazil.,Medical School of Bahia, 28111Federal University of Bahia, Salvador, Brazil
| | - Tiago da S Lopes
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, 28111Federal University of Bahia, Salvador, Brazil.,Adventist Neuromodulation and Neuroscience Laboratory, Bahia Adventist College, Cachoeira, Brazil
| | - Raphael S do Rosário
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil.,Institute of Physics, Federal University of Bahia, Salvador, Brazil
| | - Marjorie R Xavier
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil
| | - André Fonseca
- Center for Mathematics, Computation and Cognition, 488583Federal University of ABC, Santo Andre, Brazil
| | - José Garcia V Miranda
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil.,Institute of Physics, Federal University of Bahia, Salvador, Brazil
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14
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Poublanc J, Shafi R, Sobczyk O, Sam K, Mandell DM, Venkatraghavan L, Duffin J, Fisher JA, Mikulis DJ. Normal BOLD Response to a Step CO 2 Stimulus After Correction for Partial Volume Averaging. Front Physiol 2021; 12:639360. [PMID: 34194335 PMCID: PMC8236700 DOI: 10.3389/fphys.2021.639360] [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: 12/08/2020] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
Cerebrovascular reactivity (CVR) is defined as the change in cerebral blood flow induced by a change in a vasoactive stimulus. CVR using BOLD MRI in combination with changes in end-tidal CO2 is a very useful method for assessing vascular performance. In recent years, this technique has benefited from an advanced gas delivery method where end-tidal CO2 can be targeted, measured very precisely, and validated against arterial blood gas sampling (Ito et al., 2008). This has enabled more precise comparison of an individual patient against a normative atlas of healthy subjects. However, expected control ranges for CVR metrics have not been reported in the literature. In this work, we calculate and report the range of control values for the magnitude (mCVR), the steady state amplitude (ssCVR), and the speed (TAU) of the BOLD response to a standard step stimulus, as well as the time delay (TD) as observed in a cohort of 45 healthy controls. These CVR metrics maps were corrected for partial volume averaging for brain tissue types using a linear regression method to enable more accurate quantitation of CVR metrics. In brief, this method uses adjacent voxel CVR metrics in combination with their tissue composition to write the corresponding set of linear equations for estimating CVR metrics of gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF). After partial volume correction, mCVR and ssCVR increase as expected in gray matter, respectively, by 25 and 19%, and decrease as expected in white matter by 33 and 13%. In contrast, TAU and TD decrease in gray matter by 33 and 13%. TAU increase in white matter by 24%, but TD surprisingly decreased by 9%. This correction enables more accurate voxel-wise tissue composition providing greater precision when reporting gray and white matter CVR values.
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Affiliation(s)
- Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Reema Shafi
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Olivia Sobczyk
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Kevin Sam
- Department of Radiology and Radiological Sciences, Johns Hopkins University, United States
| | - Daniel M Mandell
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | | | - James Duffin
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Joseph A Fisher
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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15
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Differential regional cerebral blood flow reactivity to alterations in end-tidal gases in healthy volunteers. Can J Anaesth 2021; 68:1497-1506. [PMID: 34105067 DOI: 10.1007/s12630-021-02042-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Anesthesia is associated with alterations in end-tidal (ET) respiratory gases from the awake state. These alterations result in marked vasoactive changes in regional cerebral blood flow (rCBF). Altered regional cerebrovascular reactivity (rCVR) is linked to neurologic dysfunction. We examined these differences in reactivity from prior work by focusing on the ratio of vasoconstriction with hyperoxia/hypocapnia (HO/hc):vasodilation with hypercapnia (HC) using magnetic resonance imaging pseudo-continuous arterial spin labelling (pCASL) to measure rCBF and compare rCVR The distribution and magnitude of these ratios could provide insights into rCBF during clinical anesthesia and inform future research into the origins of postoperative delirium (POD). METHODS Ten healthy subjects underwent cerebral blood flow (CBF) studies using pCASL with computer-controlled delivery of ET gases to assess flow effects of hyperoxia, hypercapnia, and hyperoxia/hypocapnia as part of a larger study into cerebrovascular reactivity. The vasoconstrictor stimulus was compared with the vasodilator stimulus by the ratio HO/hc:HC. RESULTS Hyperoxia minimally decreased whole brain CBF by - 0.6%/100 mm Hg increase in ETO2. Hypercapnia increased CBF by +4.6%/mm Hg carbon dioxide (CO2) and with HO/hc CBF decreased by - 5.1%/mm Hg CO2. The brain exhibited markedly different rCVR-regional HO/hc:HC ratios varied from 7.2:1 (greater response to vasoconstriction) to 0.49:1 (greater response to vasodilation). Many of the ratios greater than 1, where vasoconstriction predominated, were seen in regions associated with memory, cognition, and executive function, including the entorhinal cortex, hippocampus, parahippocampus, and dorsolateral prefrontal cortex. CONCLUSIONS In awake humans, marked rCBF changes occurred with alterations in ET respiratory gases common under anesthesia. Such heterogeneous reactivity may be relevant to future studies to identify those at risk of POD.
