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Ito H, Uchida M, Takasuna H, Takumi I, Yuichiro T. Analysis of postprocedural microembolic infarctions and global oxygen extraction fraction during balloon-protected carotid artery stenting: Preliminary study. Surg Neurol Int 2021; 12:87. [PMID: 33767891 PMCID: PMC7982096 DOI: 10.25259/sni_919_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Atherosclerotic carotid stenosis with impaired cerebral perfusion is a risk factor for cerebral ischemia. In major carotid stenoocclusive diseases, increased oxygen extraction fraction (OEF) is associated with ischemic stroke. Balloon-protected carotid artery stenting (CAS) is valuable for high-grade carotid stenosis. However, while balloon-protected CAS can effectively reduce the occurrence of ischemic complications by blocking carotid flow, cerebral hypoperfusion may result in simultaneous cerebral ischemia. We sought to evaluate whether increased OEF during balloon-protected CAS can predict postprocedural microembolic infarction (MI). Methods: Eighty-four patients who underwent balloon-protected CAS were enrolled. Initial, intraprocedural, and postprocedural OEFs were calculated from the cerebral arteriovenous oxygen differences obtained from blood sampled just before the temporary occlusion and reperfusion of the internal carotid artery during and after the procedure. MIs were evaluated by diffusion-weighted imaging (DWI). Patients were classified into two groups based on the presence or absence of new MIs, and the relationship between the OEF and postprocedural MIs was analyzed. Results: New DWI-positive lesions were found in 37 cases (44.0%). Age, signal intensity ratio (SIR) of carotid plaque on T1-weighted black blood magnetic resonance imaging, and intraprocedural OEF were significantly higher in the DWI-positive group. The high SIR and intraprocedural OEF were significantly associated with the development of postprocedural MIs in multivariate analysis. MIs were correlated with the increase in OEF. Conclusion: Increased intraprocedural OEF, obtained by blood sampling during balloon-protected CAS, could predict the incidence of postprocedural MIs. Patients with carotid stenosis could be hemodynamically compromised by carotid flow blockage during balloon-protected CAS.
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Affiliation(s)
- Hidemichi Ito
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaski, Kanagawa, Japan
| | - Masashi Uchida
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaski, Kanagawa, Japan
| | - Hiroshi Takasuna
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaski, Kanagawa, Japan
| | - Ichiro Takumi
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaski, Kanagawa, Japan
| | - Tanaka Yuichiro
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaski, Kanagawa, Japan
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Sleight E, Stringer MS, Marshall I, Wardlaw JM, Thrippleton MJ. Cerebrovascular Reactivity Measurement Using Magnetic Resonance Imaging: A Systematic Review. Front Physiol 2021; 12:643468. [PMID: 33716793 PMCID: PMC7947694 DOI: 10.3389/fphys.2021.643468] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022] Open
Abstract
Cerebrovascular reactivity (CVR) magnetic resonance imaging (MRI) probes cerebral haemodynamic changes in response to a vasodilatory stimulus. CVR closely relates to the health of the vasculature and is therefore a key parameter for studying cerebrovascular diseases such as stroke, small vessel disease and dementias. MRI allows in vivo measurement of CVR but several different methods have been presented in the literature, differing in pulse sequence, hardware requirements, stimulus and image processing technique. We systematically reviewed publications measuring CVR using MRI up to June 2020, identifying 235 relevant papers. We summarised the acquisition methods, experimental parameters, hardware and CVR quantification approaches used, clinical populations investigated, and corresponding summary CVR measures. CVR was investigated in many pathologies such as steno-occlusive diseases, dementia and small vessel disease and is generally lower in patients than in healthy controls. Blood oxygen level dependent (BOLD) acquisitions with fixed inspired CO2 gas or end-tidal CO2 forcing stimulus are the most commonly used methods. General linear modelling of the MRI signal with end-tidal CO2 as the regressor is the most frequently used method to compute CVR. Our survey of CVR measurement approaches and applications will help researchers to identify good practice and provide objective information to inform the development of future consensus recommendations.
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Affiliation(s)
- Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael S. Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom,*Correspondence: Michael S. Stringer
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
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Pini R, Faggioli G, Gargiulo M, Gallitto E, Cacioppa LM, Vacirca A, Pisano E, Pilato A, Stella A. The different scenarios of urgent carotid revascularization for crescendo and single transient ischemic attack. Vascular 2018; 27:51-59. [PMID: 30193550 DOI: 10.1177/1708538118799225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Carotid stenosis with crescendo-transient-ischemic-attack (cTIA) requires a prompt intervention to reduce the stroke risk. Few data are reported in literature about cTIA suggesting a different perioperative risk compared with patients with single TIA (sTIA). This study aimed to compare the outcome of carotid endarterectomy (CEA) in patients with TIA (single/crescendo) and evaluate the outcome risk-factors. METHODS Data from two tertiary hospitals for vascular treatment were analyzed from 2007 to 2016. All patients with TIA subjected to CEA were considered, comparing the 30-day postoperative stroke and stroke/death in patients with cTIA and sTIA, particularly in the urgent (≤48 h) setting. RESULTS On a total of 3866 CEA, 888 (23%) were performed in symptomatic patients and 515 for TIA: 365 (71%) patients with sTIA and 150 (29%) with cTIA. When compared with sTIA, cTIA patients were younger and less frequently affected by coronary disease, dyslipidemia, and chronic pulmonary disease; however, contralateral carotid occlusion was more common (20% vs. 10%, P = .004; 56% vs. 46, P = .03; 16% vs. 7%, P = .01; >80 years 26% vs. 16%, P = .01 and 2% vs. 10%, P = .001; respectively). Postoperative stroke and stroke/death were significantly higher in cTIA compared with sTIA (5.3% vs. 1.6%, P = .02 and 6.0% vs. 2.2%, P = .03; respectively). Urgent CEA was performed in 58% ( n: 87) cTIA and in 11% ( n: 56) sTIA( P<.01). The urgent setting did not influence the stroke and stroke/death rate of CEA for sTIA (3.6% vs. 1.3%, P = .21 and 3.6% vs. 1.9%, P = .44, respectively), but was associated with lower rate of events in cTIA (1.1%vs. 11.1%, P = .01 and 2.3% vs. 11.1%, P = .03, respectively). This beneficial effect in patients with cTIA treated within 48-h was confirmed also by multivariate analysis (OR: 0.09, 95% CI: 0.76-0.01, P=.02). CONCLUSIONS cTIA subjected to CEA have a higher stroke and stroke/death risk compared with patients with sTIA. The urgent setting seems to reduce the stroke/death rate cTIA; for sTIA with a stable neurological condition, the timing of CEA did not influence the outcome.
