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Zhang T, Niu H, Liu Y, Cai L, Liu D, Zhao E, Li M, Liu W, Li J, Qiao P, Zheng W, Ren P, Wang Z. Dobutamine-induced alternations in cerebral blood flow of healthy adults: a 3D pseudocontinuous arterial spin labeling study. BMC Med 2023; 21:238. [PMID: 37400817 DOI: 10.1186/s12916-023-02928-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/08/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND It is unclear whether dobutamine, commonly used clinically in echocardiography and short-term congestive heart failure treatment for promoting increased myocardial contractility, affects brain microcirculatory behavior. Cerebral microcirculation plays an important role in ensuring adequate oxygen transport. Therefore, we investigated the effects of dobutamine on cerebral hemodynamics. METHODS Forty-eight healthy volunteers without cardiovascular or cerebrovascular disease underwent MRI to obtain cerebral blood flow (CBF) maps using 3D pseudocontinuous arterial spin labeling before and during the dobutamine stress test. Additionally, cerebrovascular morphology was obtained based on 3D-time-off-light (3D-TOF) magnetic resonance angiography (MRA). Electrocardiogram, heart rate (HR), respiration rate (RR), blood pressure, and blood oxygen were simultaneously recorded before and during dobutamine injection and during recovery (not during MRI). The anatomic features of the circle of Willis and the basilar artery (BA) diameter were assessed on MRA images by two radiologists with extensive neuroimaging experience. Binary logistic regression was used to test for the independent determinants of CBF changes. RESULTS HR, RR, systolic (SBP), and diastolic blood pressure (DBP) significantly increased after dobutamine infusion. Blood oxygen levels remained similar. Compared to the CBF in the resting state, the CBF values exhibited significantly lower CBF levels in both grey matter and white matter. Furthermore, compared with the CBF in the resting state, that in the stress state was decreased in the anterior circulation, mainly in the frontal lobe (voxel level P < 0.001, pixel level P < 0.05). Logistic regression showed that body mass index (BMI; odds ratio [OR] 5.80, 95% confidence interval [CI] 1.60-21.01, P = 0.008], resting SBP (OR 0.64, 95% CI 0.45-0.92, P = 0.014), and BA diameter (OR 11.04, 95% CI 1.05-116.53, P = 0.046) were significantly associated with frontal lobe CBF changes. CONCLUSIONS Dobutamine-induced stress significantly decreased CBF in the frontal lobe anterior circulation. Individuals with a high BMI and low SBP during the dobutamine stress test are more likely to have a stress-induced CBF decrease. Thus, attention should be paid to blood pressure, BMI, and cerebrovascular morphology of patients undergoing dobutamine stress echocardiography or those receiving intensive care or anesthesia.
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Affiliation(s)
- Tingting Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Haijun Niu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yawen Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Linkun Cai
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Dong Liu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Erwei Zhao
- National Space Science Center, Chinese Academy of Sciences, Beijing, China
| | - Min Li
- Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing Clinical Research Institute, Beijing, China
| | - Wenjuan Liu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - PengGang Qiao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Zheng
- National Space Science Center, Chinese Academy of Sciences, Beijing, China
| | - Pengling Ren
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Zhenchang Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Schreiber S, Bernal J, Arndt P, Schreiber F, Müller P, Morton L, Braun-Dullaeus RC, Valdés-Hernández MDC, Duarte R, Wardlaw JM, Meuth SG, Mietzner G, Vielhaber S, Dunay IR, Dityatev A, Jandke S, Mattern H. Brain Vascular Health in ALS Is Mediated through Motor Cortex Microvascular Integrity. Cells 2023; 12:957. [PMID: 36980297 PMCID: PMC10047140 DOI: 10.3390/cells12060957] [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: 02/10/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Brain vascular health appears to be critical for preventing the development of amyotrophic lateral sclerosis (ALS) and slowing its progression. ALS patients often demonstrate cardiovascular risk factors and commonly suffer from cerebrovascular disease, with evidence of pathological alterations in their small cerebral blood vessels. Impaired vascular brain health has detrimental effects on motor neurons: vascular endothelial growth factor levels are lowered in ALS, which can compromise endothelial cell formation and the integrity of the blood-brain barrier. Increased turnover of neurovascular unit cells precedes their senescence, which, together with pericyte alterations, further fosters the failure of toxic metabolite removal. We here provide a comprehensive overview of the pathogenesis of impaired brain vascular health in ALS and how novel magnetic resonance imaging techniques can aid its detection. In particular, we discuss vascular patterns of blood supply to the motor cortex with the number of branches from the anterior and middle cerebral arteries acting as a novel marker of resistance and resilience against downstream effects of vascular risk and events in ALS. We outline how certain interventions adapted to patient needs and capabilities have the potential to mechanistically target the brain microvasculature towards favorable motor cortex blood supply patterns. Through this strategy, we aim to guide novel approaches to ALS management and a better understanding of ALS pathophysiology.
