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Waddle SL, Garza M, Ying C, Davis LT, Jordan LC, An H, Donahue MJ. Vascular space occupancy asymmetric spin echo (VASO-ASE) for non-invasive quantification of cerebral oxygen extraction fraction. Magn Reson Med 2023; 90:211-221. [PMID: 36880522 PMCID: PMC10149592 DOI: 10.1002/mrm.29618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/30/2022] [Accepted: 01/27/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Asymmetric spin echo (ASE) MRI is a method for measuring regional oxygen extraction fraction (OEF); however, extravascular tissue models have been shown to under-estimate OEF. The hypothesis investigated here is that the addition of a vascular-space-occupancy (VASO) pre-pulse will more fully suppress blood water signal and provide global OEF values more consistent with physiological expectation and 15 O positron emission tomography (PET)-validated T2 -relaxation-under-spin-tagging (TRUST) OEF measures. METHODS Healthy adults (n = 14; age = 27.7 ± 5.2 y; sex = 7/7 male/female) were scanned at 3.0T. Multi-echo ASE without inter-readout refocusing (ASERF- ), multi-echo ASE with inter-readout refocusing (ASERF+ ), and single-echo VASO-ASE were acquired twice each with common spatial resolution = 3.44 × 3.44 × 3.0 mm and τ = 0-20 ms (interval = 0.5 ms). TRUST was acquired twice sequentially for independent global OEF assessment (τCPMG = 10 ms; effective TEs = 0, 40, 80, and 160 ms; spatial resolution = 3.4 × 3.4 × 5 mm). OEF intraclass-correlation-coefficients (ICC), summary statistics, and group-wise differences were assessed (Wilcoxon rank-sum; significance: two-sided p < 0.05). RESULTS ASERF+ (OEF = 36.8 ± 1.9%) and VASO-ASE (OEF = 34.4 ± 2.3%) produced OEF values similar to TRUST (OEF = 36.5 ± 4.6%, human calibration model; OEF = 32.7 ± 4.9%, bovine calibration model); however, ASERF- yielded lower OEF (OEF = 26.1 ± 1.0%; p < 0.01) relative to TRUST. VASO-ASE (ICC = 0.61) yielded lower ICC compared to other ASE variants (ICC >0.89). CONCLUSION VASO-ASE and TRUST provide similar OEF values; however, VASO-ASE spatial coverage and repeatability improvements are required.
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Affiliation(s)
- Spencer L. Waddle
- Department of Neurology, Vanderbilt University Medical Center, Nashville ,TN, USA
| | - Maria Garza
- Department of Neurology, Vanderbilt University Medical Center, Nashville ,TN, USA
| | - Chunwei Ying
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - L. Taylor Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lori C. Jordan
- Department of Neurology, Vanderbilt University Medical Center, Nashville ,TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Manus J. Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville ,TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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2
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Lindner T, Bolar DS, Achten E, Barkhof F, Bastos-Leite AJ, Detre JA, Golay X, Günther M, Wang DJJ, Haller S, Ingala S, Jäger HR, Jahng GH, Juttukonda MR, Keil VC, Kimura H, Ho ML, Lequin M, Lou X, Petr J, Pinter N, Pizzini FB, Smits M, Sokolska M, Zaharchuk G, Mutsaerts HJMM. Current state and guidance on arterial spin labeling perfusion MRI in clinical neuroimaging. Magn Reson Med 2023; 89:2024-2047. [PMID: 36695294 PMCID: PMC10914350 DOI: 10.1002/mrm.29572] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/26/2023]
Abstract
This article focuses on clinical applications of arterial spin labeling (ASL) and is part of a wider effort from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group to update and expand on the recommendations provided in the 2015 ASL consensus paper. Although the 2015 consensus paper provided general guidelines for clinical applications of ASL MRI, there was a lack of guidance on disease-specific parameters. Since that time, the clinical availability and clinical demand for ASL MRI has increased. This position paper provides guidance on using ASL in specific clinical scenarios, including acute ischemic stroke and steno-occlusive disease, arteriovenous malformations and fistulas, brain tumors, neurodegenerative disease, seizures/epilepsy, and pediatric neuroradiology applications, focusing on disease-specific considerations for sequence optimization and interpretation. We present several neuroradiological applications in which ASL provides unique information essential for making the diagnosis. This guidance is intended for anyone interested in using ASL in a routine clinical setting (i.e., on a single-subject basis rather than in cohort studies) building on the previous ASL consensus review.
