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Fellah S, Ying C, Wang Y, Guilliams KP, Fields ME, Chen Y, Lewis J, Mirro A, Cohen R, Igwe N, Eldeniz C, Jiang D, Lu H, Powers WJ, Lee JM, Ford AL, An H. Comparison of cerebral oxygen extraction fraction using ASE and TRUST methods in patients with sickle cell disease and healthy controls. J Cereb Blood Flow Metab 2024; 44:1404-1416. [PMID: 38436254 PMCID: PMC11342725 DOI: 10.1177/0271678x241237072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 01/13/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
Abnormal oxygen extraction fraction (OEF), a putative biomarker of cerebral metabolic stress, may indicate compromised oxygen delivery and ischemic vulnerability in patients with sickle cell disease (SCD). Elevated OEF was observed at the tissue level across the brain using an asymmetric spin echo (ASE) MR method, while variable global OEFs were found from the superior sagittal sinus (SSS) using a T2-relaxation-under-spin-tagging (TRUST) MRI method with different calibration models. In this study, we aimed to compare the average ASE-OEF in the SSS drainage territory and TRUST-OEF in the SSS from the same SCD patients and healthy controls. 74 participants (SCD: N = 49; controls: N = 25) underwent brain MRI. TRUST-OEF was quantified using the Lu-bovine, Bush-HbA and Li-Bush-HbS models. ASE-OEF and TRUST-OEF were significantly associated in healthy controls after controlling for hematocrit using the Lu-bovine or the Bush-HbA model. However, no association was found between ASE-OEF and TRUST-OEF in patients with SCD using either the Bush-HbA or the Li-Bush-HbS model. Plausible explanations include a discordance between spatially volume-averaged oxygenation brain tissue and flow-weighted volume-averaged oxygenation in SSS or sub-optimal calibration in SCD. Further work is needed to refine and validate non-invasive MR OEF measurements in SCD.
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Affiliation(s)
- Slim Fellah
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Chunwei Ying
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yan Wang
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kristin P Guilliams
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Melanie E Fields
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Yasheng Chen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Josiah Lewis
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Amy Mirro
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel Cohen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Nkemdilim Igwe
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Dengrong Jiang
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William J Powers
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andria L Ford
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hongyu An
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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Aumann MA, Richerson W, Song AK, Davis LT, Pruthi S, Davis S, Patel NJ, Custer C, Kassim AA, DeBaun MR, Donahue MJ, Jordan LC. Cerebral hemodynamic changes after haploidentical hematopoietic stem cell transplant in adults with sickle cell disease. Blood Adv 2024; 8:608-619. [PMID: 37883803 PMCID: PMC10838697 DOI: 10.1182/bloodadvances.2023010717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
ABSTRACT Preliminary evidence from a series of 4 adults with sickle cell disease (SCD) suggests that hematopoietic stem cell transplant (HSCT) improves cerebral hemodynamics. HSCT largely normalizes cerebral hemodynamics in children with SCD. We tested the hypothesis in adults with SCD that cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2) measured using magnetic resonance imaging, normalized to healthy values, comparing measurements from ∼1 month before to 12 to 24 months after HSCT (n = 11; age, 33.3 ± 8.9 years; 389 ± 150 days after HSCT) with age-, race- and sex-matched values from healthy adults without sickle trait (n = 28; age, 30.2 ± 5.6 years). Before transplant, 7 patients had neurological indications for transplant (eg, overt stroke) and 4 had nonneurological reasons for haploidentical bone marrow transplant (haplo-BMT). All received haplo-BMT from first-degree relatives (parent, sibling, or child donor) with reduced-intensity preparation and maintained engraftment. Before transplant, CBF was elevated (CBF, 69.11 ± 24.7 mL/100 g/min) compared with that of controls (P = .004). Mean CBF declined significantly after haplo-BMT (posttransplant CBF, 48.2 ± 13.9 mL/100 g/min; P = .003). OEF was not different from that of controls at baseline and did not change significantly after haplo-BMT (pretransplant, 43.1 ± 6.7%; posttransplant, 39.6 ± 7.0%; P = .34). After transplant, CBF and OEF were not significantly different from controls (CBF, 48.2 ± 13.4 mL/100 g/min; P = .78; and OEF, 39.6 ± 7.0%; P > .99). CMRO2 did not change significantly after haplo-BMT (pretransplant, 3.18 ± 0.87 mL O2/100 g/min; posttransplant, 2.95 ± 0.83; P = .56). Major complications of haplo-BMT included 1 infection-related death and 1 severe chronic graft-versus-host disease. Haplo-BMT in adults with SCD reduces CBF to that of control values and maintains OEF and CMRO2 on average at levels observed in healthy adult controls. The trial was registered at www.clinicaltrials.gov as #NCT01850108.
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Affiliation(s)
- Megan A. Aumann
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Wesley Richerson
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Alexander K. Song
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - L. Taylor Davis
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - Sumit Pruthi
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - Samantha Davis
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Niral J. Patel
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Chelsea Custer
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Adetola A. Kassim
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Michael R. DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Manus J. Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | - Lori C. Jordan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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DeBeer T, Jordan LC, Waddle S, Lee C, Patel NJ, Garza M, Davis LT, Pruthi S, Jones S, Donahue MJ. Red cell exchange transfusions increase cerebral capillary transit times and may alter oxygen extraction in sickle cell disease. NMR IN BIOMEDICINE 2023; 36:e4889. [PMID: 36468659 PMCID: PMC10106384 DOI: 10.1002/nbm.4889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 05/17/2023]
Abstract
Persons with sickle cell disease (SCD) suffer from chronic hemolytic anemia, reduced blood oxygen content, and lifelong risk of silent and overt stroke. Major conventional stroke risk factors are absent in most individuals with SCD, yet nearly 50% have evidence of brain infarcts by the age of 30 years, indicating alternative etiologies for ischemia. We investigated whether radiological evidence of accelerated blood water transit through capillaries, visible on arterial spin labeling (ASL) magnetic resonance imaging, reduces following transfusion-induced increases in hemoglobin and relates to oxygen extraction fraction (OEF). Neurological evaluation along with anatomical and hemodynamic imaging with cerebral blood flow (CBF)-weighted pseudocontinuous ASL and OEF imaging with T2 -relaxation-under-spin-tagging were applied in sequence before and after blood transfusion therapy (n = 32) and in a comparator cohort of nontransfused SCD participants on hydroxyurea therapy scanned at two time points to assess stability without interim intervention (n = 13). OEF was calculated separately using models derived from human hemoglobin-F, hemoglobin-A, and hemoglobin-S. Gray matter CBF and dural sinus signal, indicative of rapid blood transit, were evaluated at each time point and compared with OEF using paired statistical tests (significance: two-sided p < 0.05). No significant change in sinus signal was observed in nontransfused participants (p = 0.650), but a reduction was observed in transfused participants (p = 0.034), consistent with slower red cell transit following transfusion. The dural sinus signal intensity was inversely associated with OEF pretransfusion (p = 0.011), but not posttransfusion. Study findings suggest that transfusion-induced increases in total hemoglobin may lengthen blood transit times through cerebral capillaries and alter cerebral OEF in SCD.
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Affiliation(s)
- Tonner DeBeer
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lori C. Jordan
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Spencer Waddle
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea Lee
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niral J. Patel
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Maria Garza
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L. Taylor Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumit Pruthi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sky Jones
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J. Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Juttukonda MR, Vaclavu L, Kirkham FJ, Fields ME, Bush AM. Editorial: Cerebral oxygen supply and demand in sickle cell disease: Evidence of local ischemia despite global hyperemia. Front Physiol 2022; 13:1079889. [PMID: 36479342 PMCID: PMC9720841 DOI: 10.3389/fphys.2022.1079889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 12/01/2023] Open
Affiliation(s)
- Meher R. Juttukonda
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Lena Vaclavu
- C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Fenella J. Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie E. Fields
- Division of Pediatric Hematology/Oncology, Washington University in St. Louis, Saint Louis, MO, United States
| | - Adam M. Bush
- Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX, United States
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Murdoch R, Stotesbury H, Hales PW, Kawadler JM, Kölbel M, Clark CA, Kirkham FJ, Shmueli K. A Comparison of MRI Quantitative Susceptibility Mapping and TRUST-Based Measures of Brain Venous Oxygen Saturation in Sickle Cell Anaemia. Front Physiol 2022; 13:913443. [PMID: 36105280 PMCID: PMC9465016 DOI: 10.3389/fphys.2022.913443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
In recent years, interest has grown in the potential for magnetic resonance imaging (MRI) measures of venous oxygen saturation (Yv) to improve neurological risk prediction. T2-relaxation-under-spin-tagging (TRUST) is an MRI technique which has revealed changes in Yv in patients with sickle cell anemia (SCA). However, prior studies comparing Yv in patients with SCA relative to healthy controls have reported opposing results depending on whether the calibration model, developed to convert blood T2 to Yv, is based on healthy human hemoglobin (HbA), bovine hemoglobin (HbBV) or sickle hemoglobin (HbS). MRI Quantitative Susceptibility Mapping (QSM) is an alternative technique that may hold promise for estimating Yv in SCA as blood magnetic susceptibility is linearly dependent upon Yv, and no significant difference has been found between the magnetic susceptibility of HbA and HbS. Therefore, the aim of this study was to compare estimates of Yv using QSM and TRUST with five published calibration models in healthy controls and patients with SCA. 17 patients with SCA and 13 healthy controls underwent MRI. Susceptibility maps were calculated from a multi-parametric mapping acquisition and Yv was calculated from the mean susceptibility in a region of interest in the superior sagittal sinus. TRUST estimates of T2, within a similar but much smaller region, were converted to Yv using five different calibration models. Correlation and Bland-Altman analyses were performed to compare estimates of Yv between TRUST and QSM methods. For each method, t-tests were also used to explore group-wise differences between patients with SCA and healthy controls. In healthy controls, significant correlations were observed between QSM and TRUST measures of Yv, while in SCA, there were no such correlations. The magnitude and direction of group-wise differences in Yv varied with method. The TRUST-HbBV and QSM methods suggested decreased Yv in SCA relative to healthy controls, while the TRUST-HbS (p < 0.01) and TRUST-HbA models suggested increased Yv in SCA as in previous studies. Further validation of all MRI measures of Yv, relative to ground truth measures such as O15 PET and jugular vein catheterization, is required in SCA before QSM or TRUST methods can be considered for neurological risk prediction.