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Affiliation(s)
- Stefanie Schreiber
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany
| | - Jose Bernal
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Philipp Arndt
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Frank Schreiber
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Patrick Müller
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
- Department of Internal Medicine/Cardiology and Angiology, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Lorena Morton
- Institute of Inflammation and Neurodegeneration, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany
| | | | | | - Roberto Duarte
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK Dementia Research Institute Centre, Edinburgh EH16 4UX, UK
| | - Joanna Marguerite Wardlaw
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK Dementia Research Institute Centre, Edinburgh EH16 4UX, UK
| | - Sven Günther Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Grazia Mietzner
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany
| | - Ildiko Rita Dunay
- Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany
- Institute of Inflammation and Neurodegeneration, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Alexander Dityatev
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany
- Medical Faculty, Otto von Guericke University, 39120 Magdeburg, Germany
| | - Solveig Jandke
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Hendrik Mattern
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany
- Department of Biomedical Magnetic Resonance, Faculty of Natural Sciences, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany
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3
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Ohtomo S, Otsubo H, Arai H, Shimoda Y, Homma Y, Tominaga T. Hyperperfusion in the thalamus on arterial spin labelling indicates non-convulsive status epilepticus. Brain Commun 2020; 3:fcaa223. [PMID: 33501426 PMCID: PMC7811763 DOI: 10.1093/braincomms/fcaa223] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/04/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
Non-convulsive status epilepticus describes the syndrome of unexplained impaired consciousness in critically ill patients. Non-convulsive status epilepticus is very likely to lead to delayed diagnosis and poor outcomes because of the absence of convulsive symptoms. EEG is essential for the diagnosis of non-convulsive status epilepticus to establish the association between periodic discharges and rhythmic delta activity in addition to ictal epileptiform discharges according to the Salzburg criteria. Arterial spin labelling, a type of perfusion MRI, has been applied for rapid and non-invasive evaluation of the ictal state. Ictal cerebral cortical hyperperfusion is the most common finding to demonstrate focal onset seizures. Hyperperfusion of the thalamus on single photon emission computed tomography was found in patients with impaired awareness seizures. We hypothesized that thalamocortical hyperperfusion on arterial spin labelling identifies non-convulsive status epilepticus and such thalamic hyperperfusion specifically associates with periodic/rhythmic discharges producing impaired consciousness without convulsion. We identified 27 patients (17 females; age, 39-91 years) who underwent both arterial spin labelling and EEG within 24 h of suspected non-convulsive status epilepticus. We analysed 28 episodes of suspected non-convulsive status epilepticus and compared hyperperfusion on arterial spin labelling with periodic/rhythmic discharges. We evaluated 21 episodes as a positive diagnosis of non-convulsive status epilepticus according to the Salzburg criteria. We identified periodic discharges in 15 (12 lateralized and 3 bilateral independent) episodes and rhythmic delta activity in 13 (10 lateralized, 1 bilateral independent and 2 generalized) episodes. Arterial spin labelling showed thalamic hyperperfusion in 16 (11 unilateral and 5 bilateral) episodes and cerebral cortical hyperperfusion in 24 (20 unilateral and 4 bilateral) episodes. Thalamic hyperperfusion was significantly associated with non-convulsive status epilepticus (P = 0.0007; sensitivity, 76.2%; specificity, 100%), periodic discharges (P < 0.0001; 93.3%; 84.6%), and rhythmic delta activity (P = 0.0006; 92.3%; 73.3%). Cerebral cortical hyperperfusion was significantly associated with non-convulsive status epilepticus (P = 0.0017; 100%; 57.1%) and periodic discharges (P = 0.0349; 100%; 30.8%), but not with rhythmic delta activity. Thalamocortical hyperperfusion could be a new biomarker of non-convulsive status epilepticus according to the Salzburg criteria in critically ill patients. Specific thalamic hyperexcitability might modulate the periodic discharges and rhythmic delta activity associated with non-convulsive status epilepticus. Impaired consciousness without convulsions could be caused by predominant thalamic hyperperfusion together with cortical hyperperfusion but without ictal epileptiform discharges.
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Affiliation(s)
- Satoru Ohtomo
- Department of Neurosurgery, South Miyagi Medical Center, Shibata-gun, Miyagi, Japan
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hiroaki Arai
- Department of Neurosurgery, South Miyagi Medical Center, Shibata-gun, Miyagi, Japan
| | - Yoshiteru Shimoda
- Department of Neurosurgery, South Miyagi Medical Center, Shibata-gun, Miyagi, Japan
| | - Yoichiro Homma
- Department of General Internal Medicine, Seirei-Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Bordes S, Werner C, Mathkour M, McCormack E, Iwanaga J, Loukas M, Lammle M, Dumont AS, Tubbs RS. Arterial Supply of the Thalamus: A Comprehensive Review. World Neurosurg 2020; 137:310-318. [DOI: 10.1016/j.wneu.2020.01.237] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/14/2022]
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Fallatah SM, Pizzini FB, Gomez-Anson B, Magerkurth J, De Vita E, Bisdas S, Jäger HR, Mutsaerts HJMM, Golay X. A visual quality control scale for clinical arterial spin labeling images. Eur Radiol Exp 2018; 2:45. [PMID: 30569375 PMCID: PMC6300452 DOI: 10.1186/s41747-018-0073-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Image-quality assessment is a fundamental step before clinical evaluation of magnetic resonance images. The aim of this study was to introduce a visual scoring system that provides a quality control standard for arterial spin labeling (ASL) and that can be applied to cerebral blood flow (CBF) maps, as well as to ancillary ASL images. METHODS The proposed image quality control (QC) system had two components: (1) contrast-based QC (cQC), describing the visual contrast between anatomical structures; and (2) artifact-based QC (aQC), evaluating image quality of the CBF map for the presence of common types of artifacts. Three raters evaluated cQC and aQC for 158 quantitative signal targeting with alternating radiofrequency labelling of arterial regions (QUASAR) ASL scans (CBF, T1 relaxation rate, arterial blood volume, and arterial transient time). Spearman correlation coefficient (r), intraclass correlation coefficients (ICC), and receiver operating characteristic analysis were used. RESULTS Intra/inter-rater agreement ranged from moderate to excellent; inter-rater ICC was 0.72 for cQC, 0.60 for aQC, and 0.74 for the combined QC (cQC + aQC). Intra-rater ICC was 0.90 for cQC; 0.80 for aQC, and 0.90 for the combined QC. Strong correlations were found between aQC and CBF maps quality (r = 0.75), and between aQC and cQC (r = 0.70). A QC score of 18 was optimal to discriminate between high and low quality clinical scans. CONCLUSIONS The proposed QC system provided high reproducibility and a reliable threshold for discarding low quality scans. Future research should compare this visual QC system with an automatic QC system.