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Affiliation(s)
- Thomas Lindner
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Divya S. Bolar
- Center for Functional Magnetic Resonance Imaging, Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Eric Achten
- Department of Radiology and Nuclear Medicine, Ghent University, Ghent, Belgium
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, UK
| | | | - John A. Detre
- Department of Neurology, University of Pennsylvania, Philadelphia PA USA
| | - Xavier Golay
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Matthias Günther
- (1) University Bremen, Germany; (2) Fraunhofer MEVIS, Bremen, Germany; (3) mediri GmbH, Heidelberg, Germany
| | - Danny JJ Wang
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles CA USA
| | - Sven Haller
- (1) CIMC - Centre d’Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Genève 1201 Genève (2) Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (3) Faculty of Medicine of the University of Geneva, Switzerland. Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, P. R. China
| | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Hans R Jäger
- UCL Queen Square Institute of Neuroradiology, University College London, London, UK
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Meher R. Juttukonda
- (1) Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown MA USA (2) Department of Radiology, Harvard Medical School, Boston MA USA
| | - Vera C. Keil
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical sciences, University of Fukui, Fukui, JAPAN
| | - Mai-Lan Ho
- Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Maarten Lequin
- Division Imaging & Oncology, Department of Radiology & Nuclear Medicine | University Medical Center Utrecht & Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jan Petr
- (1) Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany (2) Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Nandor Pinter
- Dent Neurologic Institute, Buffalo, NY, USA. University at Buffalo Neurosurgery, Buffalo, NY, USA
| | - Francesca B. Pizzini
- Radiology Institute, Dept. of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Marion Smits
- (1) Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands (2) The Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering University College London Hospitals NHS Foundation Trust, UK
| | | | - Henk JMM Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
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3
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Fields ME, Mirro AE, Binkley MM, Guilliams KP, Lewis JB, Fellah S, Chen Y, Hulbert ML, An H, Ford AL, Lee J. Cerebral oxygen metabolic stress is increased in children with sickle cell anemia compared to anemic controls. Am J Hematol 2022; 97:682-690. [PMID: 35113471 DOI: 10.1002/ajh.26485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/22/2022] [Accepted: 01/29/2022] [Indexed: 01/28/2023]
Abstract
Patients with sickle cell anemia (SCA) experience cerebral metabolic stress with an increase in oxygen extraction fraction (OEF) to compensate for reduced oxygen carrying capacity due to anemia. It remains unclear if anemia alone drives this metabolic stress. Using MRI, we collected voxel-wise OEF measurements to test our hypothesis that OEF would be elevated in anemic controls without SCA (AC) compared to healthy controls (HC), but OEF would be even higher in SCA compared to AC. Brain MRIs (N = 159) were obtained in 120 participants (34 HC, 27 AC, 59 SCA). While hemoglobin was lower in AC versus HC (p < 0.001), hemoglobin was not different between AC and SCA cohorts (p = 0.459). Whole brain OEF was higher in AC compared to HC (p < 0.001), but lower compared to SCA (p = 0.001). Whole brain OEF remained significantly higher in SCA compared to HC (p = 0.001) while there was no longer a difference between AC versus HC (p = 0.935) in a multivariate model controlling for age and hemoglobin. OEF peaked within the border zone regions of the brain in both SCA and AC cohorts, but the volume of white matter with regionally elevated OEF in AC was smaller (1.8%) than SCA (58.0%). While infarcts colocalized within regions of elevated OEF, more SCA participants had infarcts than AC (p < 0.001). We conclude that children with SCA experience elevated OEF compared to AC and HC after controlling for the impact of anemia, suggesting that there are other pathophysiologic factors besides anemia contributing to cerebral metabolic stress in children with SCA.