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Affiliation(s)
- Russell Murdoch
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Patrick W. Hales
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jamie M. Kawadler
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie Kölbel
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Christopher A. Clark
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fenella J. Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Karin Shmueli
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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Shen J, Miao X, Vu C, Xu B, González-Zacarías C, Nederveen AJ, Wood JC. Anemia Increases Oxygen Extraction Fraction in Deep Brain Structures but Not in the Cerebral Cortex. Front Physiol 2022; 13:896006. [PMID: 35784894 PMCID: PMC9248375 DOI: 10.3389/fphys.2022.896006] [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: 03/14/2022] [Accepted: 05/19/2022] [Indexed: 01/26/2023] Open
Abstract
Sickle cell disease (SCD) is caused by a single amino acid mutation in hemoglobin, causing chronic anemia and neurovascular complications. However, the effects of chronic anemia on oxygen extraction fraction (OEF), especially in deep brain structures, are less well understood. Conflicting OEF values have been reported in SCD patients, but have largely attributed to different measurement techniques, faulty calibration, and different locations of measurement. Thus, in this study, we investigated the reliability and agreement of two susceptibility-based methods, quantitative susceptibility mapping (QSM) and complex image summation around a spherical or a cylindrical object (CISSCO), for OEF measurements in internal cerebral vein (ICV), reflecting oxygen saturation in deep brain structures. Both methods revealed that SCD patients and non-sickle anemia patients (ACTL) have increased OEF in ICV (42.6% ± 5.6% and 30.5% ± 3.6% in SCD by CISSCO and QSM respectively, 37.0% ± 4.1% and 28.5% ± 2.3% in ACTL) compared with controls (33.0% ± 2.3% and 26.8% ± 1.8%). OEF in ICV varied reciprocally with hematocrit (r 2 = 0.92, 0.53) and oxygen content (r 2 = 0.86, 0.53) respectively. However, an opposite relationship was observed for OEF measurements in sagittal sinus (SS) with the widely used T2-based oximetry, T2-Relaxation-Under-Spin-Tagging (TRUST), in the same cohorts (31.2% ± 6.6% in SCD, 33.3% ± 5.9% in ACTL and 36.8% ± 5.6% in CTL). Importantly, we demonstrated that hemoglobin F and other fast moving hemoglobins decreased OEF by TRUST and explained group differences in sagittal sinus OEF between anemic and control subjects. These data demonstrate that anemia causes deep brain hypoxia in anemia subjects with concomitant preservation of cortical oxygenation, as well as the key interaction of the hemoglobin dissociation curve and cortical oxygen extraction.
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Affiliation(s)
- Jian Shen
- Biomedical Engineering, University of Southern California, Los Angeles, Los Angeles, CA, United States
| | - Xin Miao
- Siemens, Boston, MA, United States
| | - Chau Vu
- Biomedical Engineering, University of Southern California, Los Angeles, Los Angeles, CA, United States
| | - Botian Xu
- Biomedical Engineering, University of Southern California, Los Angeles, Los Angeles, CA, United States
| | - Clio González-Zacarías
- Neuroscience Graduate Program, University of Southern California, Los Angeles, Los Angeles, CA, United States
| | - Aart J. Nederveen
- Amsterdam UMC, Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - John C. Wood
- Biomedical Engineering, University of Southern California, Los Angeles, Los Angeles, CA, United States,Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, United States,*Correspondence: John C. Wood,
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Cui MH, Billett HH, Suzuka SM, Ambadipudi K, Archarya S, Mowrey WB, Branch CA. Corrected cerebral blood flow and reduced cerebral inflammation in berk sickle mice with higher fetal hemoglobin. Transl Res 2022; 244:75-87. [PMID: 35091127 DOI: 10.1016/j.trsl.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/24/2022]
Abstract
Fetal hemoglobin (HbF) is known to lessen the severity of sickle cell disease (SCD), through reductions in peripheral vaso-occlusive disease and reduced risk for cerebrovascular events. However, the influence of HbF on oxygen delivery to high metabolism tissues like the brain, or its influence on cerebral perfusion, metabolism, inflammation or function have not been widely studied. We employed a Berkley mouse model (BERK) of SCD with gamma transgenes q3 expressing exclusively human α- and βS-globins with varying levels of γ globin expression to investigate the effect of HbF expression on the brain using magnetic resonance imaging (MRI), MRI diffusion tensor imaging (DTI) and spectroscopy (MRS) and hematological parameters. Hematological parameters improved with increasing γ level expression, as did markers for brain metabolism, perfusion and inflammation. Brain microstructure assessed by DTI fractional anisotropy improved, while myo-inositol levels increased, suggesting improved microstructural integrity and reduced cell loss. Our results suggest that increasing γ levels not only improves sickle peripheral disease, but also improves brain perfusion and oxygen delivery while reducing brain inflammation while protecting brain microstructural integrity.
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Affiliation(s)
- Min-Hui Cui
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, New York, New York; Department of Radiology, Albert Einstein College of Medicine, New York, New York; Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Henny H Billett
- Department of Medicine, Albert Einstein College of Medicine, New York, New York; Department of Pathology, Albert Einstein College of Medicine, New York, New York
| | - Sandra M Suzuka
- Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Kamalakar Ambadipudi
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, New York, New York; Department of Radiology, Albert Einstein College of Medicine, New York, New York
| | - Seetharama Archarya
- Department of Medicine, Albert Einstein College of Medicine, New York, New York; Department of Physiology & Biophysics, Albert Einstein College of Medicine, New York, New York
| | - Wenzhu B Mowrey
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, New York
| | - Craig A Branch
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, New York, New York; Department of Radiology, Albert Einstein College of Medicine, New York, New York; Department of Physiology & Biophysics, Albert Einstein College of Medicine, New York, New York.
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8
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Afzali-Hashemi L, Václavů L, Wood JC, Biemond BJ, Nederveen AJ, Mutsaerts HJ, Schrantee A. Assessment of functional shunting in patients with sickle cell disease. Haematologica 2022; 107:2708-2719. [PMID: 35548868 PMCID: PMC9614535 DOI: 10.3324/haematol.2021.280183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 01/26/2023] Open
Abstract
Silent cerebral infarcts (SCI) are common in patients with sickle cell disease (SCD) and are thought to be caused by a mismatch between oxygen delivery and consumption. Functional cerebrovascular shunting is defined as reduced oxygen offloading due to the rapid transit of blood through the capillaries caused by increased flow and has been suggested as a potential mechanism underlying reduced oxygenation and SCI. We investigated the venous arterial spin labeling signal (VS) in the sagittal sinus as a proxy biomarker of cerebral functional shunting, and its association with hemodynamic imaging and hematological laboratory parameters. We included 28 children and 38 adults with SCD, and ten healthy racematched adult controls. VS, cerebral blood flow (CBF), velocity in the brain feeding arteries, oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) were measured before and after acetazolamide administration. VS was higher in patients with SCD compared to controls (P<0.01) and was increased after acetazolamide administration in all groups (P<0.01). VS was primarily predicted by CBF (P<0.01), but CBF-corrected VS was also associated with decreased CMRO2 (P<0.01). Additionally, higher disease severity defined by low hemoglobin and increased hemolysis was associated with higher CBF-corrected VS. Finally, CMRO2 was negatively correlated with fetal hemoglobin, and positively correlated with lactate dehydrogenase, which could be explained by changes in oxygen affinity. These findings provide evidence for cerebral functional shunting and encourage future studies investigating the potential link to aberrant capillary exchange in SCD.