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Affiliation(s)
- S M Fallatah
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK.,The National Hospital for Neurology and Neurosurgery, London, UK.,Radiology Department, King Abdualaziz Medical City, Riyadh, Saudi Arabia
| | - F B Pizzini
- Neuroradiology, University Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy.
| | - B Gomez-Anson
- Unitat Neuroradiologia, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autonoma, Barcelona, Spain
| | - J Magerkurth
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - E De Vita
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK.,The National Hospital for Neurology and Neurosurgery, London, UK
| | - S Bisdas
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK.,The National Hospital for Neurology and Neurosurgery, London, UK
| | - H R Jäger
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK.,The National Hospital for Neurology and Neurosurgery, London, UK
| | - H J M M Mutsaerts
- Radiology Department, Academic Medical Center, Amsterdam, The Netherlands.,Radiology Department, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.,Radiology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - X Golay
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK.,The National Hospital for Neurology and Neurosurgery, London, UK
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Hagiwara H, Nakajima Y, Ikegami T, Kinno Y, Kumada M. Hemilaterally masked arterial spin labeling by intentional magnetic field changes in the labeling area due to placement of material with high susceptibility. PLoS One 2018; 13:e0200648. [PMID: 30001396 PMCID: PMC6042778 DOI: 10.1371/journal.pone.0200648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/30/2018] [Indexed: 11/18/2022] Open
Abstract
Background and purpose Arterial spin labeling(ASL)with magnetic resonance imaging (MRI) is an effective method for estimating cerebral blood flow (CBF). Furthermore, assessing perfusion territories of arteries is useful for determining the treatment strategy of patients with carotid artery stenosis. ASL with selective vessel labeling is an effective method to obtain perfusion mapping, however, the application for selective labeling is not installed on all MR scanners. The purpose of this study is to establish a method to selectively mask in the labeling area using material with high susceptibility instead of selectively labeling to obtain a partial perfusion image. Materials and methods ASL perfusion images were performed in five volunteers. Masking was applied by placing a stainless-steel bolt and nuts on the neck. The area of artifacts extended to the carotid artery was confirmed by the localizer image. In the obtained masked ASL, blood flow of the left and right cerebrum and cerebellum was measured and compared with control ASL without masking. By subtracting masked ASL from the control ASL, the perfusion territory of the carotid artery on the masked side was identified. Results Mean CBF which was 39.6 ml/(100 g × min) in control ASL decreased to 16.1 ml/(100 g × min) in masked ASL, and the masking ratio was 59.6%. There were no significant differences in the CBF of non-masked areas under the control ASL condition (39.6± 5.2 ml/[100 g × min]) btween that under the masked ASL condition (39.4 ± 7.0 ml/[100 g × min]). By subtracting masked ASL from control ASL, we successfully visualized the hemilateral carotid artery’s perfusion territory. Conclusion Intentional susceptibility artifacts with non-magnetic metals on the neck can mask spin labeling of the carotid artery. Furthermore, hemilateral carotid artery perfusion territories can be visualized in hemilaterally masked ASL.