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Affiliation(s)
- Melanie E. Fields
- Department of Pediatrics Washington University School of Medicine St. Louis Missouri USA
- Department of Neurology Washington University School of Medicine St. Louis Missouri USA
| | - Amy E. Mirro
- Department of Pediatrics Washington University School of Medicine St. Louis Missouri USA
| | - Michael M. Binkley
- Department of Neurology Washington University School of Medicine St. Louis Missouri USA
| | - Kristin P. Guilliams
- Department of Pediatrics Washington University School of Medicine St. Louis Missouri USA
- Department of Neurology Washington University School of Medicine St. Louis Missouri USA
- Mallinckrodt Institute of Radiology Washington University School of Medicine St. Louis Missouri USA
| | - Josiah B. Lewis
- Department of Neurology Washington University School of Medicine St. Louis Missouri USA
| | - Slim Fellah
- Department of Neurology Washington University School of Medicine St. Louis Missouri USA
| | - Yasheng Chen
- Department of Neurology Washington University School of Medicine St. Louis Missouri USA
| | - Monica L. Hulbert
- Department of Pediatrics Washington University School of Medicine St. Louis Missouri USA
| | - Hongyu An
- Mallinckrodt Institute of Radiology Washington University School of Medicine St. Louis Missouri USA
| | - Andria L. Ford
- Department of Neurology Washington University School of Medicine St. Louis Missouri USA
- Mallinckrodt Institute of Radiology Washington University School of Medicine St. Louis Missouri USA
| | - Jin‐Moo Lee
- Department of Neurology Washington University School of Medicine St. Louis Missouri USA
- Mallinckrodt Institute of Radiology Washington University School of Medicine St. Louis Missouri USA
- Department of Biomedical Engineering Washington University School of Medicine St. Louis Missouri USA
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Jiang D, Lu H. Cerebral oxygen extraction fraction MRI: Techniques and applications. Magn Reson Med 2022; 88:575-600. [PMID: 35510696 PMCID: PMC9233013 DOI: 10.1002/mrm.29272] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/20/2022] [Accepted: 03/29/2022] [Indexed: 12/20/2022]
Abstract
The human brain constitutes 2% of the body's total mass but uses 20% of the oxygen. The rate of the brain's oxygen utilization can be derived from a knowledge of cerebral blood flow and the oxygen extraction fraction (OEF). Therefore, OEF is a key physiological parameter of the brain's function and metabolism. OEF has been suggested to be a useful biomarker in a number of brain diseases. With recent advances in MRI techniques, several MRI-based methods have been developed to measure OEF in the human brain. These MRI OEF techniques are based on the T2 of blood, the blood signal phase, the magnetic susceptibility of blood-containing voxels, the effect of deoxyhemoglobin on signal behavior in extravascular tissue, and the calibration of the BOLD signal using gas inhalation. Compared to 15 O PET, which is considered the "gold standard" for OEF measurement, MRI-based techniques are non-invasive, radiation-free, and are more widely available. This article provides a review of these emerging MRI-based OEF techniques. We first briefly introduce the role of OEF in brain oxygen homeostasis. We then review the methodological aspects of different categories of MRI OEF techniques, including their signal mechanisms, acquisition methods, and data analyses. The strengths and limitations of the techniques are discussed. Finally, we review key applications of these techniques in physiological and pathological conditions.