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Affiliation(s)
- Rodolfo Pini
- 1 Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Gianluca Faggioli
- 1 Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Mauro Gargiulo
- 1 Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Enrico Gallitto
- 1 Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Laura M Cacioppa
- 1 Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Andrea Vacirca
- 1 Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Emilio Pisano
- 2 Vascular Surgery, Ospedale Maggiore, Bologna, Italy
| | | | - Andrea Stella
- 1 Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
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Semenyutin VB, Asaturyan GА, Nikiforova АА, Panuntsev GК, Aliev VA, Iblyaminov VB, Savello AV, Patzak А, Laptev KV, Dudanov IP, Pavlov ОА. [Severe carotid stenosis: cerebral autoregulation in the ipsilateral region]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:76-84. [PMID: 28884722 DOI: 10.17116/jnevro20171178176-84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study cerebral autoregulation (CA) in region of the stenotic carotid artery. MATERIAL AND METHODS The study involved 35 patients with critical stenosis of the carotid arteries, including 24 patients were asymptomatic and 11 patients with symptomatic course. Blood flow velocity in middle cerebral arteries was monitored using Multi Dop X (DWL, Germany) with simultaneous noninvasive systemic blood pressure registration (CNAP, Austria). CA was assessed by calculating the phase shift (PS) between spontaneous oscillations of blood flow velocity and blood pressure within the range of systemic Mayer waves (80-120 mHz). RESULTS In 18 patients, the CA indicators were in the normal range (PS 1.2±0.3 rad). Seventeen patients, including asymptomatic as well as symptomatic types, had impaired CA (PS 0.2±0.2 rad and 0.3±0.2 rad, respectively). Reconstructive surgery, irrespective of clinical manifestations, led to the significant increase in PS (p<0.001) in the early postoperative period (0.9±0.5 and 0.9±0.3 rad, respectively). CONCLUSION A significant variability in the cerebrovascular reserve capacity in symptomatic and asymptomatic types of carotid artery stenosis was found. CA can be used in determining the indications for surgical treatment and evaluation of its effectiveness in patients with stenosis of carotid arteries.
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Affiliation(s)
- V B Semenyutin
- Almazov Northwest Federal Medical Research Centre, St. Petersburg, Russia
| | - G А Asaturyan
- Almazov Northwest Federal Medical Research Centre, St. Petersburg, Russia
| | - А А Nikiforova
- Almazov Northwest Federal Medical Research Centre, St. Petersburg, Russia
| | - G К Panuntsev
- Almazov Northwest Federal Medical Research Centre, St. Petersburg, Russia
| | - V A Aliev
- Almazov Northwest Federal Medical Research Centre, St. Petersburg, Russia
| | - V B Iblyaminov
- Almazov Northwest Federal Medical Research Centre, St. Petersburg, Russia
| | - A V Savello
- Almazov Northwest Federal Medical Research Centre, St. Petersburg, Russia
| | - А Patzak
- Johannes-Mueller Institute of Physiology University Hospital Charite, Humboldt-University of Berlin, Berlin, Germany
| | - K V Laptev
- Municipal Mariinsky Hospital, St. Petersburg, Russia
| | - I P Dudanov
- Municipal Mariinsky Hospital, St. Petersburg, Russia
| | - О А Pavlov
- Municipal Mariinsky Hospital, St. Petersburg, Russia
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5
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Pellaton A, Bijlenga P, Bouchez L, Cuvinciuc V, Barnaure I, Garibotto V, Lövblad KO, Haller S. CO 2BOLD assessment of moyamoya syndrome: Validation with single photon emission computed tomography and positron emission tomography imaging. World J Radiol 2016; 8:887-894. [PMID: 27928470 PMCID: PMC5120248 DOI: 10.4329/wjr.v8.i11.887] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/25/2016] [Accepted: 09/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the assessment of cerebrovascular reserve (CVR) using CO2BOLD magnetic resonance imaging (MRI) vs positron emission tomography (PET) and single photon emission computed tomography (SPECT) as reference standard.
METHODS Ten consecutive patients (8 women, mean age of 41 ± 26 years) with moyamoya syndrome underwent 14 pre-surgical evaluations for external-internal carotid artery bypass surgery. CVR was assessed using CO2BOLD and PET (4)/SPECT (11) with a maximum interval of 36 d, and evaluated by two experienced neuroradiologists.
RESULTS The inter-rater agreement was 0.81 for SPECT (excellent), 0.43 for PET (fair) and 0.7 for CO2BOLD (good). In 9/14 cases, there was a correspondence between CO2BOLD and PET/SPECT. In 4/14 cases, CVR was over-estimated in CO2BOLD, while in 1/14 case, CVR was underestimated in CO2BOLD. The sensitivity of CO2BOLD was 86% and a specificity of 43%.
CONCLUSION CO2BOLD can be used for pre-surgical assessment of CVR in patients with moyamoya syndrome and combines the advantages of absent irradiation, high availability of MRI and assessment of brain parenchyma, cerebral vessels and surrogate CVR in one stop.
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Hage ZA, Alaraj A, Arnone GD, Charbel FT. Novel imaging approaches to cerebrovascular disease. Transl Res 2016; 175:54-75. [PMID: 27094991 DOI: 10.1016/j.trsl.2016.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 11/19/2022]
Abstract
Imaging techniques available to the physician treating neurovascular disease have substantially grown over the past several decades. New techniques as well as advances in imaging modalities continuously develop and provide an extensive array of modalities to diagnose, characterize, and understand neurovascular pathology. Modern noninvasive neurovascular imaging is generally based on computed tomography (CT), magnetic resonance (MR) imaging, or nuclear imaging and includes CT angiography, CT perfusion, xenon-enhanced CT, single-photon emission CT, positron emission tomography, magnetic resonance angiography, MR perfusion, functional magnetic resonance imaging with global and regional blood oxygen level dependent imaging, and magnetic resonance angiography with the use of the noninvasive optional vessel analysis software (River Forest, Ill). In addition to a brief overview of the technique, this review article discusses the clinical indications, advantages, and disadvantages of each of those modalities.
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Affiliation(s)
- Ziad A Hage
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA
| | - Gregory D Arnone
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA.