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Affiliation(s)
- Hiroaki Hagiwara
- Department of Radiology, Yokohama Minamikyosai Hospital, Yokohama,Kanagawa, Japan
- * E-mail:
| | - Yoshito Nakajima
- Department of Radiology, Yokohama Minamikyosai Hospital, Yokohama,Kanagawa, Japan
| | - Tadashi Ikegami
- Department of Radiology, Yokohama Minamikyosai Hospital, Yokohama,Kanagawa, Japan
| | - Yoshinori Kinno
- Department of Radiology, Yokohama Minamikyosai Hospital, Yokohama,Kanagawa, Japan
| | - Megumi Kumada
- Department of Radiology, Yokohama Minamikyosai Hospital, Yokohama,Kanagawa, Japan
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Haller S, Zaharchuk G, Thomas DL, Lovblad KO, Barkhof F, Golay X. Arterial Spin Labeling Perfusion of the Brain: Emerging Clinical Applications. Radiology 2017; 281:337-356. [PMID: 27755938 DOI: 10.1148/radiol.2016150789] [Citation(s) in RCA: 323] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Arterial spin labeling (ASL) is a magnetic resonance (MR) imaging technique used to assess cerebral blood flow noninvasively by magnetically labeling inflowing blood. In this article, the main labeling techniques, notably pulsed and pseudocontinuous ASL, as well as emerging clinical applications will be reviewed. In dementia, the pattern of hypoperfusion on ASL images closely matches the established patterns of hypometabolism on fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) images due to the close coupling of perfusion and metabolism in the brain. This suggests that ASL might be considered as an alternative for FDG, reserving PET to be used for the molecular disease-specific amyloid and tau tracers. In stroke, ASL can be used to assess perfusion alterations both in the acute and the chronic phase. In arteriovenous malformations and dural arteriovenous fistulas, ASL is very sensitive to detect even small degrees of shunting. In epilepsy, ASL can be used to assess the epileptogenic focus, both in peri- and interictal period. In neoplasms, ASL is of particular interest in cases in which gadolinium-based perfusion is contraindicated (eg, allergy, renal impairment) and holds promise in differentiating tumor progression from benign causes of enhancement. Finally, various neurologic and psychiatric diseases including mild traumatic brain injury or posttraumatic stress disorder display alterations on ASL images in the absence of visualized structural changes. In the final part, current limitations and future developments of ASL techniques to improve clinical applicability, such as multiple inversion time ASL sequences to assess alterations of transit time, reproducibility and quantification of cerebral blood flow, and to measure cerebrovascular reserve, will be reviewed. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Sven Haller
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Greg Zaharchuk
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - David L Thomas
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Karl-Olof Lovblad
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Frederik Barkhof
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Xavier Golay
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
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8
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Richter V, Helle M, van Osch MJP, Lindner T, Gersing AS, Tsantilas P, Eckstein HH, Preibisch C, Zimmer C. MR Imaging of Individual Perfusion Reorganization Using Superselective Pseudocontinuous Arterial Spin-Labeling in Patients with Complex Extracranial Steno-Occlusive Disease. AJNR Am J Neuroradiol 2017; 38:703-711. [PMID: 28183839 DOI: 10.3174/ajnr.a5090] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 12/04/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients with multiple stenoses or occlusions of the extracranial arteries require an individualized diagnostic approach. We evaluated the feasibility and clinical utility of a novel MR imaging technique for regional perfusion imaging in this patient group. MATERIALS AND METHODS Superselective pseudocontinuous arterial spin-labeling with a circular labeling spot enabling selective vessel labeling was added to routine imaging in a prospective pilot study in 50 patients (10 women, 70.05 ± 10.55 years of age) with extracranial steno-occlusive disease. Thirty-three had infarct lesions. DSC-MR imaging was performed in 16/50 (32%), and cerebral DSA, in 12/50 patients (24%). Vascular anatomy and the distribution of vessel stenoses and occlusions were defined on sonography and TOF-MRA. Stenoses were classified according to the NASCET criteria. Infarct lesions and perfusion deficits were defined on FLAIR and DSC-MR imaging, respectively. Individual perfusion patterns were defined on the superselective pseudocontinuous arterial spin-labeling maps and were correlated with vascular anatomy and infarct lesion localization. RESULTS The superselective pseudocontinuous arterial spin-labeling imaging sequence could be readily applied by trained technicians, and the additional scan time of 12.7 minutes was well-tolerated by patients. The detected vessel occlusions/stenoses and perfusion patterns corresponded between cerebral DSA and superselective pseudocontinuous arterial spin-labeling maps in all cases. Perfusion deficits on DSC-CBF maps significantly correlated with those on superselective pseudocontinuous arterial spin-labeling maps (Pearson r = 0.9593, P < .01). Individual collateral recruitment patterns were not predictable from the vascular anatomy in 71% of our patients. CONCLUSIONS Superselective pseudocontinuous arterial spin-labeling is a robust technique for regional brain perfusion imaging, suitable for the noninvasive diagnostics of individual perfusion patterns in patients with complex cerebrovascular disease.
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Affiliation(s)
- V Richter
- From the Department of Radiology (V.R.), Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - M Helle
- Department of Radiology and Neuroradiology (M.H., T.L.), University Medical Center Schleswig-Holstein, Kiel, Germany
- Philips GmbH Innovative Technologies (M.H.), Research Laboratories, Hamburg, Germany
| | - M J P van Osch
- The C. J. Gorter Center for High Field MRI (M.J.P.v.O.), Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Lindner
- Department of Radiology and Neuroradiology (M.H., T.L.), University Medical Center Schleswig-Holstein, Kiel, Germany
| | - A S Gersing
- Departments of Diagnostic and Interventional Neuroradiology (A.S.G., C.P., C.Z.)
| | - P Tsantilas
- Vascular and Endovascular Surgery (P.T., H.-H.E.), Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - H-H Eckstein
- Vascular and Endovascular Surgery (P.T., H.-H.E.), Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - C Preibisch
- Departments of Diagnostic and Interventional Neuroradiology (A.S.G., C.P., C.Z.)
| | - C Zimmer
- Departments of Diagnostic and Interventional Neuroradiology (A.S.G., C.P., C.Z.)