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Affiliation(s)
- Dengrong Jiang
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Maryland, USA
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5
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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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6
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Jiang D, Koehler RC, Liu X, Kulikowicz E, Lee JK, Lu H, Liu P. Quantitative validation of MRI mapping of cerebral venous oxygenation with direct blood sampling: A graded-O 2 study in piglets. Magn Reson Med 2021; 86:1445-1453. [PMID: 33755253 PMCID: PMC8184598 DOI: 10.1002/mrm.28786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/12/2021] [Accepted: 03/08/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To validate two neonatal cerebral venous oxygenation (Yv ) MRI techniques, T2 relaxation under phase contrast (TRUPC) and accelerated TRUPC (aTRUPC) MRI, with oxygenation measured with direct blood sampling. METHODS In vivo experiments were performed on seven healthy newborn piglets. For each piglet, a catheter was placed in the superior sagittal sinus to obtain venous blood samples for blood gas oximetry measurement as a gold standard. During the MRI experiment, three to five venous oxygenation levels were achieved in each piglet by varying inhaled O2 content and breathing rate. Under each condition, Yv values of the superior sagittal sinus measured by TRUPC, aTRUPC, and blood gas oximetry were obtained. The Yv quantification in TRUPC and aTRUPC used a standard bovine blood calibration model. The aTRUPC scan was repeated twice to assess its reproducibility. Agreements among TRUPC Yv , aTRUPC Yv , and blood gas oximetry were evaluated by intraclass correlation coefficient (ICC) and paired Student's t-test. RESULTS The mean hematocrit was 23.6 ± 6.5% among the piglets. Across all measurements, Yv values were 51.9 ± 21.3%, 54.1 ± 18.8%, and 53.7 ± 19.2% for blood gas oximetry, TRUPC and aTRUPC, respectively, showing no significant difference between any two methods (P > .3). There were good correlations between TRUPC and blood gas Yv (ICC = 0.801; P < .0001), between aTRUPC and blood gas Yv (ICC = 0.809; P < .0001), and between aTRUPC and TRUPC Yv (ICC = 0.887; P < .0001). The coefficient of variation of aTRUPC Yv was 8.1 ± 9.9%. CONCLUSION The values of Yv measured by TRUPC and aTRUPC were in good agreement with blood gas oximetry. These findings suggest that TRUPC and aTRUPC can provide accurate quantifications of Yv in major cerebral veins.
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Affiliation(s)
- Dengrong Jiang
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raymond C. Koehler
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xiuyun Liu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ewa Kulikowicz
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer K. Lee
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Maryland, USA
| | - Peiying Liu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kalteren WS, Verhagen EA, Mintzer JP, Bos AF, Kooi EMW. Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review. Front Pediatr 2021; 9:644462. [PMID: 33718309 PMCID: PMC7952449 DOI: 10.3389/fped.2021.644462] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Anemia remains a common comorbidity of preterm infants in the neonatal intensive care unit (NICU). Left untreated, severe anemia may adversely affect organ function due to inadequate oxygen supply to meet oxygen requirements, resulting in hypoxic tissue injury, including cerebral tissue. To prevent hypoxic tissue injury, anemia is generally treated with packed red blood cell (RBC) transfusions. Previously published data raise concerns about the impact of anemia on cerebral oxygen delivery and, therefore, on neurodevelopmental outcome (NDO). Objective: To provide a systematic overview of the impact of anemia and RBC transfusions during NICU admission on cerebral oxygenation, measured using near-infrared spectroscopy (NIRS), brain injury and development, and NDO in preterm infants. Data Sources: PubMed, Embase, reference lists. Study Selection: We conducted 3 different searches for English literature between 2000 and 2020; 1 for anemia, RBC transfusions, and cerebral oxygenation, 1 for anemia, RBC transfusions, and brain injury and development, and 1 for anemia, RBC transfusions, and NDO. Data Extraction: Two authors independently screened sources and extracted data. Quality of case-control studies or cohort studies, and RCTs was assessed using either the Newcastle-Ottawa Quality Assessment Scale or the Van Tulder Scale, respectively. Results: Anemia results in decreased oxygen-carrying capacity, worsening the burden of cerebral hypoxia in preterm infants. RBC transfusions increase cerebral oxygenation. Improved brain development may be supported by avoidance of cerebral hypoxia, although restrictive RBC transfusion strategies were associated with better long-term neurodevelopmental outcomes. Conclusions: This review demonstrated that anemia and RBC transfusions were associated with cerebral oxygenation, brain injury and development and NDO in preterm infants. Individualized care regarding RBC transfusions during NICU admission, with attention to cerebral tissue oxygen saturation, seems reasonable and needs further investigation to improve both short-term effects and long-term neurodevelopment of preterm infants.