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Affiliation(s)
- Liza Afzali-Hashemi
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Lena Václavů
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - John C. Wood
- Division of Cardiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bart J. Biemond
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Henk J.M.M. Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands,HJMMM and AS contributed equally as co-senior authors
| | - Anouk Schrantee
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands,HJMMM and AS contributed equally as co-senior authors
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9
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Sayin ES, Sobczyk O, Poublanc J, Mikulis DJ, Fisher JA, Kuo KHM, Duffin J. Assessing Cerebrovascular Resistance in Patients With Sickle Cell Disease. Front Physiol 2022; 13:847969. [PMID: 35422710 PMCID: PMC9002264 DOI: 10.3389/fphys.2022.847969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/08/2022] [Indexed: 02/05/2023] Open
Abstract
In patients with sickle cell disease (SCD) the delivery of oxygen to the brain is compromised by anemia, abnormal rheology, and steno-occlusive vascular disease. Meeting demands for oxygen delivery requires compensatory features of brain perfusion. The cerebral vasculature’s regulatory function and reserves can be assessed by observing the flow response to a vasoactive stimulus. In a traditional approach we measured voxel-wise change in Blood Oxygen-Level Dependent (BOLD) MRI signal as a surrogate of cerebral blood flow (CBF) in response to a linear progressive ramping of end-tidal partial pressure of carbon dioxide (PETCO2). Cerebrovascular reactivity (CVR) was defined as ΔBOLD/ΔPETCO2. We used a computer model to fit a virtual sigmoid resistance curve to the progressive CBF response to the stimulus, enabling the calculation of resistance parameters: amplitude, midpoint, range response, resistance sensitivity and vasodilatory reserve. The quality of the resistance sigmoid fit was expressed as the r2 of the fit. We tested 35 patients with SCD, as well as 24 healthy subjects to provide an indication of the normal ranges of the resistance parameters. We found that gray matter CVR and resistance amplitude, range, reserve, and sensitivity are reduced in patients with SCD compared to healthy controls, while resistance midpoint was increased. This study is the first to document resistance measures in adult patients with SCD. It is also the first to score these vascular resistance measures in comparison to the normal range. We anticipate these data will complement the current understanding of the cerebral vascular pathophysiology of SCD, identify paths for therapeutic interventions, and provide biomarkers for monitoring the progress of the disease.
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Affiliation(s)
- Ece Su Sayin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Olivia Sobczyk
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - David J. Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Joseph A. Fisher
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Kevin H. M. Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- *Correspondence: James Duffin,
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10
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Lin Z, McIntyre T, Jiang D, Cannon A, Liu P, Tekes A, Casella JF, Slifer K, Lu H, Lance E. Brain Oxygen Extraction and Metabolism in Pediatric Patients With Sickle Cell Disease: Comparison of Four Calibration Models. Front Physiol 2022; 13:814979. [PMID: 35222083 PMCID: PMC8874251 DOI: 10.3389/fphys.2022.814979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/21/2022] [Indexed: 12/11/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy with an increased risk of neurological complications. Due to anemia and other factors related to the underlying hemoglobinopathy, cerebral blood flow (CBF) increases as compensation; however, the nature of alterations in oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) in SCD remains controversial, largely attributed to the different calibration models. In addition, limited studies have been done to investigate oxygen metabolism in pediatric patients. Thus, this study used a non-invasive T2-based MR oximetry, T2-Relaxation-Under-Spin-Tagging (TRUST) MRI, to measure oxygen homeostasis in pediatric patients with SCD using four different calibration models and examined its relationship to hematological measures. It was found that, compared with controls, SCD patients showed an increased CBF, unchanged total oxygen delivery and increased venous blood T2. The results of OEF and CMRO2 were dependent on the calibration models used. When using sickle-specific, hemoglobin S (HbS) level-dependent calibration, there was a decreased OEF and CMRO2, while the bovine model showed an opposite result. OEF and CMRO2 were also associated with hemoglobin and HbS level; the direction of the relationship was again dependent on the model. Future studies with in vivo calibration are needed to provide more accurate information on the T2-Yv relationship.
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Affiliation(s)
- Zixuan Lin
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tiffany McIntyre
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Dengrong Jiang
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alicia Cannon
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Peiying Liu
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aylin Tekes
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - James F. Casella
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Keith Slifer
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Eboni Lance
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Eboni Lance,
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11
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Vu C, Bush A, Choi S, Borzage M, Miao X, Nederveen AJ, Coates TD, Wood JC. Reduced global cerebral oxygen metabolic rate in sickle cell disease and chronic anemias. Am J Hematol 2021; 96:901-913. [PMID: 33891719 PMCID: PMC8273150 DOI: 10.1002/ajh.26203] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/18/2022]
Abstract
Anemia is the most common blood disorder in the world. In patients with chronic anemia, such as sickle cell disease or major thalassemia, cerebral blood flow increases to compensate for decreased oxygen content. However, the effects of chronic anemia on oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2 ) are less well understood. In this study, we examined 47 sickle-cell anemia subjects (age 21.7 ± 7.1, female 45%), 27 non-sickle anemic subjects (age 25.0 ± 10.4, female 52%) and 44 healthy controls (age 26.4 ± 10.6, female 71%) using MRI metrics of brain oxygenation and flow. Phase contrast MRI was used to measure resting cerebral blood flow, while T2 -relaxation-under-spin-tagging (TRUST) MRI with disease appropriate calibrations were used to measure OEF and CMRO2 . We observed that patients with sickle cell disease and other chronic anemias have decreased OEF and CMRO2 (respectively 27.4 ± 4.1% and 3.39 ± 0.71 ml O2 /100 g/min in sickle cell disease, 30.8 ± 5.2% and 3.53 ± 0.64 ml O2 /100 g/min in other anemias) compared to controls (36.7 ± 6.0% and 4.00 ± 0.65 ml O2 /100 g/min). Impaired CMRO2 was proportional to the degree of anemia severity. We further demonstrate striking concordance of the present work with pooled historical data from patients having broad etiologies for their anemia. The reduced cerebral oxygen extraction and metabolism are consistent with emerging data demonstrating increased non-nutritive flow, or physiological shunting, in sickle cell disease patients.
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Affiliation(s)
- Chau Vu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - Adam Bush
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
- Department of Radiology, Stanford University, Stanford, CA
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA
| | - Matthew Borzage
- Division of Neonatology, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Xin Miao
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - Aart J. Nederveen
- University of Amsterdam, Amsterdam UMC, Radiology and Nuclear Medicine, the Netherlands
| | - Thomas D. Coates
- Division of Hematology-Oncology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA
- Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - John C. Wood
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
- Division of Cardiology, Departments of Pediatrics and Radiology, Children’s Hospital Los Angeles, Los Angeles, CA
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12
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Jordan LC, DeBaun MR, Donahue MJ. Advances in neuroimaging to improve care in sickle cell disease. Lancet Neurol 2021; 20:398-408. [PMID: 33894194 DOI: 10.1016/s1474-4422(20)30490-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/26/2022]
Abstract
Sickle cell disease is associated with progressive and increased neurological morbidity throughout the lifespan. In people with sickle cell anaemia (the most common and severe type of sickle cell disease), silent cerebral infarcts are found in more than a third of adolescents by age 18 years and roughly half of young adults by age 30 years, many of whom have cognitive impairment despite having few or no conventional stroke risk factors. Common anatomical neuroimaging in individuals with sickle disease can assess structural brain injury, such as stroke and silent cerebral infarcts; however, emerging advanced neuroimaging methods can provide novel insights into the pathophysiology of sickle cell disease, including insights into the cerebral haemodynamic and metabolic contributors of neurological injury. Advanced neuroimaging methods, particularly methods that report on aberrant cerebral blood flow and oxygen delivery, have potential for triaging patients for appropriate disease-modifying or curative therapies before they have irreversible neurological injury, and for confirming the benefit of new therapies on brain health in clinical trials.
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Affiliation(s)
- Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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13
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Juttukonda MR, Donahue MJ, Waddle SL, Davis LT, Lee CA, Patel NJ, Pruthi S, Kassim AA, Jordan LC. Reduced oxygen extraction efficiency in sickle cell anemia patients with evidence of cerebral capillary shunting. J Cereb Blood Flow Metab 2021; 41:546-560. [PMID: 32281458 PMCID: PMC7922746 DOI: 10.1177/0271678x20913123] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Arterial spin labeling (ASL) magnetic resonance imaging (MRI) utilizes arterial blood water as an endogenous contrast agent to provide a quantitative measure of cerebral blood flow (CBF). Recently, hyperintense signal within dural venous sinuses in ASL images of sickle cell anemia (SCA) patients has been shown to be consistent with elevated flow velocities and may indicate capillary shunting and reduced oxygen extraction. Here, we performed oxygen extraction fraction (OEF) and CBF measurements in adults (cumulative n = 114) with (n = 69) and without (n = 45) SCA to test the hypothesis that hyperintense venous ASL signal is associated with reduced OEF. Higher categorical scores of shunting on ASL MRI were associated with lower OEF in participants with silent cerebral infarcts or white matter hyperintensities (p = 0.003), but not in those without lesions (p = 0.551). These findings indicate that venous hyperintense signal in ASL images in SCA patients may represent a marker of capillary-level disturbances in oxygen exchange efficiency and small vessel pathology.