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Hartkamp NS, Hendrikse J, De Cocker LJL, de Borst GJ, Kappelle LJ, Bokkers RPH. Misinterpretation of ischaemic infarct location in relationship to the cerebrovascular territories. J Neurol Neurosurg Psychiatry 2016; 87:1084-90. [PMID: 27466359 PMCID: PMC5036207 DOI: 10.1136/jnnp-2015-312906] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 06/15/2016] [Indexed: 11/05/2022]
Abstract
PURPOSE Cerebral perfusion territories are known to vary widely among individuals. This may lead to misinterpretation of the symptomatic artery in patients with ischaemic stroke to a wrong assumption of the underlying aetiology being thromboembolic or hypoperfusion. The aim of the present study was to investigate such potential misinterpretation with territorial arterial spin labelling (T-ASL) by correlating infarct location with imaging of the perfusion territory of the carotid arteries or basilar artery. MATERIALS AND METHODS 223 patients with subacute stroke underwent MRI including structural imaging scans to determine infarct location, time-of-flight MR angiography (MRA) to determine the morphology of the circle of Willis and T-ASL to identify the perfusion territories of the internal carotid arteries, and basilar artery. Infarct location and the perfusion territory of its feeding artery were classified with standard MRI and MRA according to a perfusion atlas, and were compared to the classification made according to T-ASL. RESULTS A total of 149 infarctions were detected in 87 of 223 patients. 15 out of 149 (10%) infarcts were erroneously attributed to a single perfusion territory; these infarcts were partly located in the originally determined perfusion territory but proved to be localised in the border zone with the adjacent perfusion territory instead. 12 out of 149 (8%) infarcts were misclassified with standard assessments and were not located in the original perfusion territory. CONCLUSIONS T-ASL with territorial perfusion imaging may provide important additional information for classifying the symptomatic brain-feeding artery when compared to expert evaluation with MRI and MRA.
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Affiliation(s)
- Nolan S Hartkamp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laurens J L De Cocker
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert Jan de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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10
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Arterial Spin Labeling Techniques 2009-2014. J Med Imaging Radiat Sci 2016; 47:98-107. [PMID: 31047171 DOI: 10.1016/j.jmir.2015.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 07/03/2015] [Accepted: 08/18/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Arterial spin labeling (ASL) techniques have been implemented across a diverse range of clinical and experimental applications. This review aims to evaluate the current feasibility of ASL in clinical neuroradiology based on recent improvements to ASL sequences and highlight areas for potential clinical applications. METHODS AND MATERIALS In December 2014, a literature search was conducted on PubMed Central, EMBASE, and Scopus using the search terms: "arterial spin labeling, neuroradiology," for studies published between 2009 and 2014 (inclusive). Of 483 studies matching the inclusion criteria, the number of studies using continuous, pseudocontinuous, pulsed, and velocity-selective ASL sequences was 42, 209, 226, and 3, respectively. Studies were classified based on several common clinical applications according to the type of ASL sequence used. Studies using pulsed ASL and pseudo-continuous ASL were grouped based on common sequences. RESULTS The number of clinical studies was 264. Numerous studies applied ASL to stroke management (43 studies), drug testing (21 studies), neurodegenerative diseases (40 studies), and psychiatric disorders (26 studies). CONCLUSIONS This review discusses several factors hindering the implementation of clinical ASL and ASL-related radiofrequency safety issues encountered in clinical practice. However, a limited number of search terms were used. Further development of robust sequences with multislice imaging capabilities and reduced radiofrequency energy deposition will hopefully improve the clinical acceptance of ASL.
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11
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Qu L, Feng J, Zou S, Bai J, Hu Z, Guo M, Jing Z. Improved visual, acoustic, and neurocognitive functions after carotid endarterectomy in patients with minor stroke from severe carotid stenosis. J Vasc Surg 2015; 62:635-44.e2. [DOI: 10.1016/j.jvs.2015.04.401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 04/19/2015] [Indexed: 11/25/2022]
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12
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Lövblad KO, Montandon ML, Viallon M, Rodriguez C, Toma S, Golay X, Giannakopoulos P, Haller S. Arterial Spin-Labeling Parameters Influence Signal Variability and Estimated Regional Relative Cerebral Blood Flow in Normal Aging and Mild Cognitive Impairment: FAIR versus PICORE Techniques. AJNR Am J Neuroradiol 2015; 36:1231-6. [PMID: 25882291 DOI: 10.3174/ajnr.a4291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/05/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Arterial spin-labeling is a noninvasive method to map cerebral blood flow, which might be useful for early diagnosis of neurodegenerative diseases. We directly compared 2 arterial spin-labeling techniques in healthy elderly controls and individuals with mild cognitive impairment. MATERIALS AND METHODS This prospective study was approved by the local ethics committee and included 198 consecutive healthy controls (mean age, 73.65 ± 4.02 years) and 43 subjects with mild cognitive impairment (mean age, 73.38 ± 5.85 years). Two pulsed arterial spin-labeling sequences were performed at 3T: proximal inversion with a control for off-resonance effects (PICORE) and flow-sensitive alternating inversion recovery technique (FAIR). Relative cerebral blood flow maps were calculated by using commercial software and standard parameters. Data analysis included spatial normalization of gray matter-corrected relative CBF maps, whole-brain average, and voxelwise comparison of both arterial spin-labeling sequences. RESULTS Overall, FAIR yielded higher relative CBF values compared with PICORE (controls, 32.7 ± 7.1 versus 30.0 ± 13.1 mL/min/100 g, P = .05; mild cognitive impairment, 29.8 ± 5.4 versus 26.2 ± 8.6 mL/min/100 g, P < .05; all, 32.2 ± 6.8 versus 29.3 ± 12.3 mL/min/100 g, P < .05). FAIR had lower variability (controls, 36.2% versus 68.8%, P < .00001; mild cognitive impairment, 18.9% versus 22.9%, P < .0001; all, 34.4% versus 64.9% P < .00001). The detailed voxelwise analysis revealed a higher signal for FAIR, notably in both convexities, while PICORE had higher signal predominantly in deep cerebral regions. CONCLUSIONS Overall, FAIR had higher estimated relative CBF and lower interindividual variability than PICORE. In more detail, there were regional differences between both arterial spin-labeling sequences. In summary, these results highlight the need to calibrate arterial spin-labeling sequences.