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Affiliation(s)
- Willemien S Kalteren
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Elise A Verhagen
- Department of Neonatology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jonathan P Mintzer
- Division of Newborn Medicine, Department of Pediatrics, Mountainside Medical Center, Montclair, NJ, United States
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Elisabeth M W Kooi
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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8
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Ze B, Liu L, Yang Jin GS, Shan M, Geng Y, Zhou C, Wu T, Wu H, Hou X. Near-Infrared Spectroscopy Monitoring of Cerebral Oxygenation and Influencing Factors in Neonates from High-Altitude Areas. Neonatology 2021; 118:348-353. [PMID: 34107488 DOI: 10.1159/000514403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accurate detection of cerebral oxygen saturation (rSO2) may be useful for neonatal brain injury prevention, and the normal range of rSO2 of neonates at high altitude remained unclear. OBJECTIVE To compare cerebral rSO2 and cerebral fractional tissue oxygen extraction (cFTOE) at high-altitude and low-altitude areas in healthy neonates and neonates with underlying diseases. METHODS 515 neonates from low-altitude areas and 151 from Tibet were enrolled. These neonates were assigned into the normal group, hypoxic-ischemic encephalopathy (HIE) group, and other diseases group. Near-infrared spectroscopy was used to measure rSO2 in neonates within 24 h after admission. The differences of rSO2, pulse oxygen saturation (SpO2), and cFTOE levels were compared between neonates from low- and high-altitude areas. RESULTS (1) The mean rSO2 and cFTOE levels in normal neonates from Tibet were 55.0 ± 6.4% and 32.6 ± 8.5%, significantly lower than those from low-altitude areas (p < 0.05). (2) At high altitude, neonates with HIE, pneumonia (p < 0.05), anemia, and congenital heart disease (p < 0.05) have higher cFTOE than healthy neonates. (3) Compared with HIE neonates from plain areas, neonates with HIE at higher altitude had lower cFTOE (p < 0.05), while neonates with heart disease in plateau areas had higher cFTOE than those in plain areas (p < 0.05). CONCLUSIONS The rSO2 and cFTOE levels in normal neonates from high-altitude areas are lower than neonates from the low-altitude areas. Lower cFTOE is possibly because of an increase in blood flow to the brain, and this may be adversely affected by disease states which may increase the risk of brain injury.
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Affiliation(s)
- Bi Ze
- Pediatric Department, Peking University First Hospital, Beijing, China.,Pediatric Department, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Lili Liu
- Pediatric Department, Peking University First Hospital, Beijing, China
| | - Ge Sang Yang Jin
- Pediatric Department, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Minna Shan
- Pediatric Department, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Yuehang Geng
- Pediatric Department, Peking University First Hospital, Beijing, China
| | - Congle Zhou
- Pediatric Department, Peking University First Hospital, Beijing, China
| | - Tianqi Wu
- Pediatric Department, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Hong Wu
- Pediatric Department, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Xinlin Hou
- Pediatric Department, Peking University First Hospital, Beijing, China.,Pediatric Department, Tibet Autonomous Region People's Hospital, Lhasa, China
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9
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Germuska M, Chandler H, Okell T, Fasano F, Tomassini V, Murphy K, Wise R. A frequency-domain machine learning method for dual-calibrated fMRI mapping of oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen consumption (CMRO 2). Front Artif Intell 2020; 3. [PMID: 32885165 PMCID: PMC7116003 DOI: 10.3389/frai.2020.00012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Magnetic resonance imaging (MRI) offers the possibility to non-invasively map the brain's metabolic oxygen consumption (CMRO2), which is essential for understanding and monitoring neural function in both health and disease. However, in depth study of oxygen metabolism with MRI has so far been hindered by the lack of robust methods. One MRI method of mapping CMRO2 is based on the simultaneous acquisition of cerebral blood flow (CBF) and blood oxygen level dependent (BOLD) weighted images during respiratory modulation of both oxygen and carbon dioxide. Although this dual-calibrated methodology has shown promise in the research setting, current analysis methods are unstable in the presence of noise and/or are computationally demanding. In this paper, we present a machine learning implementation for the multi-parametric assessment of dual-calibrated fMRI data. The proposed method aims to address the issues of stability, accuracy, and computational overhead, removing significant barriers to the investigation of oxygen metabolism with MRI. The method utilizes a time-frequency transformation of the acquired perfusion and BOLD-weighted data, from which appropriate feature vectors are selected for training of machine learning regressors. The implemented machine learning methods are chosen for their robustness to noise and their ability to map complex non-linear relationships (such as those that exist between BOLD signal weighting and blood oxygenation). An extremely randomized trees (ET) regressor is used to estimate resting blood flow and a multi-layer perceptron (MLP) is used to estimate CMRO2 and the oxygen extraction fraction (OEF). Synthetic data with additive noise are used to train the regressors, with data simulated to cover a wide range of physiologically plausible parameters. The performance of the implemented analysis method is compared to published methods both in simulation and with in-vivo data (n = 30). The proposed method is demonstrated to significantly reduce computation time, error, and proportional bias in both CMRO2 and OEF estimates. The introduction of the proposed analysis pipeline has the potential to not only increase the detectability of metabolic difference between groups of subjects, but may also allow for single subject examinations within a clinical context.