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Affiliation(s)
- Meher R Juttukonda
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Spencer L Waddle
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Larry T Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea A Lee
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niral J Patel
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumit Pruthi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adetola A Kassim
- Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lori C Jordan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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14
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Fields ME, Mirro AE, Guilliams KP, Binkley MM, Gil Diaz L, Tan J, Fellah S, Eldeniz C, Chen Y, Ford AL, Shimony JS, King AA, An H, Smyser CD, Lee JM. Functional Connectivity Decreases with Metabolic Stress in Sickle Cell Disease. Ann Neurol 2020; 88:995-1008. [PMID: 32869335 PMCID: PMC7592195 DOI: 10.1002/ana.25891] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/16/2020] [Accepted: 08/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Children with sickle cell disease (SCD) experience cognitive deficits even when unaffected by stroke. Using functional connectivity magnetic resonance imaging (MRI) as a potential biomarker of cognitive function, we tested our hypothesis that children with SCD would have decreased functional connectivity, and that children experiencing the greatest metabolic stress, indicated by elevated oxygen extraction fraction, would have the lowest connectivity. METHODS We prospectively obtained brain MRIs and cognitive testing in healthy controls and children with SCD. RESULTS We analyzed data from 60 participants (20 controls and 40 with sickle cell disease). There was no difference in global cognition or cognitive subdomains between cohorts. However, we found decreased functional connectivity within the sensory-motor, lateral sensory-motor, auditory, salience, and subcortical networks in participants with SCD compared with controls. Further, as white matter oxygen extraction fraction increased, connectivity within the visual (p = 0.008, parameter estimate = -0.760 [95% CI = -1.297, -0.224]), default mode (p = 0.012, parameter estimate = -0.417 [95% CI = -0.731, -0.104]), and cingulo-opercular (p = 0.009, parameter estimate = -0.883 [95% CI = -1.517, -0.250]) networks decreased. INTERPRETATION We conclude that there is diminished functional connectivity within these anatomically contiguous networks in children with SCD compared with controls, even when differences are not seen with cognitive testing. Increased white matter oxygen extraction fraction was associated with decreased connectivity in select networks. These data suggest that elevated oxygen extraction fraction and disrupted functional connectivity are potentially presymptomatic neuroimaging biomarkers for cognitive decline in SCD. ANN NEUROL 2020;88:995-1008.
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Affiliation(s)
- Melanie E Fields
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Amy E Mirro
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kristin P Guilliams
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael M Binkley
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Luisa Gil Diaz
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jessica Tan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Slim Fellah
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yasheng Chen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andria L Ford
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Allison A King
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Program of Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher D Smyser
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, USA
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15
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Østergaard L. Blood flow, capillary transit times, and tissue oxygenation: the centennial of capillary recruitment. J Appl Physiol (1985) 2020; 129:1413-1421. [PMID: 33031017 DOI: 10.1152/japplphysiol.00537.2020] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The transport of oxygen between blood and tissue is limited by blood's capillary transit time, understood as the time available for diffusion exchange before blood returns to the heart. If all capillaries contribute equally to tissue oxygenation at all times, this physical limitation would render vasodilation and increased blood flow insufficient means to meet increased metabolic demands in the heart, muscle, and other organs. In 1920, Danish physiologist August Krogh was awarded the Nobel Prize in Physiology or Medicine for his mathematical and quantitative, experimental demonstration of a solution to this conceptual problem: capillary recruitment, the active opening of previously closed capillaries to meet metabolic demands. Today, capillary recruitment is still mentioned in textbooks. When we suspect symptoms might represent hypoxia of a vascular origin, however, we search for relevant, flow-limiting conditions in our patients and rarely ascribe hypoxia or hypoxemia to short capillary transit times. This review describes how natural changes in capillary transit-time heterogeneity (CTH) and capillary hematocrit (HCT) across open capillaries during blood flow increases can account for a match of oxygen availability to metabolic demands in normal tissue. CTH and HCT depend on a number of factors: on blood properties, including plasma viscosity, the number, size, and deformability of blood cells, and blood cell interactions with capillary endothelium; on anatomical factors including glycocalyx, endothelial cells, basement membrane, and pericytes that affect the capillary diameter; and on any external compression. The review describes how risk factor- and disease-related changes in CTH and HCT interfere with flow-metabolism coupling and tissue oxygenation and discusses whether such capillary dysfunction contributes to vascular disease pathology.
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Affiliation(s)
- Leif Østergaard
- Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Neuroradiology Research Unit, Section of Neuroradiology, Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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16
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Sathialingam E, Williams EK, Lee SY, McCracken CE, Lam WA, Buckley EM. Hematocrit significantly confounds diffuse correlation spectroscopy measurements of blood flow. BIOMEDICAL OPTICS EXPRESS 2020; 11:4786-4799. [PMID: 32923078 PMCID: PMC7449719 DOI: 10.1364/boe.397613] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 05/11/2023]
Abstract
Diffuse correlation spectroscopy (DCS) is an optical modality used to measure an index of blood flow in biological tissue. This blood flow index depends on both the red blood cell flow rate and density (i.e., hematocrit), although the functional form of hematocrit dependence is not well delineated. Herein, we develop and validate a novel tissue-simulating phantom containing hundreds of microchannels to investigate the influence of hematocrit on blood flow index. For a fixed flow rate, we demonstrate a significant inverse relationship between hematocrit and blood flow index that must be accounted for to accurately estimate blood flow under anemic conditions.
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Affiliation(s)
- Eashani Sathialingam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Dr, NE, Atlanta, GA 30322, USA
| | - Evelyn Kendall Williams
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Dr, NE, Atlanta, GA 30322, USA
| | - Seung Yup Lee
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Dr, NE, Atlanta, GA 30322, USA
| | - Courtney E. McCracken
- Department of Pediatrics, School of Medicine, Emory University, 2015 Uppergate Dr., Atlanta, GA 30322, USA
| | - Wilbur A. Lam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Dr, NE, Atlanta, GA 30322, USA
- Department of Pediatrics, School of Medicine, Emory University, 2015 Uppergate Dr., Atlanta, GA 30322, USA
| | - Erin M. Buckley
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Dr, NE, Atlanta, GA 30322, USA
- Department of Pediatrics, School of Medicine, Emory University, 2015 Uppergate Dr., Atlanta, GA 30322, USA
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17
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Václavů L, Petr J, Petersen ET, Mutsaerts HJ, Majoie CB, Wood JC, VanBavel E, Nederveen AJ, Biemond BJ. Cerebral oxygen metabolism in adults with sickle cell disease. Am J Hematol 2020; 95:401-412. [PMID: 31919876 PMCID: PMC7155077 DOI: 10.1002/ajh.25727] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 02/01/2023]
Abstract
In sickle cell disease (SCD), oxygen delivery is impaired due to anemia, especially during times of increased metabolic demand, and cerebral blood flow (CBF) must increase to meet changing physiologic needs. But hyperemia limits cerebrovascular reserve (CVR) and ischemic risk prevails despite elevated CBF. The cerebral metabolic rate of oxygen (CMRO2 ) directly reflects oxygen supply and consumption and may therefore be more insightful than flow-based CVR measures for ischemic risk in SCD. We hypothesized that adults with SCD have impaired CMRO2 at rest and that a vasodilatory challenge with acetazolamide would improve CMRO2 . CMRO2 was calculated from CBF and oxygen extraction fraction (OEF), measured with arterial spin labeling and T2 -prepared tissue relaxation with inversion recovery (T2 -TRIR) MRI. We studied 36 adults with SCD without a clinical history of overt stroke, and nine healthy controls. As expected, CBF was higher in patients with SCD versus controls (mean ± SD: 74 ± 16 versus 46 ± 5 mL/100 g/min, P < .001), resulting in similar oxygen delivery (SCD: 377 ± 67 versus controls: 368 ± 42 μmol O2 /100g/min, P = .69). OEF was lower in patients versus controls (27 ± 4 versus 35 ± 4%, P < .001), resulting in lower CMRO2 in patients versus controls (102 ± 24 versus 127 ± 20 μmol O2 /100g/min, P = .002). After acetazolamide, CMRO2 declined further in patients (P < .01) and did not decline significantly in controls (P = .78), indicating that forcing higher CBF worsened oxygen utilization in SCD patients. This lower CMRO2 could reflect variation between healthy and unhealthy vascular beds in terms of dilatory capacity and resistance whereby dysfunctional vessels become more oxygen-deprived, hence increasing the risk of localized ischemia.