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16
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Krishnamurthy V, Sprick JD, Krishnamurthy LC, Barter JD, Turabi A, Hajjar IM, Nocera JR. The Utility of Cerebrovascular Reactivity MRI in Brain Rehabilitation: A Mechanistic Perspective. Front Physiol 2021; 12:642850. [PMID: 33815146 PMCID: PMC8009989 DOI: 10.3389/fphys.2021.642850] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/22/2021] [Indexed: 01/06/2023] Open
Abstract
Cerebrovascular control and its integration with other physiological systems play a key role in the effective maintenance of homeostasis in brain functioning. Maintenance, restoration, and promotion of such a balance are one of the paramount goals of brain rehabilitation and intervention programs. Cerebrovascular reactivity (CVR), an index of cerebrovascular reserve, plays an important role in chemo-regulation of cerebral blood flow. Improved vascular reactivity and cerebral blood flow are important factors in brain rehabilitation to facilitate desired cognitive and functional outcomes. It is widely accepted that CVR is impaired in aging, hypertension, and cerebrovascular diseases and possibly in neurodegenerative syndromes. However, a multitude of physiological factors influence CVR, and thus a comprehensive understanding of underlying mechanisms are needed. We are currently underinformed on which rehabilitation method will improve CVR, and how this information can inform on a patient's prognosis and diagnosis. Implementation of targeted rehabilitation regimes would be the first step to elucidate whether such regimes can modulate CVR and in the process may assist in improving our understanding for the underlying vascular pathophysiology. As such, the high spatial resolution along with whole brain coverage offered by MRI has opened the door to exciting recent developments in CVR MRI. Yet, several challenges currently preclude its potential as an effective diagnostic and prognostic tool in treatment planning and guidance. Understanding these knowledge gaps will ultimately facilitate a deeper understanding for cerebrovascular physiology and its role in brain function and rehabilitation. Based on the lessons learned from our group's past and ongoing neurorehabilitation studies, we present a systematic review of physiological mechanisms that lead to impaired CVR in aging and disease, and how CVR imaging and its further development in the context of brain rehabilitation can add value to the clinical settings.
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Affiliation(s)
- Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Justin D. Sprick
- Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Lisa C. Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Physics & Astronomy, Georgia State University, Atlanta, GA, United States
| | - Jolie D. Barter
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Aaminah Turabi
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Biology, Georgia State University, Atlanta, GA, United States
| | - Ihab M. Hajjar
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Joe R. Nocera
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
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17
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Sleight E, Stringer MS, Marshall I, Wardlaw JM, Thrippleton MJ. Cerebrovascular Reactivity Measurement Using Magnetic Resonance Imaging: A Systematic Review. Front Physiol 2021; 12:643468. [PMID: 33716793 PMCID: PMC7947694 DOI: 10.3389/fphys.2021.643468] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022] Open
Abstract
Cerebrovascular reactivity (CVR) magnetic resonance imaging (MRI) probes cerebral haemodynamic changes in response to a vasodilatory stimulus. CVR closely relates to the health of the vasculature and is therefore a key parameter for studying cerebrovascular diseases such as stroke, small vessel disease and dementias. MRI allows in vivo measurement of CVR but several different methods have been presented in the literature, differing in pulse sequence, hardware requirements, stimulus and image processing technique. We systematically reviewed publications measuring CVR using MRI up to June 2020, identifying 235 relevant papers. We summarised the acquisition methods, experimental parameters, hardware and CVR quantification approaches used, clinical populations investigated, and corresponding summary CVR measures. CVR was investigated in many pathologies such as steno-occlusive diseases, dementia and small vessel disease and is generally lower in patients than in healthy controls. Blood oxygen level dependent (BOLD) acquisitions with fixed inspired CO2 gas or end-tidal CO2 forcing stimulus are the most commonly used methods. General linear modelling of the MRI signal with end-tidal CO2 as the regressor is the most frequently used method to compute CVR. Our survey of CVR measurement approaches and applications will help researchers to identify good practice and provide objective information to inform the development of future consensus recommendations.