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Affiliation(s)
- K-O Lövblad
- From the Divisions of Diagnostic and Interventional Neuroradiology (K.-O.L., M.-L.M., M.V., S.H.)
| | - M-L Montandon
- From the Divisions of Diagnostic and Interventional Neuroradiology (K.-O.L., M.-L.M., M.V., S.H.)
| | - M Viallon
- From the Divisions of Diagnostic and Interventional Neuroradiology (K.-O.L., M.-L.M., M.V., S.H.) CREATIS (M.V.), UMR CNRS 5220-Institut National de la Santé et de la Recherche Médicale U1044, INSA de Lyon, Université de Lyon, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | - C Rodriguez
- Psychiatry (C.R., S.T., P.G.), Geneva University Hospitals, Geneva, Switzerland
| | - S Toma
- Psychiatry (C.R., S.T., P.G.), Geneva University Hospitals, Geneva, Switzerland
| | - X Golay
- Institute of Neurology (X.G.), University College London, London, United Kingdom
| | - P Giannakopoulos
- Psychiatry (C.R., S.T., P.G.), Geneva University Hospitals, Geneva, Switzerland
| | - S Haller
- From the Divisions of Diagnostic and Interventional Neuroradiology (K.-O.L., M.-L.M., M.V., S.H.)
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13
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Algra SO, Jansen NJ, van der Tweel I, Schouten AN, Groenendaal F, Toet M, van Oeveren W, van Haastert IC, Schoof PH, de Vries LS, Haas F. Neurological Injury After Neonatal Cardiac Surgery. Circulation 2014; 129:224-33. [DOI: 10.1161/circulationaha.113.003312] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Selma O. Algra
- From the Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.)
| | - Nicolaas J.G. Jansen
- From the Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.)
| | - Ingeborg van der Tweel
- From the Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.)
| | - Antonius N.J. Schouten
- From the Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.)
| | - Floris Groenendaal
- From the Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.)
| | - Mona Toet
- From the Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.)
| | - Wim van Oeveren
- From the Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.)
| | - Ingrid C. van Haastert
- From the Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.)
| | - Paul H. Schoof
- From the Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.)
| | - Linda S. de Vries
- From the Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.)
| | - Felix Haas
- From the Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.)
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Hartkamp NS, Petersen ET, De Vis JB, Bokkers RPH, Hendrikse J. Mapping of cerebral perfusion territories using territorial arterial spin labeling: techniques and clinical application. NMR IN BIOMEDICINE 2013; 26:901-912. [PMID: 22807022 DOI: 10.1002/nbm.2836] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 06/12/2012] [Accepted: 06/17/2012] [Indexed: 06/01/2023]
Abstract
A knowledge of the exact cerebral perfusion territory which is supplied by any artery is of great importance in the understanding and diagnosis of cerebrovascular disease. The development and optimization of territorial arterial spin labeling (T-ASL) MRI techniques in the past two decades have made it possible to visualize and determine the cerebral perfusion territories in individual patients and, more importantly, to do so without contrast agents or otherwise invasive procedures. This review provides an overview of the development of ASL techniques that aim to visualize the general cerebral perfusion territories or the territory of a specific artery of interest. The first efforts of T-ASL with pulsed, continuous and pseudo-continuous techniques are summarized and subsequent clinical studies using T-ASL are highlighted. In the healthy population, the perfusion territories of the brain-feeding arteries are highly variable. This high variability requires special consideration in specific patient groups, such as patients with cerebrovascular disease, stroke, steno-occlusive disease of the large arteries and arteriovenous malformations. In the past, catheter angiography with selective contrast injection was the only available method to visualize the cerebral perfusion territories in vivo. Several T-ASL methods, sometimes referred to as regional perfusion imaging, are now available that can easily be combined with conventional brain MRI examinations to show the relationship between the cerebral perfusion territories, vascular anatomy and brain infarcts or other pathology. Increased availability of T-ASL techniques on clinical MRI scanners will allow radiologists and other clinicians to gain further knowledge of the relationship between vasculature and patient diagnosis and prognosis. Treatment decisions, such as surgical revascularization, may, in the near future, be guided by information provided by T-ASL MRI in close correlation with structural MRI and quantitative perfusion information.