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Influence of Vascular Variant of the Posterior Cerebral Artery (PCA) on Cerebral Blood Flow, Vascular Response to CO2 and Static Functional Connectivity. PLoS One 2016; 11:e0161121. [PMID: 27532633 PMCID: PMC4988665 DOI: 10.1371/journal.pone.0161121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/30/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction The fetal origin of the posterior cerebral artery (fPCA) is a frequent vascular variant in 11–29% of the population. For the fPCA, blood flow in the PCA originates from the anterior instead of the posterior circulation. We tested whether this blood supply variant impacts the cerebral blood flow assessed by arterial spin labeling (ASL), cerebrovascular reserve as well as resting-state static functional connectivity (sFC) in the sense of a systematic confound. Methods The study included 385 healthy, elderly subjects (mean age: 74.18 years [range: 68.9–90.4]; 243 female). Participants were classified into normal vascular supply (n = 296, 76.88%), right fetal origin (n = 23, 5.97%), left fetal origin (n = 16, 4.16%), bilateral fetal origin (n = 4, 1.04%), and intermediate (n = 46, 11.95%, excluded from further analysis) groups. ASL-derived relative cerebral blood flow (relCBF) maps and cerebrovascular reserve (CVR) maps derived from a CO2 challenge with blocks of 7% CO2 were compared. Additionally, sFC between 90 regions of interest (ROIs) was compared between the groups. Results CVR was significantly reduced in subjects with ipsilateral fPCA, most prominently in the temporal lobe. ASL yielded a non-significant trend towards reduced relCBF in bilateral posterior watershed areas. In contrast, conventional atlas-based sFC did not differ between groups. Conclusions In conclusion, fPCA presence may bias the assessment of cerebrovascular reserve by reducing the response to CO2. In contrast, its effect on ASL-assessed baseline perfusion was marginal. Moreover, fPCA presence did not systematically impact resting-state sFC. Taken together, this data implies that perfusion variables should take into account the vascularization patterns.
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8
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Hage ZA, Behbahani M, Amin-Hanjani S, Charbel FT. Carotid bypass for carotid occlusion. Curr Atheroscler Rep 2016; 17:36. [PMID: 25983136 DOI: 10.1007/s11883-015-0517-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The 2-year risk of ipsilateral ischemic stroke following internal carotid artery occlusion (ICAO) in a patient undergoing maximal medical therapy is 5-8% per year. While medical therapy may reduce the risk of stroke, it does not completely eliminate it. Since the 1985 extracranial-intracranial (EC-IC) bypass study, additional trials have been conducted to further investigate the usefulness of EC-IC bypass surgery in more selected patients with cerebral ischemia and impaired hemodynamic reserve. These important studies will be briefly reviewed in this article, as well as a discussion regarding the utility of bypass surgery for ICAO in current clinical practice. In addition, a short discussion regarding the pathophysiology of carotid occlusion will be presented. We will also highlight our own institutional patient selection criteria based on the latest methods for hemodynamic assessment, as well as our intraoperative flow assisted surgical techniques (FAST), and post-operative patient follow-up.
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Affiliation(s)
- Ziad A Hage
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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9
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Boudiaf N, Attyé A, Warnking JM, Troprès I, Lamalle L, Pietras J, Krainik A. BOLD fMRI of cerebrovascular reactivity in the middle cerebral artery territory: A 100 volunteers' study. J Neuroradiol 2015; 42:338-44. [PMID: 26031884 DOI: 10.1016/j.neurad.2015.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/26/2015] [Accepted: 04/05/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE The assessment of cerebrovascular reactivity (CVR) has shown promising results for its use in medical diagnosis and prognosis, especially in patients suffering from severe intracranial arterial stenosis. However, its quantification remains uncertain because of a large variability inherent in brain anatomy and in methodological settings. To overcome this variability, we provide lateralization index (LI) values for CVR within the middle cerebral artery territory to detect CVR impairment. MATERIALS AND METHODS We assessed CVR in 100 volunteers (41 females; 47.52 ± 21.58 years) without cervico-encephalic arterial stenosis using BOLD-fMRI contrast with a block-design hypercapnic challenge. Averaged end-tidal CO2 was used as a physiological regressor for statistical analyses with a general linear model. We measured %BOLD signal-change in segmented gray matter regions of interest in the middle cerebral artery territory (MCA). We calculated a laterality index according to the following formula: LI=(CVRleft-CVRright)/(CVRleft+CVRright). We tested the effects of methodological settings (i.e. hypercapnic gas, gas administration means, MR acquisition and sex) on %BOLD signal change and LI values with analysis of variance. RESULTS No adverse effects of the hypercapnic challenge were reported. LI values were independent of experimental conditions. Mean LI calculated in MCA territories was 0.016 ± 0.031, giving the lower and upper limits of 95% (m ± 2SD) of this population distribution at]-0.05; 0.08[. CONCLUSION LI can effectively help us to overcome measurement variabilities. Therefore, it can be used to detect abnormal asymmetries in CVR and identify patients at higher risk of ischemic stroke.
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Affiliation(s)
- Naïla Boudiaf
- Université Grenoble Alpes 3bis, CNRS, LPNC, 38000 Grenoble, France; Université Savoie 3, LPNC, 73000 Chambéry, France.
| | - Arnaud Attyé
- Inserm, université Grenoble Alpes, GIN, CHU de Grenoble, 38000 Grenoble, France; Department of Neuroradiology and MRI, University Hospital of Grenoble-IFR1, Grenoble, France
| | - Jan M Warnking
- Inserm, université Grenoble Alpes, GIN, CHU de Grenoble, 38000 Grenoble, France
| | - Irène Troprès
- Inserm, université Grenoble Alpes, GIN, CHU de Grenoble, 38000 Grenoble, France; Inserm, université Grenoble Alpes, CNRS, IRMaGe, CHU de Grenoble, 38000 Grenoble, France
| | - Laurent Lamalle
- Inserm, université Grenoble Alpes, CNRS, IRMaGe, CHU de Grenoble, 38000 Grenoble, France
| | - Johan Pietras
- Inserm, université Grenoble Alpes, CNRS, IRMaGe, CHU de Grenoble, 38000 Grenoble, France
| | - Alexandre Krainik
- Inserm, université Grenoble Alpes, GIN, CHU de Grenoble, 38000 Grenoble, France; Inserm, université Grenoble Alpes, CNRS, IRMaGe, CHU de Grenoble, 38000 Grenoble, France; Department of Neuroradiology and MRI, University Hospital of Grenoble-IFR1, Grenoble, France
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10
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Viallon M, Cuvinciuc V, Delattre B, Merlini L, Barnaure-Nachbar I, Toso-Patel S, Becker M, Lovblad KO, Haller S. State-of-the-art MRI techniques in neuroradiology: principles, pitfalls, and clinical applications. Neuroradiology 2015; 57:441-67. [PMID: 25859832 DOI: 10.1007/s00234-015-1500-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/04/2015] [Indexed: 12/20/2022]
Abstract
This article reviews the most relevant state-of-the-art magnetic resonance (MR) techniques, which are clinically available to investigate brain diseases. MR acquisition techniques addressed include notably diffusion imaging (diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DKI)) as well as perfusion imaging (dynamic susceptibility contrast (DSC), arterial spin labeling (ASL), and dynamic contrast enhanced (DCE)). The underlying models used to process these images are described, as well as the theoretic underpinnings of quantitative diffusion and perfusion MR imaging-based methods. The technical requirements and how they may help to understand, classify, or follow-up neurological pathologies are briefly summarized. Techniques, principles, advantages but also intrinsic limitations, typical artifacts, and alternative solutions developed to overcome them are discussed. In this article, we also review routinely available three-dimensional (3D) techniques in neuro MRI, including state-of-the-art and emerging angiography sequences, and briefly introduce more recently proposed 3D quantitative neuro-anatomy sequences, and new technology, such as multi-slice and multi-transmit imaging.