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Affiliation(s)
- Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael S. Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom,*Correspondence: Michael S. Stringer
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
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18
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Stotesbury H, Kawadler JM, Hales PW, Saunders DE, Clark CA, Kirkham FJ. Vascular Instability and Neurological Morbidity in Sickle Cell Disease: An Integrative Framework. Front Neurol 2019; 10:871. [PMID: 31474929 PMCID: PMC6705232 DOI: 10.3389/fneur.2019.00871] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/26/2019] [Indexed: 12/20/2022] Open
Abstract
It is well-established that patients with sickle cell disease (SCD) are at substantial risk of neurological complications, including overt and silent stroke, microstructural injury, and cognitive difficulties. Yet the underlying mechanisms remain poorly understood, partly because findings have largely been considered in isolation. Here, we review mechanistic pathways for which there is accumulating evidence and propose an integrative systems-biology framework for understanding neurological risk. Drawing upon work from other vascular beds in SCD, as well as the wider stroke literature, we propose that macro-circulatory hyper-perfusion, regions of relative micro-circulatory hypo-perfusion, and an exhaustion of cerebral reserve mechanisms, together lead to a state of cerebral vascular instability. We suggest that in this state, tissue oxygen supply is fragile and easily perturbed by changes in clinical condition, with the potential for stroke and/or microstructural injury if metabolic demand exceeds tissue oxygenation. This framework brings together recent developments in the field, highlights outstanding questions, and offers a first step toward a linking pathophysiological explanation of neurological risk that may help inform future screening and treatment strategies.
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Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Patrick W Hales
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Dawn E Saunders
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom.,Department of Radiology, Great Ormond Hospital, London, United Kingdom
| | - Christopher A Clark
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom.,Department of Child Health, University Hospital Southampton, Southampton, United Kingdom.,Department of Paediatric Neurology, Kings College Hospital NHS Foundation Trust, London, United Kingdom
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19
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Václavů L, Meynart BN, Mutsaerts HJMM, Petersen ET, Majoie CBLM, VanBavel ET, Wood JC, Nederveen AJ, Biemond BJ. Hemodynamic provocation with acetazolamide shows impaired cerebrovascular reserve in adults with sickle cell disease. Haematologica 2019; 104:690-699. [PMID: 30523051 PMCID: PMC6442969 DOI: 10.3324/haematol.2018.206094] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/23/2018] [Indexed: 01/26/2023] Open
Abstract
Sickle cell disease is characterized by chronic hemolytic anemia and vascular inflammation, which can diminish the vasodilatory capacity of the small resistance arteries, making them less adept at regulating cerebral blood flow. Autoregulation maintains adequate oxygen delivery, but when vasodilation is maximized, the low arterial oxygen content can lead to ischemia and silent cerebral infarcts. We used magnetic resonance imaging of cerebral blood flow to quantify whole-brain cerebrovascular reserve in 36 adult patients with sickle cell disease (mean age, 31.9±11.3 years) and 11 healthy controls (mean age, 37.4±15.4 years), and we used high-resolution 3D FLAIR magnetic resonance imaging to determine the prevalence of silent cerebral infarcts. Cerebrovascular reserve was calculated as the percentage change in cerebral blood flow after a hemodynamic challenge with acetazolamide. Co-registered lesion maps were used to demonstrate prevalent locations for silent cerebral infarcts. Cerebral blood flow was elevated in patients with sickle cell disease compared to controls (median [interquartile range]: 82.8 [20.1] vs 51.3 [4.8] mL/100g/min, P<0.001). Cerebral blood flow was inversely associated with age, hemoglobin, and fetal hemoglobin, and correlated positively with bilirubin, and LDH, indicating that cerebral blood flow may reflect surrogates of hemolytic rate. Cerebrovascular reserve in sickle cell disease was decreased by half compared to controls (34.1 [33.4] vs 69.5 [32.4] %, P<0.001) and was associated with hemoglobin and erythrocyte count indicating anemia-induced hemodynamic adaptations. In total, 29/36 patients (81%) and 5/11 controls (45%) had silent cerebral infarcts (median volume of 0.34 vs 0.02 mL, P=0.03). Lesions were preferentially located in the borderzone. In conclusion, patients with sickle cell disease have a globally reduced cerebrovascular reserve as determined by arterial spin labeling with acetazolamide and reflects anemia-induced impaired vascular function in sickle cell disease. This study was registered at clinicaltrials.gov identifier 02824406.