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Affiliation(s)
- Michael Germuska
- CUBRIC, Department of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Hannah Chandler
- CUBRIC, Department of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Thomas Okell
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | | | - Valentina Tomassini
- CUBRIC, Department of Psychology, Cardiff University, Cardiff, United Kingdom.,Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom.,Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio University" of Chieti-Pescara, 66100, Chieti, Italy
| | - Kevin Murphy
- CUBRIC, Department of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Richard Wise
- CUBRIC, Department of Psychology, Cardiff University, Cardiff, United Kingdom.,Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio University" of Chieti-Pescara, 66100, Chieti, Italy.,Institute for Advanced Biomedical Technologies, "G. D'Annunzio University" of Chieti-Pescara, 66100, Chieti, Italy
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Duffin J, Hare GM, Fisher JA. A mathematical model of cerebral blood flow control in anaemia and hypoxia. J Physiol 2020; 598:717-730. [DOI: 10.1113/jp279237] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- James Duffin
- Departments of Anaesthesia and PhysiologyUniversity of Toronto Toronto Ontario Canada
- Thornhill Research Inc. Toronto Ontario Canada
| | - Gregory M.T Hare
- Departments of Anaesthesia and PhysiologyUniversity of Toronto Toronto Ontario Canada
- Department of AnesthesiaKeenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St Michael's HospitalUnity Health Toronto Toronto Ontario Canada
| | - Joseph A. Fisher
- Departments of Anaesthesia and PhysiologyUniversity of Toronto Toronto Ontario Canada
- Thornhill Research Inc. Toronto Ontario Canada
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Progressive anemia of prematurity is associated with a critical increase in cerebral oxygen extraction. Early Hum Dev 2019; 140:104891. [PMID: 31669878 PMCID: PMC7180102 DOI: 10.1016/j.earlhumdev.2019.104891] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Elevated cerebral fractional tissue oxygen extraction (cFTOE) is an adaptation to anemia of prematurity (AOP). cFTOE ≥0.4 is associated with brain injury in infants ≤30 weeks. This longitudinal study sought to investigate the utility of cFTOE in the evaluation of AOP. METHODS Infants ≤30 weeks estimated gestational age (EGA) underwent weekly hemoglobin, cerebral saturation, and pulse oximetry recordings from the second through 36 weeks post-menstrual age (PMA). Recordings were excluded if they were under 1 h or if hemoglobin was not measured within 7 days of recording. Mean cFTOE was calculated for each recording. Statistical analysis used linear mixed-effects modeling and receiver operating characteristic analysis. RESULTS 144 recordings from 39 infants (mean EGA 27.6 ± 2.2 weeks, BW 1139 ± 286 g) were included of whom 39% (15/39) were transfused. The mean recording length was 2.8 ± 1.3 h. There was a significant negative correlation between hemoglobin and cFTOE (R = -0.423, p ≤.001). In a multivariate model, adjusting for EGA, PMA, and patent ductus arteriosus treatment the AUC was 0.821. A critical increase in cFTOE occurred at a hemoglobin level of 9.6 g/dL. CONCLUSIONS AOP is associated with a critical increase in cFTOE that occurs at a significantly higher hemoglobin level than standard clinical thresholds for transfusion.
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