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Affiliation(s)
- Magalie Viallon
- CREATIS, UMR CNRS 5220 - INSERM U1044, INSA de Lyon, Université de Lyon, Lyon, France,
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11
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Buterbaugh J, Wynstra C, Provencio N, Combs D, Gilbert M, Parthasarathy S. Cerebrovascular reactivity in young subjects with sleep apnea. Sleep 2015; 38:241-50. [PMID: 25409111 DOI: 10.5665/sleep.4406] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 10/24/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Regional brain alterations may be involved in the pathogenesis and adverse consequences of obstructive sleep apnea (OSA). The objectives for the current study were to (1) determine cerebrovascular reactivity in the motor areas that control upper airway musculature in patients with OSA, and (2) determine whether young patients with OSA have decreased cerebrovascular reactivity in response to breath holding. DESIGN Case-control study. SETTING Academic center. PARTICIPANTS Twelve subjects with OSA (age 24-42 y; apnea-hypopnea index 17; interquartile range [IQR] 9, 69 per hour) and control subjects (n = 10; age 29-44 y; AHI 2; IQR 1, 3 per hour). MEASUREMENTS AND RESULTS Subjects underwent blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) while awake, swallowing, and breath holding. In subjects with OSA, during swallowing, there was less activity in the brainstem than in controls (P = 0.03) that remained reduced after adjusting for cortical motor strip activity (P = 0.036). In OSA subjects, brain regions of increased cerebrovascular reactivity (38; IQR 17, 96 cm(3)) was smaller than that in controls (199; IQR 5, 423 cm(3); P = 0.01). In OSA subjects, brain regions of decreased cerebrovascular reactivity during breath hold was greater (P = 0.01), and the ratio of increased-to-decreased brain regions was lower than that of controls (P = 0.006). Adjustment for cerebral volumes, body mass index, and white matter lesions did not change these results substantively. CONCLUSIONS In patients with obstructive sleep apnea (OSA), diminished change in brainstem activity during swallowing and reduced cerebrovascular reactivity may contribute to the etiopathogenesis and adverse cerebrovascular consequences, respectively. We speculate that decreased cerebral auto-regulation may be causative of gray matter loss in OSA.
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Affiliation(s)
- John Buterbaugh
- Southern Arizona Veterans Administration Health Care System, Tucson, AZ
| | - Charles Wynstra
- Southern Arizona Veterans Administration Health Care System, Tucson, AZ.,Arizona Respiratory Center, Tucson, AZ
| | - Natalie Provencio
- Southern Arizona Veterans Administration Health Care System, Tucson, AZ.,Arizona Respiratory Center, Tucson, AZ
| | - Daniel Combs
- Arizona Respiratory Center, Tucson, AZ.,Department of Medicine of University of Arizona, Tucson, AZ
| | - Michael Gilbert
- Southern Arizona Veterans Administration Health Care System, Tucson, AZ
| | - Sairam Parthasarathy
- Southern Arizona Veterans Administration Health Care System, Tucson, AZ.,Arizona Respiratory Center, Tucson, AZ.,Department of Medicine of University of Arizona, Tucson, AZ
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12
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Bouvier J, Detante O, Tahon F, Attye A, Perret T, Chechin D, Barbieux M, Boubagra K, Garambois K, Tropres I, Grand S, Barbier EL, Krainik A. Reduced CMRO₂ and cerebrovascular reserve in patients with severe intracranial arterial stenosis: a combined multiparametric qBOLD oxygenation and BOLD fMRI study. Hum Brain Mapp 2014; 36:695-706. [PMID: 25307948 DOI: 10.1002/hbm.22657] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/23/2014] [Accepted: 10/01/2014] [Indexed: 11/08/2022] Open
Abstract
Multiparametric quantitative blood oxygenation level dependent (mqBOLD) magnetic resonance Imaging (MRI) approach allows mapping tissular oxygen saturation (StO2 ) and cerebral metabolic rate of oxygen (CMRO2 ). To identify hemodynamic alteration related to severe intracranial arterial stenosis (SIAS), functional MRI of cerebrovascular reserve (CVR BOLD fMRI) to hypercapnia has been proposed. Diffusion imaging suggests chronic low grade ischemia in patients with impaired CVR. The aim of the present study was to evaluate how oxygen parameters (StO2 and CMRO2 ), assessed with mqBOLD approach, correlate with CVR in patients (n = 12) with SIAS and without arterial occlusion. The perfusion (dynamic susceptibility contrast), oxygenation, and CVR were compared. The MRI protocol conducted at 3T lasted approximately 1 h. Regions of interest measures on maps were delineated on segmented gray matter (GM) of middle cerebral artery territories. We have shown that decreased CVR is spatially associated with decreased CMRO2 in GM of patients with SIAS. Further, the degree of ipsilateral CVR reduction was well-correlated with the amplitude of the CMRO2 deficit. The altered CMRO2 suggests the presence of a moderate ischemia explained by both a decrease in perfusion and in CVR. CVR and mqBOLD method may be helpful in the selection of patients with SIAS to advocate for medical therapy or percutaneous transluminal angioplasty-stenting.
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Affiliation(s)
- Julien Bouvier
- Inserm, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France; Philips France (Healthcare Activity), Suresnes, France
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Koyanagi M, Yoshida K, Kurosaki Y, Sadamasa N, Narumi O, Sato T, Chin M, Handa A, Yamagata S, Miyamoto S. Reduced cerebrovascular reserve is associated with an increased risk of postoperative ischemic lesions during carotid artery stenting. J Neurointerv Surg 2014; 8:576-80. [DOI: 10.1136/neurintsurg-2014-011163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 08/19/2014] [Indexed: 11/04/2022]
Abstract
BackgroundReduced cerebrovascular reserve (CVR) is associated with increased risk of ischemic events in carotid steno-occlusive diseases.ObjectiveTo determine whether pretreatment CVR can predict postoperative ischemic lesions after carotid artery stenting (CAS) by retrospective analysis.MethodsWe retrospectively reviewed the medical records of 46 patients (42 men; mean age 74.2±8.3 years) who underwent CAS and preprocedural cerebral blood flow measurement by quantitative single-photon emission CT. Ischemic lesions were evaluated by diffusion-weighted image (DWI) within 72 h after the intervention. We also evaluated plaque characteristics using black-blood MR plaque imaging.ResultsNew ipsilateral DWI-positive lesions were found in 11 cases (23.9%). Patients were classified into two groups based on the presence or absence of new DWI-positive lesions, and no significant differences in characteristics were found between the DWI-positive and DWI-negative groups, except for age and CVR of the ipsilateral middle cerebral artery (MCA) territory. The DWI-positive group was significantly older than the DWI-negative group (79.7±4.1 vs 72.5±8.6 years; p=0.0085) and had lower average regional CVR (1.4±18.2% vs 22.4±25.8%; p=0.016). MR plaque imaging showed no significant difference in relative overall plaque MR signal intensity between the two groups (1.53±0.37 vs 1.34±0.26; p=0.113). In multivariate logistic regression analysis, lower CVR of the ipsilateral MCA territory (<11%) was the only independent risk factor for new ischemic lesions following CAS (OR=6.99; 95% CI 1.17 to 41.80; p=0.033).ConclusionsImpaired pretreatment CVR was associated with increased incidence of new infarction after CAS.