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Affiliation(s)
- Lena Václavů
- Radiology & Nuclear Medicine, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
- C.J. Gorter Center for High Field MRI, Department of Radiology Leiden University Medical Center, Leiden University Leiden The Netherlands
| | - Jan Petr
- Helmholtz‐Zentrum Dresden‐Rossendorf Institute of Radiopharmaceutical Cancer Research Dresden Germany
| | - Esben Thade Petersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research Copenhagen University Hospital Hvidovre Hvidovre Denmark
- Center for Magnetic Resonance, Department of Health Technology Technical University of Denmark Kongens Lyngby Denmark
| | - Henri J.M.M. Mutsaerts
- Radiology & Nuclear Medicine, Amsterdam UMC Vrije Universiteit Amsterdam The Netherlands
| | - Charles B.L. Majoie
- Radiology & Nuclear Medicine, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - John C. Wood
- Cardiology & Radiology Children's Hospital of Los Angeles Los Angeles California
| | - Ed VanBavel
- Biomedical Engineering & Physics, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Aart J. Nederveen
- Radiology & Nuclear Medicine, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Bart J. Biemond
- Hematology, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
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18
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Li W, Xu X, Liu P, Strouse JJ, Casella JF, Lu H, van Zijl PCM, Qin Q. Quantification of whole-brain oxygenation extraction fraction and cerebral metabolic rate of oxygen consumption in adults with sickle cell anemia using individual T 2 -based oxygenation calibrations. Magn Reson Med 2019; 83:1066-1080. [PMID: 31483528 DOI: 10.1002/mrm.27972] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/18/2019] [Accepted: 08/05/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate different T2 -oxygenation calibrations for estimating venous oxygenation in people with sickle cell anemia (SCA). METHODS Blood T2 values were measured at 3 T in the internal jugular veins of 12 healthy volunteers and 11 SCA participants with no history of stroke, recent transfusion, or renal impairment. T2 -oxygenation relationships of both sickled and normal blood samples were calibrated individually and compared with values generated from published models. After converting venous T2 values to venous oxygenation, whole-brain oxygen extraction fraction and cerebral metabolic rate of oxygen were calculated. RESULTS Sickle blood samples' oxygenation values calculated from our individual calibrations agreed well with measurements using a blood analyzer, whereas previous T2 calibrations based on normal blood samples showed 13%-19% underestimation. Meanwhile, oxygenation values calculated from previous grouped T2 calibration for sickle blood agreed well with experimental measurement on averaged values, but showed up to 20% variation for several individual samples. Using individual T2 calibrations, the whole-brain oxygen extraction fraction and cerebral metabolic rate of oxygen of SCA participants were 0.38 ± 0.08 and 172 ± 42 µmol/min/100 g, respectively, which were comparable to those values measured on healthy volunteers. CONCLUSION Our results confirm that sickle blood T2 values not only depend on the hematocrit and oxygenation values, but also on other hematological factors. The individual T2 calibrations minimized the effect of heterogeneity of sickle blood between different SCA populations and improved the accuracy of T2 -based oximetry. The measured oxygen extraction fraction and cerebral metabolic rate of oxygen of this group of SCA participants were found to not differ significantly from those of healthy individuals.
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Affiliation(s)
- Wenbo Li
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Xiang Xu
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Peiying Liu
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John J Strouse
- Department of Pediatrics, Division of Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Hematology, Duke University, Durham, North Carolina
| | - James F Casella
- Department of Pediatrics, Division of Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hanzhang Lu
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter C M van Zijl
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Qin Qin
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
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19
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Stotesbury H, Kawadler JM, Hales PW, Saunders DE, Clark CA, Kirkham FJ. Vascular Instability and Neurological Morbidity in Sickle Cell Disease: An Integrative Framework. Front Neurol 2019; 10:871. [PMID: 31474929 PMCID: PMC6705232 DOI: 10.3389/fneur.2019.00871] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/26/2019] [Indexed: 12/20/2022] Open
Abstract
It is well-established that patients with sickle cell disease (SCD) are at substantial risk of neurological complications, including overt and silent stroke, microstructural injury, and cognitive difficulties. Yet the underlying mechanisms remain poorly understood, partly because findings have largely been considered in isolation. Here, we review mechanistic pathways for which there is accumulating evidence and propose an integrative systems-biology framework for understanding neurological risk. Drawing upon work from other vascular beds in SCD, as well as the wider stroke literature, we propose that macro-circulatory hyper-perfusion, regions of relative micro-circulatory hypo-perfusion, and an exhaustion of cerebral reserve mechanisms, together lead to a state of cerebral vascular instability. We suggest that in this state, tissue oxygen supply is fragile and easily perturbed by changes in clinical condition, with the potential for stroke and/or microstructural injury if metabolic demand exceeds tissue oxygenation. This framework brings together recent developments in the field, highlights outstanding questions, and offers a first step toward a linking pathophysiological explanation of neurological risk that may help inform future screening and treatment strategies.
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Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Patrick W Hales
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Dawn E Saunders
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom.,Department of Radiology, Great Ormond Hospital, London, United Kingdom
| | - Christopher A Clark
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom.,Department of Child Health, University Hospital Southampton, Southampton, United Kingdom.,Department of Paediatric Neurology, Kings College Hospital NHS Foundation Trust, London, United Kingdom
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20
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Lee SY, Cowdrick KR, Sanders B, Sathialingam E, McCracken CE, Lam WA, Joiner CH, Buckley EM. Noninvasive optical assessment of resting-state cerebral blood flow in children with sickle cell disease. NEUROPHOTONICS 2019; 6:035006. [PMID: 31482101 PMCID: PMC6699550 DOI: 10.1117/1.nph.6.3.035006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/24/2019] [Indexed: 05/08/2023]
Abstract
Sickle cell disease (SCD) is a genetic blood disorder that has profound effects on the brain. Chronic anemia combined with both macro- and microvascular perfusion abnormalities that arise from stenosis or occlusion of blood vessels increased blood viscosity, adherence of red blood cells to the vascular endothelium, and impaired autoregulatory mechanisms in SCD patients all culminate in susceptibility to cerebral infarction. Indeed, the risk of stroke is 250 times higher in children with SCD than in the general population. Unfortunately, while transcranial Doppler ultrasound (TCD) has been widely clinically adopted to longitudinally monitor macrovascular perfusion in these patients, routine clinical screening of microvascular perfusion abnormalities is challenging with current modalities (e.g., positron emission tomography and magnetic resonance imaging) given their high-cost, requirement for sedation in children < 6 year, and need for trained personnel. We assess the feasibility of a low-cost, noninvasive optical technique known as diffuse correlation spectroscopy (DCS) to quantify an index of resting-state cortical cerebral blood flow (BFI) in 11 children with SCD along with 11 sex- and age-matched healthy controls. As expected, BFI was significantly higher in SCD subjects compared to healthy controls ( p < 0.001 ). Within SCD subjects, BFI was inversely proportional to resting-state arterial hemoglobin levels ( p = 0.012 ), consistent with expected anemia-induced compensatory vasodilation that aims to maintain adequate oxygen delivery to the tissue. Further, in a subset of patients measured with TCD ( n = 7 ), DCS-measured blood flow was correlated with TCD-measured blood flow velocity in middle cerebral artery ( R s = 0.68 ), although the trend was not statistically significant ( p = 0.11 ). These results are consistent with those of several previous studies using traditional neuroimaging techniques, suggesting that DCS may be a promising low-cost tool for assessment of tissue-level CBF in pediatric SCD.
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Affiliation(s)
- Seung Yup Lee
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Kyle R. Cowdrick
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Bharat Sanders
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Eashani Sathialingam
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Courtney E. McCracken
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States
| | - Wilbur A. Lam
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States
| | - Clinton H. Joiner
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, Georgia, United States
| | - Erin M. Buckley
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States
- Children’s Healthcare of Atlanta, Children’s Research Scholar, Atlanta, Georgia, United States
- Address all correspondence to Erin M. Buckley, E-mail:
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21
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Detterich JA, Kato R, Bush A, Chalacheva P, Ponce D, De Zoysa M, Shah P, Khoo MC, Meiselman HJ, Coates TD, Wood JC. Sickle cell microvascular paradox-oxygen supply-demand mismatch. Am J Hematol 2019; 94:678-688. [PMID: 30916797 DOI: 10.1002/ajh.25476] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
Abstract
We have previously demonstrated that sickle cell disease (SCD) patients maintain normal global systemic and cerebral oxygen delivery by increasing cardiac output. However, ischemic end-organ injury remains common suggesting that tissue oxygen delivery may be impaired by microvascular dysregulation or damage. To test this hypothesis, we performed fingertip laser Doppler flowmetry measurements at the base of the nailbed and regional oxygen saturation (rSO2 ) on the dorsal surface of the same hand. This was done during flow mediated dilation (FMD) studies in 26 chronically transfused SCD, 75 non-transfused SCD, and 18 control subjects. Chronically transfused SCD patients were studied prior to and following a single transfusion and there was no acute change in rSO2 or perfusion. Laser Doppler estimates of resting perfusion were 76% higher in non-transfused and 110% higher in transfused SCD patients, compared to control subjects. In contrast, rSO2 was 12 saturation points lower in non-transfused SCD patients, but normal in the transfused SCD patients. During cuff occlusion, rSO2 declined at the same rate in all subjects suggesting similar intrinsic oxygen consumption rates. Upon cuff release, laser doppler post occlusive hyperemia was blunted in SCD patients in proportion to their resting perfusion values. Transfusion therapy did not improve the hyperemia response. FMD was impaired in SCD subjects but partially ameliorated in transfused SCD subjects. Taken together, non-transfused SCD subjects demonstrate impaired conduit artery FMD, impaired microcirculatory post-occlusive hyperemia, and resting hypoxia in the hand despite compensated oxygen delivery, suggesting impaired oxygen supply-demand matching. Transfusion improves FMD and oxygen supply-demand matching but not microcirculation hyperemic response.