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Affiliation(s)
- Nolan S Hartkamp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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15
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Liu TT. Neurovascular factors in resting-state functional MRI. Neuroimage 2013; 80:339-48. [PMID: 23644003 DOI: 10.1016/j.neuroimage.2013.04.071] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/12/2013] [Accepted: 04/16/2013] [Indexed: 11/16/2022] Open
Abstract
There has been growing interest in the use of resting-state functional magnetic resonance imaging (rsfMRI) for the assessment of disease and treatment, and a number of studies have reported significant disease-related changes in resting-state blood oxygenation level dependent (BOLD) signal amplitude and functional connectivity. rsfMRI is particularly suitable for clinical applications because the approach does not require the patient to perform a task and scans can be obtained in a relatively short amount of time. However, the mechanisms underlying resting-state BOLD activity are not well understood and thus the interpretation of changes in resting state activity is not always straightforward. The BOLD signal represents the hemodynamic response to neural activity, and changes in resting-state activity can reflect a complex combination of neural, vascular, and metabolic factors. This paper examines the role of neurovascular factors in rsfMRI and reviews approaches for the interpretation and analysis of resting state measures in the presence of confounding factors.
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Affiliation(s)
- Thomas T Liu
- Center for Functional Magnetic Resonance Imaging, University of California San Diego, 9500 Gilman Drive, MC 0677, La Jolla, CA 92093-0677, USA.
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16
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Förster A, Nölte I, Wenz H, Al-Zghloul M, Kerl HU, Brockmann MA, Groden C. Anatomical variations in the posterior part of the circle of willis and vascular pathology in bilateral thalamic infarction. J Neuroimaging 2013; 24:325-30. [PMID: 23621712 DOI: 10.1111/jon.12022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 11/11/2012] [Accepted: 12/21/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Bilateral paramedian thalamic infarction is a rare subtype of stroke the etiology of which still remains undetermined in many patients. METHODS From a computed tomography (CT)/magnetic resonance imaging report database, we identified and analyzed 48 patients with bilateral paramedian thalamic infarction on diffusion-weighted imaging. Vascular pathologies were noted on CT angiography (CTA)/magnetic resonance angiography (MRA) and the P1 segments of the posterior cerebral artery (PCA) described as normal, hypoplastic, or absent. RESULTS Vascular imaging revealed top of the basilar artery (BA) occlusion in 6 (12.5%), BA occlusion in 4 (8.3%), BA stenosis in 1 (2.1%), and BA hypoplasia in 3 (6.3%), PCA occlusion in 4 (8.3%), and PCA stenosis in 4 (8.3%) patients. In 18 (37.5%) patients, one or both P1 segments of the PCA were hypoplastic or absent. Patients with hypoplastic/absent P1 segments were more likely to have exclusively bilateral paramedian thalamic lesions (P < .001). An embolic source could be identified in 25 (55.6%) patients; there were no significant differences between both groups. CONCLUSIONS Vascular imaging is useful to determine underlying vascular pathologies and may support the diagnosis of small vessel disease in those patients with isolated bilateral paramedian thalamic infarction, hypoplastic/absent P1 segment of the PCA, and lack of vascular pathology.
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Affiliation(s)
- Alex Förster
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
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17
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Recent advances in medical imaging: anatomical and clinical applications. Surg Radiol Anat 2012; 34:675-86. [DOI: 10.1007/s00276-012-0985-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/15/2012] [Indexed: 12/27/2022]
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Lövblad KO, Haller S, Pereira VM. Stroke: high-field magnetic resonance imaging. Neuroimaging Clin N Am 2012; 22:191-205, x. [PMID: 22548928 DOI: 10.1016/j.nic.2012.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Diagnostic modalities for the diagnosis of acute stroke have increased in number and quality. Magnetic resonance imaging has increasingly become a central tool for the management of patients with stroke. New sequences, such as diffusion and perfusion, provide insight into the infarcted core and the hypoperfused brain. The use of higher magnetic fields allows us to gain in signal strength, which can be used to improve imaging speed and/or resolution. Recent additional sequences allow perfusion without contrast and susceptibility-weighted imaging can help identify early bleeding. These new techniques should provide more information about the on going ischemic process.
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Affiliation(s)
- Karl-Olof Lövblad
- Division of Neuroradiology, Department of Imaging and Medical Informatics, Geneva University Hospitals HUG, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
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19
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Diffusion tensor and perfusion imaging of brain tumors in high-field MR imaging. Neuroimaging Clin N Am 2012; 22:123-34, ix. [PMID: 22548924 DOI: 10.1016/j.nic.2012.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Diffusion tensor imaging (DTI) and perfusion-weighted imaging (PWI) are essential tools for diagnosing, differentiating, and monitoring brain tumors. High-field MRI provides higher signal-to-noise ratio, shorter scan time, and better image quality. One-stop multiparametric study, including DTI and PWI, is possible with high-field MRI in brain tumors. DTI can be used for assessing spatial relationship between major white matter tract and tumor, differentiating gliomas from nonglial tumors, and postoperative evaluation. PWI provides reliable biomarkers for glioma grading, therapeutic responses, and differential diagnosis of various brain tumors. With higher field strength, better-quality DTI and PWI can raise the diagnostic accuracy in brain tumors.
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20
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Hendrikse J, Petersen ET, Golay X. Vascular disorders: insights from arterial spin labeling. Neuroimaging Clin N Am 2012; 22:259-69, x-xi. [PMID: 22548931 DOI: 10.1016/j.nic.2012.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The introduction of high-field magnetic imaging (≥3 T) has made noninvasive arterial spin labeling (ASL) a realistic clinical option for perfusion assessment in vascular disorders. Combined with the advances provided by territorial imaging of individual intracerebral arteries and the measurement of vascular reactivity, ASL is a powerful tool for evaluating vascular diseases of the brain. This article evaluates its use in chronic cerebrovascular disease, stroke, moyamoya disease, and arteriovenous malformation, but ASL may also find applications in related diseases such as vascular dementia.