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Richiardi J, Monsch AU, Haas T, Barkhof F, Van de Ville D, Radü EW, Kressig RW, Haller S. Altered cerebrovascular reactivity velocity in mild cognitive impairment and Alzheimer's disease. Neurobiol Aging 2014; 36:33-41. [PMID: 25146454 DOI: 10.1016/j.neurobiolaging.2014.07.020] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 07/15/2014] [Accepted: 07/18/2014] [Indexed: 02/02/2023]
Abstract
Interindividual variation in neurovascular reserve and its relationship with cognitive performance is not well understood in imaging in neurodegeneration. We assessed the neurovascular reserve in amnestic mild cognitive impairment (aMCI) and Alzheimer's dementia (AD). Twenty-eight healthy controls (HC), 15 aMCI, and 20 AD patients underwent blood oxygen level-dependent imaging for 9 minutes, breathing alternatively air and 7% carbon dioxide mixture. The data were parcellated into 88 anatomic regions, and carbon dioxide regressors accounting for different washin and washout velocities were fitted to regional average blood oxygen level-dependent signals. Velocity of cerebrovascular reactivity (CVR) was analyzed and correlated with cognitive scores. aMCI and AD patients had significantly slower response than HC (mean time to reach 90% of peak: HC 33 seconds, aMCI and AD 59 seconds). CVR velocity correlated with Mini Mental State Examination in 35 of 88 brain regions (p = 0.019, corrected for multiple comparisons), including 10 regions of the default-mode network, an effect modulated by age. This easily applicable protocol yielded a practical assessment of CVR in cognitive decline.
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Affiliation(s)
- Jonas Richiardi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA; Department of Neurosciences, University of Geneva, Geneva, Switzerland; Department of Neurology, University of Geneva, Geneva, Switzerland
| | - Andreas U Monsch
- Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter Hospital, Basel, Switzerland
| | - Tanja Haas
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, the Netherlands
| | - Dimitri Van de Ville
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Genève, Switzerland; Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Ernst W Radü
- Medical Image Analysis Center MIAC, University Hospital Basel, Basel, Switzerland
| | - Reto W Kressig
- University Center for Medicine of Aging Basel, Felix Platter Hospital, Basel, Switzerland
| | - Sven Haller
- Service neuro-diagnostique et neuro-interventionnel DISIM, Hôpitaux Universitaires de Genève, Genève, Switzerland.
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Faraco CC, Strother MK, Dethrage LM, Jordan L, Singer R, Clemmons PF, Donahue MJ. Dual echo vessel-encoded ASL for simultaneous BOLD and CBF reactivity assessment in patients with ischemic cerebrovascular disease. Magn Reson Med 2014; 73:1579-92. [PMID: 24757044 DOI: 10.1002/mrm.25268] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/05/2014] [Accepted: 04/07/2014] [Indexed: 11/07/2022]
Abstract
PURPOSE Blood oxygenation level-dependent (BOLD)-weighted and vessel-encoded arterial spin labeling (VE-ASL) MRI provide complementary information and can be used in sequence to gauge hemodynamic contributions to cerebrovascular reactivity. Here, cerebrovascular reactivity is assessed using dual echo VE-ASL MRI to understand how VE labeling preparations influence BOLD and ASL contrast in flow-limited and healthy perfusion territories. METHODS Patients (n = 12; age = 55 +/- 14 years; 6F/6M) presenting with ischemic steno-occlusive cerebrovascular disease underwent 3.0T angiographic imaging, T1 -weighted structural, and planning-free dual echo hypercarbic hyperoxic (i.e., carbogen) VE-ASL MRI. Vasculopathy extent, timecourses, and cerebrovascular reactivity (signal change and Z-statistic) for different VE-ASL images were contrasted across flow territories and Bonferroni-corrected P-values reported. RESULTS BOLD cerebrovascular reactivity (i.e., long-TE VE-ASL) Z-statistics were similarly sensitive to asymmetric disease (P ≤ 0.002) regardless of labeling scenario. Cerebral blood flow reactivity correlated significantly with BOLD reactivity (Z-statistic). However, BOLD signal changes did not differ significantly between labeling scenarios (P > 0.003) or across territories (P > 0.002), indicating BOLD signal changes in response to carbogen offer low sensitivity to lateralizing disease. CONCLUSION Dual echo VE-ASL can provide simultaneous cerebral blood flow and qualitative BOLD contrast consistent with lateralizing disease severity in patients with asymmetric steno-occlusive disease. The methodological strengths and limitations of composite BOLD and VE-ASL measurements in the clinic are discussed.
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Affiliation(s)
- Carlos C Faraco
- Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Krainik A, Villien M, Troprès I, Attyé A, Lamalle L, Bouvier J, Pietras J, Grand S, Le Bas JF, Warnking J. Functional imaging of cerebral perfusion. Diagn Interv Imaging 2013; 94:1259-78. [PMID: 24011870 DOI: 10.1016/j.diii.2013.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The functional imaging of perfusion enables the study of its properties such as the vasoreactivity to circulating gases, the autoregulation and the neurovascular coupling. Downstream from arterial stenosis, this imaging can estimate the vascular reserve and the risk of ischemia in order to adapt the therapeutic strategy. This method reveals the hemodynamic disorders in patients suffering from Alzheimer's disease or with arteriovenous malformations revealed by epilepsy. Functional MRI of the vasoreactivity also helps to better interpret the functional MRI activation in practice and in clinical research.
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Affiliation(s)
- A Krainik
- Clinique universitaire de neuroradiologie et IRM, CHU de Grenoble, CS 10217, 38043 Grenoble cedex, France; Inserm U836, université Joseph-Fourier, site santé, chemin Fortuné-Ferrini, 38706 La Tronche cedex, France; UMS IRMaGe, unité IRM 3T recherche, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 9, France.