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Affiliation(s)
- Jon A. Detterich
- Division of Cardiology, Children's Hospital Los AngelesUniversity of Southern California Keck School of Medicine Los Angeles California
- Department of Physiology and NeuroscienceUniversity of Southern California Keck School of Medicine Los Angeles California
| | - Roberta Kato
- Division of Pediatric PulmonologyChildren's Hospital Los Angeles Los Angeles California
| | - Adam Bush
- Department of Biomedical EngineeringUniversity of Southern California Viterbi School of Engineering
| | - Patjanaporn Chalacheva
- Department of Biomedical EngineeringUniversity of Southern California Viterbi School of Engineering
| | - Derek Ponce
- Division of Cardiology, Children's Hospital Los AngelesUniversity of Southern California Keck School of Medicine Los Angeles California
| | - Madushka De Zoysa
- Division of Cardiology, Children's Hospital Los AngelesUniversity of Southern California Keck School of Medicine Los Angeles California
| | - Payal Shah
- Division of Hematology Oncology, Children's Hospital Los AngelesUniversity of Southern California Keck School of Medicine Los Angeles California
| | - Michael C. Khoo
- Department of Biomedical EngineeringUniversity of Southern California Viterbi School of Engineering
| | - Herbert J. Meiselman
- Department of Physiology and NeuroscienceUniversity of Southern California Keck School of Medicine Los Angeles California
| | - Thomas D. Coates
- Division of Hematology Oncology, Children's Hospital Los AngelesUniversity of Southern California Keck School of Medicine Los Angeles California
| | - John C. Wood
- Division of Cardiology, Children's Hospital Los AngelesUniversity of Southern California Keck School of Medicine Los Angeles California
- Department of Biomedical EngineeringUniversity of Southern California Viterbi School of Engineering
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22
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Chai Y, Bush AM, Coloigner J, Nederveen AJ, Tamrazi B, Vu C, Choi S, Coates TD, Lepore N, Wood JC. White matter has impaired resting oxygen delivery in sickle cell patients. Am J Hematol 2019; 94:467-474. [PMID: 30697803 PMCID: PMC6874897 DOI: 10.1002/ajh.25423] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/27/2018] [Accepted: 01/22/2019] [Indexed: 12/13/2022]
Abstract
Although modern medical management has lowered overt stroke occurrence in patients with sickle cell disease (SCD), progressive white matter (WM) damage remains common. It is known that cerebral blood flow (CBF) increases to compensate for anemia, but sufficiency of cerebral oxygen delivery, especially in the WM, has not been systematically investigated. Cerebral perfusion was measured by arterial spin labeling in 32 SCD patients (age range: 10-42 years old, 14 males, 7 with HbSC, 25 HbSS) and 25 age and race-matched healthy controls (age range: 15-45 years old, 10 males, 12 with HbAS, 13 HbAA); 8/24 SCD patients were receiving regular blood transfusions and 14/24 non-transfused SCD patients were taking hydroxyurea. Imaging data from control subjects were used to calculate maps for CBF and oxygen delivery in SCD patients and their T-score maps. Whole brain CBF was increased in SCD patients with a mean T-score of 0.5 and correlated with lactate dehydrogenase (r2 = 0.58, P < 0.0001). When corrected for oxygen content and arterial saturation, whole brain and gray matter (GM) oxygen delivery were normal in SCD, but WM oxygen delivery was 35% lower than in controls. Age and hematocrit were the strongest predictors for WM CBF and oxygen delivery in patients with SCD. There was spatial co-localization between regions of low oxygen delivery and WM hyperintensities on T2 FLAIR imaging. To conclude, oxygen delivery is preserved in the GM of SCD patients, but is decreased throughout the WM, particularly in areas prone to WM silent strokes.
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Affiliation(s)
- Yaqiong Chai
- Department of Biomedical Engineering, University of Southern California Engineering, School, Los Angeles, California
| | - Adam M. Bush
- Department of Radiology, Stanford, University, California
| | - Julie Coloigner
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, VISAGES - ERL U 1228, Rennes, France
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Benita Tamrazi
- Department of Radiology and Nuclear Medicine, Children’s Hospital Los Angeles,Los Angeles, California
| | - Chau Vu
- Department of Biomedical Engineering, University of Southern California Engineering, School, Los Angeles, California
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California
- Division of Cardiology, Children’s Hospital Los Angeles, Los Angeles, California
| | - Thomas D. Coates
- Section of Hematology, Children’s Hospital Los Angeles, Los Angeles, California
| | - Natasha Lepore
- Department of Biomedical Engineering, University of Southern California Engineering, School, Los Angeles, California
- Department of Radiology and Nuclear Medicine, Children’s Hospital Los Angeles,Los Angeles, California
| | - John C. Wood
- Department of Biomedical Engineering, University of Southern California Engineering, School, Los Angeles, California
- Division of Cardiology, Children’s Hospital Los Angeles, Los Angeles, California
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23
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Juttukonda MR, Lee CA, Patel NJ, Davis LT, Waddle SL, Gindville MC, Pruthi S, Kassim AA, DeBaun MR, Donahue MJ, Jordan LC. Differential cerebral hemometabolic responses to blood transfusions in adults and children with sickle cell anemia. J Magn Reson Imaging 2018; 49:466-477. [PMID: 30324698 DOI: 10.1002/jmri.26213] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/18/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Blood transfusions are administered to children and adults with sickle cell anemia (SCA) for secondary stroke prevention, or as treatment for recurrent pain crises or acute anemia, but transfusion effects on cerebral hemodynamics and metabolism are not well-characterized. PURPOSE To compare blood transfusion-induced changes in hemometabolic parameters, including oxygen extraction fraction (OEF) and cerebral blood flow (CBF), within and between adults and children with SCA. STUDY TYPE Prospective, longitudinal study. SUBJECTS Adults with SCA (n = 16) receiving simple (n = 7) or exchange (n = 9) transfusions and children with SCA (n = 11) receiving exchange transfusions were scanned once when hematocrit was near nadir and again within 7 days of transfusion. Adult controls without SCA or sickle trait (n = 7) were scanned twice on separate days. FIELD STRENGTH/SEQUENCE 3.0T T1 -weighted, T2 -weighted, and T2 -relaxation-under-spin-tagging (TRUST) imaging, and phase contrast angiography. ASSESSMENT Global OEF was computed as the relative difference between venous oxygenation (from TRUST) and arterial oxygenation (from pulse oximetry). Global CBF was computed as total blood flow to the brain normalized by intracranial tissue volume. STATISTICAL TESTS Hemometabolic variables were compared using two-sided Wilcoxon signed-rank tests; associations were analyzed using two-sided Spearman's correlation testing. RESULTS In adults with SCA, posttransfusion OEF = 0.38 ± 0.05 was lower (P = 0.001) than pretransfusion OEF = 0.45 ± 0.09. A change in OEF was correlated with increases in hematocrit (P = 0.02; rho = -0.62) and with pretransfusion hematocrit (P = 0.02; rho = 0.65). OEF changes after transfusion were greater (P = 0.002) in adults receiving simple versus exchange transfusions. Posttransfusion CBF = 77.7 ± 26.4 ml/100g/min was not different (P = 0.27) from pretransfusion CBF = 82.3 ± 30.2 ml/100g/min. In children with SCA, both posttransfusion OEF = 0.28 ± 0.04 and CBF = 76.4 ± 26.4 were lower than pretransfusion OEF = 0.36 ± 0.06 (P = 0.004) and CBF = 96.4 ± 16.5 (P = 0.004). DATA CONCLUSION Cerebral OEF reduces following transfusions in adults and children with SCA. CBF reduces following transfusions more often in children compared to adults, indicating that vascular reserve capacity may remain near exhaustion posttransfusion in many adults. LEVEL OF EVIDENCE 2 Technical Efficacy Stage 5 J. Magn. Reson. Imaging 2019;49:466-477.