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Affiliation(s)
- Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Room E01.132, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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Asahi K, Hori M, Hamasaki N, Sato S, Nakanishi H, Kuwatsuru R, Sasai K, Aoki S. Dynamic alteration of regional cerebral blood flow during carotid compression and proof of reversibility. Acta Radiol Short Rep 2012; 1:10.1258_arsr.2012.110015. [PMID: 23986833 PMCID: PMC3738342 DOI: 10.1258/arsr.2012.110015] [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: 11/15/2011] [Accepted: 03/12/2012] [Indexed: 11/18/2022] Open
Abstract
Background It is difficult to non-invasively visualize changes in regional cerebral blood flow caused by manual compression of the carotid artery. Purpose To visualize dynamic changes in regional cerebral blood flow during and after manual compression of the carotid artery. Material and Methods Two healthy volunteers were recruited. Anatomic features and flow directions in the circle of Willis were evaluated with time-of-flight magnetic resonance angiography (MRA) and two-dimensional phase-contrast (2DPC) MRA, respectively. Regional cerebral blood flow was visualized with territorial arterial spin-labeling magnetic resonance imaging (TASL-MRI). TASL-MRI and 2DPC-MRA were performed in three states: at rest, during manual compression of the right carotid artery, and after decompression. In one volunteer, time-space labeling inversion pulse (Time-SLIP) MRA was performed to confirm collateral flow. Results During manual carotid compression, in one volunteer, the right thalamus changed to be fed only by the vertebrobasilar system, and the right basal ganglia changed to be fed by the left internal carotid artery. In the other volunteer, the right basal ganglia changed to be fed by the vertebrobasilar system. 2DPC-MRA showed that the flow direction changed in the right A1 segment of the anterior cerebral artery and the right posterior communicating artery. Perfusion patterns and flow directions recovered after decompression. Time-SLIP MRA showed pial vessels and dural collateral circulation when the right carotid artery was manually compressed. Conclusion Use of TASL-MRI and 2DPC-MRA was successful for non-invasive visualization of the dynamic changes in regional cerebral blood flow during and after manual carotid compression.
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Affiliation(s)
- Kouichi Asahi
- Department of Radiology, Juntendo University School of Medicine , Tokyo , Japan
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Förster A, Griebe M, Gass A, Hennerici MG, Szabo K. Recent advances in magnetic resonance imaging in posterior circulation stroke: implications for diagnosis and prognosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:268-77. [PMID: 21331537 DOI: 10.1007/s11936-011-0119-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OPINION STATEMENT For some time, posterior circulation stroke has been neglected in diagnostic and therapeutic studies for various reasons, such as minor incidence compared to anterior circulation stroke or anatomical and vascular characteristics. This changed at least partly when the New England Medical Center (NEMC) Posterior Circulation Registry was initiated, and now the number of publications concerning posterior circulation stroke is continuously increasing. Whether the differences outweigh the similarities between posterior and anterior circulation stroke remains open to debate, but both are the subject of intensive investigations. In this article, we review the most recent literature on different MRI techniques, such as diffusion-weighted and diffusion tensor imaging (DWI and DTI), perfusion-weighted imaging (PWI), vascular imaging, and susceptibility weighted imaging (SWI), in posterior circulation stroke and discuss their diagnostic and prognostic impact as well as general implications for acute treatment.
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Affiliation(s)
- Alex Förster
- Department of Neurology, Universitätsmedizin Medizin Mannheim, Theodor-Kutzer-Ufer, 68137, Mannheim, Germany,
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Hartkamp NS, Bokkers RPH, van der Worp HB, van Osch MJP, Kappelle LJ, Hendrikse J. Distribution of cerebral blood flow in the caudate nucleus, lentiform nucleus and thalamus in patients with carotid artery stenosis. Eur Radiol 2011; 21:875-81. [PMID: 20853001 PMCID: PMC3047207 DOI: 10.1007/s00330-010-1952-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 08/01/2010] [Accepted: 08/17/2010] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the influence of internal carotid artery (ICA) stenosis on the distribution of blood flow to the caudate nucleus, lentiform nucleus, and thalamus. METHODS We studied 18 healthy control subjects, 20 patients with a unilateral asymptomatic ICA stenosis, and 15 patients with a recently symptomatic unilateral ICA stenosis. The contribution of the ICAs and the basilar artery to the perfusion of the deep brain structures was assessed by perfusion territory selective arterial spin labeling (ASL) MRI. Differences were tested with a two-tailed Fishers' exact test. RESULTS The caudate nucleus was predominantly supplied with blood by the ipsilateral ICA in all groups. In 4 of the 15 (27%) the symptomatic patients, the caudate nucleus partially received blood from the contralateral ICA, compared to none of the 18 healthy control subjects (p = 0.03). The lentiform nucleus and the thalamus were predominantly supplied with blood by the ipsilateral ICA and basilar artery respectively in all groups. CONCLUSION In patients with a symptomatic ICA stenosis, the caudate nucleus may be supplied with blood by the contralateral ICA more often than in healthy controls.
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Affiliation(s)
- Nolan S Hartkamp
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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