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Affiliation(s)
- Lena Václavů
- Amsterdam UMC, Radiology and Nuclear Medicine, University of Amsterdam, the Netherlands
| | - Benoit N Meynart
- Amsterdam UMC, Radiology and Nuclear Medicine, University of Amsterdam, the Netherlands
| | - Henri J M M Mutsaerts
- Amsterdam UMC, Radiology and Nuclear Medicine, University of Amsterdam, the Netherlands
| | - Esben Thade Petersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Charles B L M Majoie
- Amsterdam UMC, Radiology and Nuclear Medicine, University of Amsterdam, the Netherlands
| | - Ed T VanBavel
- Amsterdam UMC, Biomedical Engineering and Physics, University of Amsterdam, the Netherlands
| | - John C Wood
- Cardiology and Radiology, Children's Hospital of Los Angeles, CA, USA
| | - Aart J Nederveen
- Amsterdam UMC, Radiology and Nuclear Medicine, University of Amsterdam, the Netherlands
| | - Bart J Biemond
- Amsterdam UMC, Hematology, Internal Medicine, University of Amsterdam, the Netherlands
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20
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Atwi S, Shao H, Crane DE, da Costa L, Aviv RI, Mikulis DJ, Black SE, MacIntosh BJ. BOLD-based cerebrovascular reactivity vascular transfer function isolates amplitude and timing responses to better characterize cerebral small vessel disease. NMR IN BIOMEDICINE 2019; 32:e4064. [PMID: 30693582 DOI: 10.1002/nbm.4064] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
Cerebrovascular reactivity (CVR) is a dynamic measure of the cerebral blood vessel response to vasoactive stimulus. Conventional CVR measures amplitude changes in the blood-oxygenation-level-dependent (BOLD) signal per unit change in end-tidal CO2 (PET CO2 ), effectively discarding potential timing information. This study proposes a deconvolution procedure to characterize CVR responses based on a vascular transfer function (VTF) that separates amplitude and timing CVR effects. We implemented the CVR-VTF to primarily evaluate normal-appearing white matter (WM) responses in those with a range of small vessel disease. Comparisons between simulations of PET CO2 input models revealed that boxcar and ramp hypercapnia paradigms had the lowest relative deconvolution error. We used a T2 * BOLD-MRI sequence on a 3 T MRI scanner, with a boxcar delivery model of CO2 , to test the CVR-VTF approach in 18 healthy adults and three white matter hyperintensity (WMH) groups: 20 adults with moderate WMH, 12 adults with severe WMH, and 10 adults with genetic WMH (CADASIL). A subset of participants performed a second CVR session at a one-year follow-up. Conventional CVR, area under the curve of VTF (VTF-AUC), and VTF time-to-peak (VTF-TTP) were assessed in WM and grey matter (GM) at baseline and one-year follow-up. WMH groups had lower WM VTF-AUC compared with the healthy group (p < 0.0001), whereas GM CVR did not differ between groups (p > 0.1). WM VTF-TTP of the healthy group was less than that in the moderate WMH group (p = 0.016). Baseline VTF-AUC was lower than follow-up VTF-AUC in WM (p = 0.013) and GM (p = 0.026). The intraclass correlation for VTF-AUC in WM was 0.39 and coefficient of repeatability was 0.08 [%BOLD/mm Hg]. This study assessed CVR timing and amplitude information without applying model assumptions to the CVR response; this approach may be useful in the development of robust clinical biomarkers of CSVD.