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Attyé A, Villien M, Tahon F, Warnking J, Detante O, Krainik A. Normalization of cerebral vasoreactivity using BOLD MRI after intravascular stenting. Hum Brain Mapp 2013; 35:1320-4. [PMID: 23426780 DOI: 10.1002/hbm.22255] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 11/14/2012] [Accepted: 12/17/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND PURPOSE Intravascular angioplasty and stenting of intracranial arterial stenosis provided controversial results. Besides the expertise of the practitioners, the selection of the patients remains challenging. BOLD MRI of the cerebral vasoreactivity (BOLD MRI CVR) to hypercapnia provides reproducible maps of the entire brain of the vascular reserve, and could be helpful to assess the best therapeutic strategy. CASE HISTORY We report the case of a 63-year-old woman referred for a severe stenosis of the proximal portion of the left middle cerebral artery, revealed by a lenticulostriate and precentral infarction. Despite an aggressive medical treatment during 5 months, the occurrence of iterative transient ischemic attacks motivated intravascular stenting. Functional MRI of the vasoreactivity to hypercapnia using both Blood Oxygen Level Dependent (BOLD) and arterial spin labeling sequences showed normal basal perfusion and impaired vasoreactivity in the left middle cerebral artery territory. Three months after stenting, the BOLD MRI CVR showed vasoreactivity normalization. Since, the patient remains free of ischemic disorders one year after stenting. CONCLUSION BOLD MRI of the CVR to hypercapnia may be helpful to optimize the treatment of patients with intracranial arterial stenosis, and could be performed in future therapeutic trials.
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Affiliation(s)
- Arnaud Attyé
- Department of Neuroradiology and MRI, University Hospital of Grenoble-IFR1, Grenoble, France; Inserm, U836, Grenoble, France; Université Joseph Fourier, Grenoble Institute of Neurosciences UMR-S836, Grenoble, France
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Krainik A, Maillet A, Fleury V, Sahin M, Troprès I, Lamalle L, Thobois S, Fraix V, Villien M, Warnking J, Pollak P, Pinto S, Krack P. Levodopa does not change cerebral vasoreactivity in Parkinson's disease. Mov Disord 2012; 28:469-75. [DOI: 10.1002/mds.25267] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 09/27/2012] [Accepted: 09/30/2012] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | | | - Mehmet Sahin
- Department of Neuroradiology and MRI; University Hospital of Grenoble; Grenoble; France
| | | | | | - Stephane Thobois
- Hospices Civils de Lyon; Hôpital Neurologique; Université Lyon I; Faculté de Médecine Lyon Sud; CNRS; UMR 5229; Lyon; France
| | | | | | | | - Pierre Pollak
- Department of Neurology; University Hospitals of Geneva; Geneva; Switzerland
| | - Serge Pinto
- Laboratoire Parole et Langage; UMR 7309 CNRS/Aix-Marseille University; Aix-en-Provence; France
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Momjian-Mayor I, Burkhard P, Murith N, Mugnai D, Yilmaz H, Narata AP, Lovblad K, Pereira V, Righini M, Bounameaux H, Sztajzel RF. Diagnosis of and treatment for symptomatic carotid stenosis: an updated review. Acta Neurol Scand 2012; 126:293-305. [PMID: 22607370 DOI: 10.1111/j.1600-0404.2012.01672.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2012] [Indexed: 10/28/2022]
Abstract
Carotid stenoses of ≥50% account for about 15-20% of strokes. Their degree may be moderate (50-69%) or severe (70-99%). Current diagnostic methods include ultrasound, MR- or CT-angiography. Stenosis severity, irregular plaque surface, and presence of microembolic signals detected by transcranial Doppler predict the early recurrence risk, which may be as high as 20%. Initial therapy comprises antiplatelets and statins. Benefit of revascularization is greater in men, in older patients, and in severe stenosis; patients with moderate stenoses may also profit particularly if the plaque has an irregular aspect. An intervention should be performed within <2 weeks. In large randomized studies comparing endarterectomy and stenting, endovascular therapy was associated with a higher risk of periprocedural stroke, yet in some studies, with a lower risk of myocardial infarction and of cranial neuropathy. These trials support endarterectomy as the first choice treatment. Risk factors for each of the two therapies have been indentified: coronary artery disease, neck radiation, contralateral laryngeal nerve palsy for endarterectomy, and, elderly patients (>70 years), arch vessel tortuosity and plaques with low echogenicity on ultrasound for carotid stenting. Lastly, in direct comparisons, a contralateral occlusion increases the risk of periprocedural complications in both types of treatment.
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Affiliation(s)
- I. Momjian-Mayor
- Neurology Department, Faculty of Medicine, Geneva University Hospitals; University of Geneva; Geneva; Switzerland
| | - P. Burkhard
- Neurology Department, Faculty of Medicine, Geneva University Hospitals; University of Geneva; Geneva; Switzerland
| | - N. Murith
- Cardio-Vascular Surgery Department, Faculty of Medicine, Geneva University Hospitals; University of Geneva; Geneva; Switzerland
| | - D. Mugnai
- Cardio-Vascular Surgery Department, Faculty of Medicine, Geneva University Hospitals; University of Geneva; Geneva; Switzerland
| | - H. Yilmaz
- Neuroradiology Department, Faculty of Medicine, Geneva University Hospitals; University of Geneva; Geneva; Switzerland
| | - A.-P. Narata
- Neuroradiology Department, Faculty of Medicine, Geneva University Hospitals; University of Geneva; Geneva; Switzerland
| | - K. Lovblad
- Neuroradiology Department, Faculty of Medicine, Geneva University Hospitals; University of Geneva; Geneva; Switzerland
| | - V. Pereira
- Neuroradiology Department, Faculty of Medicine, Geneva University Hospitals; University of Geneva; Geneva; Switzerland
| | - M. Righini
- Angiology and Haemostasis Department, Faculty of Medicine, Geneva University Hospitals; University of Geneva; Geneva; Switzerland
| | - H. Bounameaux
- Angiology and Haemostasis Department, Faculty of Medicine, Geneva University Hospitals; University of Geneva; Geneva; Switzerland
| | - R. F. Sztajzel
- Neurology Department, Faculty of Medicine, Geneva University Hospitals; University of Geneva; Geneva; Switzerland
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Van De Ville D, Jhooti P, Haas T, Kopel R, Lovblad KO, Scheffler K, Haller S. Recovery of the default mode network after demanding neurofeedback training occurs in spatio-temporally segregated subnetworks. Neuroimage 2012; 63:1775-81. [PMID: 22960086 DOI: 10.1016/j.neuroimage.2012.08.061] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/21/2012] [Accepted: 08/23/2012] [Indexed: 11/25/2022] Open
Abstract
The default mode (DM) network is a major large-scale cerebral network that can be identified with functional magnetic resonance imaging (fMRI) during resting state. Most studies consider functional connectivity networks as stationary phenomena. Consequently, the transient behavior of the DM network and its subnetworks is still largely unexplored. Most functional connectivity fMRI studies assess the steady state of resting without any task. To specifically investigate the recovery of the DM network during the transition from activation to rest, we implemented a cognitively demanding real-time fMRI neurofeedback task that targeted down-regulation of the primary auditory cortex. Each of twelve healthy subjects performed 16 block-design fMRI runs (4 runs per day repeated on 4 days) resulting 192 runs in total. The analysis included data-driven independent component analysis (ICA) and high-resolution latency estimation between the four components that corresponded to subnetworks of the DM network. These different subnetworks reemerged after regulation with an average time lag or 3.3s and a time lag of 4.4s between the first and fourth components; i.e., the DM recovery first shifts from anterior to posterior, and then gradually focuses on the ventral part of the posterior cingulate cortex, which is known to be implicated in internally directed cognition. In addition, we found less reactivation in the early anterior subnetwork as regulation strength increased, but more reactivation with larger regulation for the late subnetwork that encompassed the ventral PCC. This finding confirms that the level of task engagement influences inversely the subsequent recovery of regions related to attention compared to those related to internally directed cognition.