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Affiliation(s)
- Meher R Juttukonda
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chelsea A Lee
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Niral J Patel
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Larry T Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Spencer L Waddle
- Chemical and Physical Biology Program, Vanderbilt University, Nashville, Tennessee, USA
| | - Melissa C Gindville
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sumit Pruthi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adetola A Kassim
- Department of Medicine, Division of Hematology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael R DeBaun
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee, USA
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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24
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Watchmaker JM, Juttukonda MR, Davis LT, Scott AO, Faraco CC, Gindville MC, Jordan LC, Cogswell PM, Jefferson AL, Kirshner HS, Donahue MJ. Hemodynamic mechanisms underlying elevated oxygen extraction fraction (OEF) in moyamoya and sickle cell anemia patients. J Cereb Blood Flow Metab 2018; 38:1618-1630. [PMID: 28029271 PMCID: PMC6125968 DOI: 10.1177/0271678x16682509] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Moyamoya is a bilateral, complex cerebrovascular condition characterized by progressive non-atherosclerotic intracranial stenosis and collateral vessel formation. Moyamoya treatment focuses on restoring cerebral blood flow (CBF) through surgical revascularization, however stratifying patients for revascularization requires abilities to quantify how well parenchyma is compensating for arterial steno-occlusion. Globally elevated oxygen extraction fraction (OEF) secondary to CBF reduction may serve as a biomarker for tissue health in moyamoya patients, as suggested in patients with sickle cell anemia (SCA) and reduced oxygen carrying capacity. Here, OEF was measured (TRUST-MRI) to test the hypothesis that OEF is globally elevated in patients with moyamoya (n = 18) and SCA (n = 18) relative to age-matched controls (n = 43). Mechanisms underlying the hypothesized OEF increases were evaluated by performing sequential CBF-weighted, cerebrovascular reactivity (CVR)-weighted, and structural MRI. Patients were stratified by treatment and non-parametric tests applied to compare study variables (significance: two-sided P < 0.05). OEF was significantly elevated in moyamoya participants (interquartile range = 0.38-0.45) compared to controls (interquartile range = 0.29-0.38), similar to participants with SCA (interquartile range = 0.37-0.45). CBF was inversely correlated with OEF in moyamoya participants. Elevated OEF was only weakly related to reductions in CVR, consistent with basal CBF level, rather than vascular reserve capacity, being most closely associated with OEF.
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Affiliation(s)
- Jennifer M Watchmaker
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Meher R Juttukonda
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Larry T Davis
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Allison O Scott
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Carlos C Faraco
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Melissa C Gindville
- 2 Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, USA
| | - Lori C Jordan
- 2 Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, USA
| | - Petrice M Cogswell
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Angela L Jefferson
- 3 Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, USA.,4 Department of Neurology, Vanderbilt University Medical Center, Nashville, USA
| | - Howard S Kirshner
- 4 Department of Neurology, Vanderbilt University Medical Center, Nashville, USA
| | - Manus J Donahue
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA.,4 Department of Neurology, Vanderbilt University Medical Center, Nashville, USA.,5 Department of Psychiatry, Vanderbilt University Medical Center, Nashville, USA
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25
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Jordan LC, DeBaun MR. Cerebral hemodynamic assessment and neuroimaging across the lifespan in sickle cell disease. J Cereb Blood Flow Metab 2018; 38:1438-1448. [PMID: 28417646 PMCID: PMC6125971 DOI: 10.1177/0271678x17701763] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children and adults with sickle cell anemia (SCA) have a higher risk of strokes compared to age- and race-matched peers. Velocity in the middle cerebral or distal internal carotid artery as measured by transcranial Doppler ultrasound is a recognized method to identify children but not adults with SCA at high-risk for first stroke. For both children and adults with SCA that have had a stroke, no methods clearly identify individuals at highest risk of recurrent strokes or an initial silent stroke, the most common neurological injury. Methods to assess cerebral hemodynamics in SCA have been utilized for decades but often required radiotracers making them not feasible for screening and longitudinal follow-up. MRI approaches that do not require exogenous contrast have been introduced and are appealing in both clinical and research scenarios. Improved neuroimaging strategies hold promise for identifying individuals with SCA at increased risk of initial and recurrent infarcts, justifying more aggressive risk-based therapy. We review the epidemiology of stroke in SCA, the impact of strokes, stroke mechanisms, and potential imaging strategies including regional and global oxygen extraction fraction, cerebral blood flow, and vessel wall imaging to identify individuals at high-risk of stroke.
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Affiliation(s)
- Lori C Jordan
- 1 Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael R DeBaun
- 2 Department of Pediatrics, Vanderbilt-Meharry Sickle Cell Disease Center of Excellence, Vanderbilt University Medical Center, Nashville, TN, USA
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26
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Bush AM, Coates TD, Wood JC. Diminished cerebral oxygen extraction and metabolic rate in sickle cell disease using T2 relaxation under spin tagging MRI. Magn Reson Med 2018; 80:294-303. [PMID: 29194727 PMCID: PMC5876140 DOI: 10.1002/mrm.27015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/26/2017] [Accepted: 10/26/2017] [Indexed: 11/09/2022]
Abstract
PURPOSE T2 MRI oximetry can noninvasively determine oxygen saturation (Y) but requires empirical MR calibration models to convert the measured blood transverse relaxation (T2b ) into Y. The accuracy of existing T2b models in the presence of blood disorders such as sickle cell disease (SCD) remains unknown. METHODS A Carr Purcell Meiboom Gill T2 preparation sequence was used to make 83 whole blood measurements from 11 subjects with SCD to derive an ex vivo sickle hemoglobin (HbS) T2b model. Forearm venous blood gas, sagittal sinus T2 (T2 Relaxation Under Spin Tagging) and total brain blood flow (phase contrast MRI) were measured in 37 healthy controls and 33 SCD subjects (age 24.6 ± 10.2 years). Cerebral oxygen saturation, extraction fraction, and metabolic rate estimates were calculated using three separate T2b models. Cerebral and forearm oxygen extraction fraction were compared. RESULTS Ex vivo, SCD blood had greater saturation dependent relaxivity than control blood, with a weak dependence on HbS and no dependence on hematocrit. In vivo, the HbS T2b model predicted Yv values with lowest coefficient of variation (compared with existing T2b models) and the strongest correlation with peripheral venous oximetry (r2 = .29). The HbS T2b model predicted systematically higher Yv measurements in SCD patients (73 ± 5 and 61 ± 6; P < 0.0001) which was mirrored by peripheral venous measurements (75 ± 20 and 45 ± 20; P < 0.0001). CONCLUSION Cerebral and peripheral oxygen extraction are decreased in SCD patients, suggesting either blood flow is increased beyond metabolic demands or the presence of physiological arterial-venous shunting. Magn Reson Med 80:294-303, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Adam M Bush
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Thomas D Coates
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - John C Wood
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California, USA
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27
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Stotesbury H, Hales PW, Kirkham FJ. The promise of noninvasive cerebral hemodynamic assessment in sickle cell anemia. Neurology 2018; 90:585-586. [PMID: 29500289 DOI: 10.1212/wnl.0000000000005236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hanne Stotesbury
- From Developmental Neuroscience (H.S., F.J.K.) and Developmental Imaging and Biophysics (H.S., P.W.H.), UCL Great Ormond Street Institute of Child Health, London, UK
| | - Patrick W Hales
- From Developmental Neuroscience (H.S., F.J.K.) and Developmental Imaging and Biophysics (H.S., P.W.H.), UCL Great Ormond Street Institute of Child Health, London, UK
| | - Fenella J Kirkham
- From Developmental Neuroscience (H.S., F.J.K.) and Developmental Imaging and Biophysics (H.S., P.W.H.), UCL Great Ormond Street Institute of Child Health, London, UK.
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28
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Croal PL, Leung J, Kosinski P, Shroff M, Odame I, Kassner A. Assessment of cerebral blood flow with magnetic resonance imaging in children with sickle cell disease: A quantitative comparison with transcranial Doppler ultrasonography. Brain Behav 2017; 7:e00811. [PMID: 29201539 PMCID: PMC5698856 DOI: 10.1002/brb3.811] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/01/2017] [Accepted: 08/05/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Transcranial Doppler ultrasonography (TCD) is a clinical tool for stratifying ischemic stroke risk by identifying abnormal elevations in blood flow velocity (BFV) in the middle cerebral artery (MCA). However, TCD is not effective at screening for subtle neurologic injury such as silent cerebral infarcts. To better understand this disparity, we compared TCD measures of BFV with tissue-level cerebral blood flow (CBF) using arterial spin-labeling MRI in children with and without sickle cell disease, and correlated these measurements against clinical hematologic measures of disease severity. METHODS TCD and MRI assessment were performed in 13 pediatric sickle cell disease patients and eight age-matched controls. Using MRI measures of MCA diameter and territory weight, TCD measures of BFV in the MCA [cm/s] were converted into units of CBF [ml min-1100 g-1] for comparison. RESULTS There was no significant association between TCD measures of BFV in the MCA and corresponding MRI measures of CBF in patients (r = .28, p = .39) or controls (r = .10, p = .81). After conversion from BFV into units of CBF, a strong association was observed between TCD and MRI measures (r = .67, p = .017 in patients, r = .86, p = .006 in controls). While BFV in the MCA showed a lack of correlation with arterial oxygen content, an inverse association was observed for CBF measurements. CONCLUSIONS This study demonstrates that BFV in the MCA cannot be used as a surrogate marker for tissue-level CBF in children with sickle cell disease. Therefore, TCD alone may not be sufficient for understanding and predicting subtle pathophysiology in this population, highlighting the potential clinical value of tissue-level CBF.