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Affiliation(s)
- Sarah Atwi
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Han Shao
- Division of Engineering Science, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, Canada
| | - David E Crane
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Leodante da Costa
- Division of Neurosurgery, Department of Surgery, Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Richard I Aviv
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - David J Mikulis
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Centre, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
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21
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Stotesbury H, Kirkham FJ, Kölbel M, Balfour P, Clayden JD, Sahota S, Sakaria S, Saunders DE, Howard J, Kesse-Adu R, Inusa B, Pelidis M, Chakravorty S, Rees DC, Awogbade M, Wilkey O, Layton M, Clark CA, Kawadler JM. White matter integrity and processing speed in sickle cell anemia. Neurology 2018; 90:e2042-e2050. [PMID: 29752305 PMCID: PMC5993179 DOI: 10.1212/wnl.0000000000005644] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/14/2018] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of this retrospective cross-sectional study was to investigate whether changes in white matter integrity are related to slower processing speed in sickle cell anemia. Methods Thirty-seven patients with silent cerebral infarction, 46 patients with normal MRI, and 32 sibling controls (age range 8–37 years) underwent cognitive assessment using the Wechsler scales and 3-tesla MRI. Tract-based spatial statistics analyses of diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) parameters were performed. Results Processing speed index (PSI) was lower in patients than controls by 9.34 points (95% confidence interval: 4.635–14.855, p = 0.0003). Full Scale IQ was lower by 4.14 scaled points (95% confidence interval: −1.066 to 9.551, p = 0.1), but this difference was abolished when PSI was included as a covariate (p = 0.18). There were no differences in cognition between patients with and without silent cerebral infarction, and both groups had lower PSI than controls (both p < 0.001). In patients, arterial oxygen content, socioeconomic status, age, and male sex were identified as predictors of PSI, and correlations were found between PSI and DTI scalars (fractional anisotropy r = 0.614, p < 0.00001; r = −0.457, p < 0.00001; mean diffusivity r = −0.341, p = 0.0016; radial diffusivity r = −0.457, p < 0.00001) and NODDI parameters (intracellular volume fraction r = 0.364, p = 0.0007) in widespread regions. Conclusion Our results extend previous reports of impairment that is independent of presence of infarction and may worsen with age. We identify processing speed as a vulnerable domain, with deficits potentially mediating difficulties across other domains, and provide evidence that reduced processing speed is related to the integrity of normal-appearing white matter using microstructure parameters from DTI and NODDI.
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Affiliation(s)
- Hanne Stotesbury
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Fenella J Kirkham
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK.
| | - Melanie Kölbel
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Philippa Balfour
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jonathan D Clayden
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Sati Sahota
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Simrat Sakaria
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Dawn E Saunders
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jo Howard
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Rachel Kesse-Adu
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Baba Inusa
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Maria Pelidis
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Subarna Chakravorty
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - David C Rees
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Moji Awogbade
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Olu Wilkey
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Mark Layton
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Christopher A Clark
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jamie M Kawadler
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
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22
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A novel perspective to calibrate temporal delays in cerebrovascular reactivity using hypercapnic and hyperoxic respiratory challenges. Neuroimage 2017; 187:154-165. [PMID: 29217405 DOI: 10.1016/j.neuroimage.2017.11.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/19/2017] [Accepted: 11/20/2017] [Indexed: 01/21/2023] Open
Abstract
Redistribution of blood flow across different brain regions, arising from the vasoactive nature of hypercapnia, can introduce errors when examining cerebrovascular reactivity (CVR) response delays. In this study, we propose a novel analysis method to characterize hemodynamic delays in the blood oxygen level dependent (BOLD) response to hypercapnia, and hyperoxia, as a way to provide insight into transient differences in vascular reactivity between cortical regions, and across tissue depths. A pseudo-continuous arterial spin labeling sequence was used to acquire BOLD and cerebral blood flow simultaneously in 19 healthy adults (12 F; 20 ± 2 years) during boxcar CO2 and O2 gas inhalation paradigms. Despite showing distinct differences in hypercapnia-induced response delay times (P < 0.05; Bonferroni corrected), grey matter regions showed homogenous hemodynamic latencies (P > 0.05) once calibrated for bolus arrival time derived using non-vasoactive hyperoxic gas challenges. Longer hypercapnic temporal delays were observed as the depth of the white matter tissue increased, although no significant differences in response lag were found during hyperoxia across tissue depth, or between grey and white matter. Furthermore, calibration of hypercapnic delays using hyperoxia revealed that deeper white matter layers may be more prone to dynamic redistribution of blood flow, which introduces response lag times ranging between 1 and 3 s in healthy subjects. These findings suggest that the combination of hypercapnic and hyperoxic gas-inhalation MRI can be used to distinguish between differences in CVR that arise as a result of delayed stimulus arrival time (due to the local architecture of the cerebrovasculature), or preferential blood flow distribution. Calibrated response delays to hypercapnia provide important insights into cerebrovascular physiology, and may be used to correct response delays associated with vascular impairment.
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