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Affiliation(s)
- Dimitri Van De Ville
- Department of Radiology and Medical Informatics, University of Geneva, Switzerland.
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21
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Impaired hemodynamic response in the ischemic brain assessed with BOLD fMRI. Neuroimage 2012; 61:579-90. [DOI: 10.1016/j.neuroimage.2012.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 03/29/2012] [Accepted: 04/01/2012] [Indexed: 11/21/2022] Open
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Donahue MJ, Strother MK, Hendrikse J. Novel MRI approaches for assessing cerebral hemodynamics in ischemic cerebrovascular disease. Stroke 2012; 43:903-15. [PMID: 22343644 DOI: 10.1161/strokeaha.111.635995] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Changes in cerebral hemodynamics underlie a broad spectrum of ischemic cerebrovascular disorders. An ability to accurately and quantitatively measure hemodynamic (cerebral blood flow and cerebral blood volume) and related metabolic (cerebral metabolic rate of oxygen) parameters is important for understanding healthy brain function and comparative dysfunction in ischemia. Although positron emission tomography, single-photon emission tomography, and gadolinium-MRI approaches are common, more recently MRI approaches that do not require exogenous contrast have been introduced with variable sensitivity for hemodynamic parameters. The ability to obtain hemodynamic measurements with these new approaches is particularly appealing in clinical and research scenarios in which follow-up and longitudinal studies are necessary. The purpose of this review is to outline current state-of-the-art MRI methods for measuring cerebral blood flow, cerebral blood volume, and cerebral metabolic rate of oxygen and provide practical tips to avoid imaging pitfalls. MRI studies of cerebrovascular disease performed without exogenous contrast are synopsized in the context of clinical relevance and methodological strengths and limitations.
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Affiliation(s)
- Manus J Donahue
- Department of Radiology, Vanderbilt University, Nashville, TN, USA.
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Impaired cerebral vasoreactivity to CO2 in Alzheimer's disease using BOLD fMRI. Neuroimage 2011; 58:579-87. [PMID: 21745581 DOI: 10.1016/j.neuroimage.2011.06.070] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 05/13/2011] [Accepted: 06/23/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the cerebral vasoreactivity using blood oxygenation level dependent functional MRI during carbogen inhalation with 7% CO(2) in Alzheimer's disease and amnestic mild cognitive impairment. PARTICIPANTS AND METHODS Thirty nine subjects were included to be investigated using blood oxygenation level dependent (BOLD) functional MRI at 1.5T during a block-design carbogen inhalation paradigm, with a high concentration face-mask under physiological monitoring. Basal cerebral perfusion was measured using pulsed arterial spin labeling. Image analyses were conducted using Matlab® and SPM5 with physiological regressors and corrected for partial volume effect. RESULTS Among selected participants, 12 subjects were excluded because of incomplete protocol, leaving for analysis 27 subjects without significant microangiopathy diagnosed for Alzheimer's disease (n=9), amnestic mild cognitive impairment (n=7), and matched controls (n=11). No adverse reaction related to the CO(2) challenge was reported. Carbogen inhalation induced a whole-brain signal increase, predominant in the gray matter. In patients, signal changes corrected for gray matter partial volume were decreased (0.36±0.13% BOLD/mmHg in Alzheimer's disease, 0.36±0.12 in patients with mild cognitive impairment, 0.62±0.20 in controls). Cerebral vasoreactivity impairments were diffuse but seemed predominant in posterior areas. The basal hypoperfusion in Alzheimer's disease was not significantly different from patients with mild cognitive impairment and controls. Among clinical and biological parameters, no effect of apoE4 genotype was detected. Cerebral vasoreactivity values were correlated with cognitive performances and hippocampal volumes. Among age and hippocampal atrophy, mean CVR was the best predictor of the mini-mental status examination. CONCLUSION This BOLD functional MRI study on CO(2) challenge shows impaired cerebral vasoreactivity in patients with Alzheimer's disease and amnestic mild cognitive impairment at the individual level. These preliminary findings using a new MRI approach may help to better characterize patients with cognitive disorders in clinical practice and further investigate vaso-protective therapeutics.
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Magnetic resonance imaging techniques in white matter disease: potentials and limitations. Top Magn Reson Imaging 2011; 20:301-12. [PMID: 21187723 DOI: 10.1097/rmr.0b013e318207a5a9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES excellent soft tissue contrast, noninvasiveness, assessment of multiple structural and functional parameters, and absence of radiation are the essential properties of magnetic resonance imaging explaining why this modality is the technique of choice for the assessment of cerebral white matter (WM). METHODS the present review discusses various standard and advance magnetic resonance imaging techniques with respect to WM assessment in a clinical context. Techniques assessing predominantly structure are T2, fluid-attenuated inversion recovery, echo-gradient T2*, and susceptibility weighted imaging. Techniques assessing a mix between structure and function are diffusion-weighted and diffusion tensor imaging to investigate WM tracts, magnetization transfer to assess bound and free water pool, and magnetic resonance spectroscopy investigating brain metabolites. Finally, functional techniques are perfusion-weighted imaging and perfusion reserve imaging to assess cerebral perfusion and cerebral perfusion reserve, respectively. CONCLUSIONS magnetic resonance imaging may assess various and complementary WM parameters. Because acquisition time is limited in the clinical setting, MR techniques must be adapted to the primary question asked. The basic imaging of WM might include axial T2, diffusion-weighted imaging, and coronal fluid-attenuated inversion recovery. This provides an excellent overview in a relatively short time and 2 imaging planes. The remaining MR techniques can add complementary information, for example, PWI/perfusion reserve imaging in vascular disease, T2*/susceptibility weighted imaging in degenerative disease (iron deposition) and head trauma (microbleeds), magnetic resonance spectroscopy (metabolic disease and neoplasm), magnetization transfer (demyelinating disease), and diffusion tensor imaging (degenerative diseases, presurgical evaluation).
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Mandell DM, Han JS, Poublanc J, Crawley AP, Fierstra J, Tymianski M, Fisher JA, Mikulis DJ. Quantitative measurement of cerebrovascular reactivity by blood oxygen level-dependent MR imaging in patients with intracranial stenosis: preoperative cerebrovascular reactivity predicts the effect of extracranial-intracranial bypass surgery. AJNR Am J Neuroradiol 2011; 32:721-7. [PMID: 21436343 DOI: 10.3174/ajnr.a2365] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE CVR is a measure of cerebral hemodynamic impairment. A recently validated technique quantifies CVR by using a precise CO(2) vasodilatory stimulus and BOLD MR imaging. Our aim was to determine whether preoperative CO(2) BOLD CVR predicts the hemodynamic effect of ECIC bypass surgery in patients with intracranial steno-occlusive disease. MATERIALS AND METHODS Twenty-five patients undergoing ECIC bypass surgery for treatment of intracranial stenosis or occlusion were recruited. CVR was measured preoperatively and postoperatively and expressed as %ΔBOLD MR signal intensity per mm Hg ΔPetCO(2). Using normative data from healthy subjects, we stratified patients on the basis of preoperative CVR into 3 groups: normal CVR, reduced CVR, and negative (paradoxical) CVR. Wilcoxon 2-sample tests (2-sided, α = 0.05) were used to determine whether the 3 groups differed with respect to change in CVR following bypass surgery. RESULTS The group with normal preoperative CVR demonstrated no significant change in CVR following bypass surgery (mean, 0.22% ± 0.05% to 0.22% ± 0.01%; P = .881). The group with reduced preoperative CVR demonstrated a significant improvement following bypass surgery (mean, 0.08% ± 0.05% to 0.21 ± 0.08%; P < .001), and the group with paradoxical preoperative CVR demonstrated the greatest improvement (mean change, -0.04% ± 0.03% to 0.27% ± 0.03%; P = .028). CONCLUSIONS Preoperative measurement of CVR by using CO(2) BOLD MR imaging predicts the hemodynamic effect of ECIC bypass in patients with intracranial steno-occlusive disease. The technique is potentially useful for selecting patients for surgical revascularization.
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Affiliation(s)
- D M Mandell
- Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Schaaf M, Mommertz G, Ludolph A, Geibprasert S, Mühlenbruch G, Das M, Krings T. Functional MR imaging in patients with carotid artery stenosis before and after revascularization. AJNR Am J Neuroradiol 2010; 31:1791-8. [PMID: 20801766 DOI: 10.3174/ajnr.a2219] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Significant extracranial stenosis of the ICA is a known risk factor for future stroke and it has been shown that revascularization reduces the risk of future stroke. We applied BOLD fMRI in patients with carotid artery stenosis before and after CEA. Our purpose was to determine whether fMRI is able to demonstrate impaired CVR and to identify patient parameters that are associated with postoperative changes of cerebral hemodynamics. MATERIALS AND METHODS Nineteen consecutive patients with symptomatic (n = 13) and asymptomatic (n = 6) stenosis of the ICA were prospectively recruited (male/female ratio = 16:3; age, 69 ± 8,1 years). fMRI using a simple bilateral motor task was performed immediately before and after CEA. RESULTS Mean BOLD MSC was significantly increased postoperatively (MSC, 0.13 ± 0.66; P = 0.0002). Patients with a stenosis of <80% demonstrated an increase in MSC (MSC, 0.32 ± 0.59; P ≤ .0001). Patients with previous ischemic stroke showed a larger MSC than patients with TIAs (stroke: MSC, 0.55 ± 0.65; P ≤ .0001; TIA: MSC, 0.05 ± 0.26; P = 0.054). Patients older than 70 years had a significantly larger MSC following surgery (≤70 years: MSC, -0.01 ± 0.39; P = .429; >70 years: MSC, 0.29 ± 0.48; P ≤ .0001). CONCLUSIONS BOLD fMRI can demonstrate changes in cerebral hemodynamics before and after CEA, indicative of an ameliorated CVR. This response is dependent on the age of the patient, the degree of preoperative stenosis, and the patient's symptoms.
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Affiliation(s)
- M Schaaf
- Departments of Neuroradiology, University Hospital Aachen, Aachen University, Germany
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Simultaneous Dynamic Blood Oxygen Level-Dependent Magnetic Resonance Imaging of Foot and Calf Muscles. Invest Radiol 2009; 44:741-7. [DOI: 10.1097/rli.0b013e3181b248f9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Carotid endarterectomy improves cerebrovascular reserve capacity preferentially in patients with preoperative impairment as indicated by asymmetric BOLD response to hypercapnia. Eur J Vasc Endovasc Surg 2009; 38:546-51. [PMID: 19744868 DOI: 10.1016/j.ejvs.2009.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 06/14/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE In patients with symptomatic carotid artery disease the predominant mechanism causing ischaemic injury is considered to be thromboembolic, however compromise of cerebral haemodynamics is considered to be a significant factor. Removal of the embolic source is accepted as the major benefit from carotid endarterectomy (CEA), however improvement in cerebral haemodynamics may be another beneficial outcome as suggested by transcranial doppler (TCD). Blood oxygen level-dependent (BOLD) hypercapnia functional magnetic resonance imaging (fMRI) can be used to map the cerebrovascular reserve (CVR). The aim of this study was to assess the effects of carotid surgery on cerebral haemodynamics in patients with carotid artery disease using a hypercapnia BOLD fMRI and assessment of hemispheric asymmetry. MATERIALS AND METHODS Seventeen patients with symptomatic internal carotid artery stenosis were scanned using a clinical 1.5T MR scanner. Scanning was done immediately prior to and between 4 and 8 weeks after CEA. 10% carbon dioxide was administered to achieve transient episodes of hypercapnia. The data was analyzed using FMRIB Software Library (FSL) software to derive percentage signal change (PSC) for the grey matter of the middle cerebral artery (MCA-GM) territory for both hemispheres. MCA-GM PSC was furthermore normalized to the contralateral hemisphere to derive an Hemispheric Asymmetry Index (hAI) for all patients pre- and postoperatively. RESULTS Ipsilateral GM CVR improved significantly following CEA (2.47% preoperatively vs. 2.73% postoperatively, p=0.038). There was no change in CVR in the contralateral grey and white matter MCA territories (p=0.27, p=0.1). Also, the hAI was significantly more shifted to the ipsilateral hemisphere after CEA (preoperative hAI -0.56, vs. -3.90 postoperatively, p=0.02). Patients with an impaired hAI preoperatively were found to show the greatest improvement in PSC and hAI following CEA (p=0.007). CONCLUSIONS CEA resulted in improved CVR in patients with carotid artery disease as shown by the absolute and hemispheric asymmetry of BOLD response to hypercapnia.. These findings show that benefits from recanalisation may go beyond removal of the embolic source, by improving the cerebrovascular reserve. Moreover, hypercapnia BOLD fMRI may be a useful clinical tool in predicting this therapeutic potential in patients with severe carotid artery disease.
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Haller S, Bartsch AJ. Pitfalls in fMRI. Eur Radiol 2009; 19:2689-706. [DOI: 10.1007/s00330-009-1456-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 03/10/2009] [Accepted: 03/21/2009] [Indexed: 11/27/2022]
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