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Affiliation(s)
- Paula L Croal
- Physiology & Experimental Medicine The Hospital for Sick Children Toronto ON Canada
| | - Jackie Leung
- Physiology & Experimental Medicine The Hospital for Sick Children Toronto ON Canada
| | | | - Manohar Shroff
- Department of Diagnostic Imaging The Hospital for Sick Children Toronto ON Canada
| | - Isaac Odame
- Division of Haematology/Oncology The Hospital for Sick Children Toronto ON Canada
| | - Andrea Kassner
- Physiology & Experimental Medicine The Hospital for Sick Children Toronto ON Canada.,Institute of Medical Science University of Toronto Toronto ON Canada
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Xu F, Li W, Liu P, Hua J, Strouse JJ, Pekar JJ, Lu H, van Zijl PCM, Qin Q. Accounting for the role of hematocrit in between-subject variations of MRI-derived baseline cerebral hemodynamic parameters and functional BOLD responses. Hum Brain Mapp 2017; 39:344-353. [PMID: 29024300 DOI: 10.1002/hbm.23846] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/22/2017] [Accepted: 10/04/2017] [Indexed: 12/19/2022] Open
Abstract
Baseline hematocrit fraction (Hct) is a determinant for baseline cerebral blood flow (CBF) and between-subject variation of Hct thus causes variation in task-based BOLD fMRI signal changes. We first verified in healthy volunteers (n = 12) that Hct values can be derived reliably from venous blood T1 values by comparison with the conventional lab test. Together with CBF measured using phase-contrast MRI, this noninvasive estimation of Hct, instead of using a population-averaged Hct value, enabled more individual determination of oxygen delivery (DO2 ), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2 ). The inverse correlation of CBF and Hct explained about 80% of between-subject variation of CBF in this relatively uniform cohort of subjects, as expected based on the regulation of DO2 to maintain constant CMRO2 . Furthermore, we compared the relationships of visual task-evoked BOLD response with Hct and CBF. We showed that Hct and CBF contributed 22%-33% of variance in BOLD signal and removing the positive correlation with Hct and negative correlation with CBF allowed normalization of BOLD signal with 16%-22% lower variability. The results of this study suggest that adjustment for Hct effects is useful for studies of MRI perfusion and BOLD fMRI. Hum Brain Mapp 39:344-353, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Feng Xu
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland.,Developing Brain Research Lab, Children's National Medical Center, Washington DC, Washington
| | - Wenbo Li
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Peiying Liu
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Jun Hua
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - John J Strouse
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina
| | - James J Pekar
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Peter C M van Zijl
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
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Coloigner J, Kim Y, Bush A, Choi S, Balderrama MC, Coates TD, O’Neil SH, Lepore N, Wood JC. Contrasting resting-state fMRI abnormalities from sickle and non-sickle anemia. PLoS One 2017; 12:e0184860. [PMID: 28981541 PMCID: PMC5628803 DOI: 10.1371/journal.pone.0184860] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 08/31/2017] [Indexed: 11/20/2022] Open
Abstract
Sickle cell disease (SCD) is a chronic blood disorder that is often associated with acute and chronic cerebrovascular complications, including strokes and impaired cognition. Using functional resting state magnetic resonance images, we performed whole-brain analysis of the amplitude of low frequency fluctuations (ALFF), to detect areas of spontaneous blood oxygenation level dependent signal across brain regions. We compared the ALFF of 20 SCD patients to that observed in 19 healthy, age and ethnicity-matched, control subjects. Significant differences were found in several brain regions, including the insula, precuneus, anterior cingulate cortex and medial superior frontal gyrus. To identify the ALFF differences resulting from anemia alone, we also compared the ALFF of SCD patients to that observed in 12 patients having comparable hemoglobin levels but lacking sickle hemoglobin. Increased ALFF in the orbitofrontal cortex and the anterior and posterior cingulate cortex and decreased ALFF in the frontal pole, cerebellum and medial superior frontal gyrus persisted after accounting for the effect of anemia. The presence of white matter hyperintensities was associated with depressed frontal and medial superior frontal gyri activity in the SCD subjects. Decreased ALFF in the frontal lobe was correlated with decreased verbal fluency and cognitive flexibility. These findings may lead to a better understanding of the pathophysiology of SCD.
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Affiliation(s)
- Julie Coloigner
- CIBORG laboratory, Division of Radiology, Children’s Hospital, Los Angeles, California, United States of America
| | - Yeun Kim
- CIBORG laboratory, Division of Radiology, Children’s Hospital, Los Angeles, California, United States of America
| | - Adam Bush
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United States of America
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, United States of America
| | - Melissa C. Balderrama
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children’s Hospital, Los Angeles, California, United States of America
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Thomas D. Coates
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children’s Hospital, Los Angeles, California, United States of America
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Sharon H. O’Neil
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Division of Neurology, Children’s Hospital, Los Angeles, California, United States of America
- The Saban Research Institute, Children’s Hospital, Los Angeles, California, United States of America
| | - Natasha Lepore
- CIBORG laboratory, Division of Radiology, Children’s Hospital, Los Angeles, California, United States of America
| | - John C. Wood
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Division of Cardiology, Children’s Hospital, Los Angeles, California, United States of America
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31
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Charlot K, Antoine-Jonville S, Moeckesch B, Jumet S, Romana M, Waltz X, Divialle-Doumdo L, Hardy-Dessources MD, Petras M, Tressières B, Tarer V, Hue O, Etienne-Julan M, Connes P. Cerebral and muscle microvascular oxygenation in children with sickle cell disease: Influence of hematology, hemorheology and vasomotion. Blood Cells Mol Dis 2017; 65:23-28. [PMID: 28411485 DOI: 10.1016/j.bcmd.2017.03.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/03/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
The present study investigated cerebral and muscle hemoglobin oxygen saturation (tissue oxygen index, TOI) in children with sickle cell anemia (SS), sickle cell hemoglobin C disease (SC) and healthy children (AA). TOI was measured by near-infrared spectroscopy (NIRS) and spectral analysis of the TOI variability was used to assess flowmotion and vasomotion. Arterial oxyhemoglobin saturation (SpO2), hemorheological and hematological parameters were also measured in SS and SC children. Both TOI were lower in SS compared to both AA and SC children, with SC exhibiting lower values than AA children. Cerebral vasomotion expressed in absolute values was enhanced in SS compared to AA and SC children. Muscle vasomotion did not differ between the three groups. Hematocrit, SpO2 and red blood cell deformability were positively associated with cerebral TOI in SS children. We demonstrated that 1) cerebral and muscle TOI were markedly decreased in SS children while the decrease of TOI was milder in SC children, 2) cerebral TOI level was associated with several biological markers in SS children only and 3) cerebral vasomotion was enhanced in SS, possibly to counterbalance the effects of chronic cerebral hypoxia.
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Affiliation(s)
- Keyne Charlot
- Université des Antilles, Inserm, Unité Biologie Intégrée du Globule Rouge, Laboratoire d'Excellence du Globule Rouge GR-Ex, Paris, France; Université des Antilles, Laboratoire ACTES (EA 3596), Pointe-à-Pitre, Guadeloupe; Département Institut de Recherche Biomédicale des Armées, Environnements Opérationnels, Brétigny-sur-Orge, France
| | | | - Berenike Moeckesch
- Université des Antilles, Inserm, Unité Biologie Intégrée du Globule Rouge, Laboratoire d'Excellence du Globule Rouge GR-Ex, Paris, France; Université des Antilles, Laboratoire ACTES (EA 3596), Pointe-à-Pitre, Guadeloupe.
| | - Stéphane Jumet
- Université des Antilles, Laboratoire ACTES (EA 3596), Pointe-à-Pitre, Guadeloupe
| | - Marc Romana
- Université des Antilles, Inserm, Unité Biologie Intégrée du Globule Rouge, Laboratoire d'Excellence du Globule Rouge GR-Ex, Paris, France.
| | - Xavier Waltz
- Université des Antilles, Inserm, Unité Biologie Intégrée du Globule Rouge, Laboratoire d'Excellence du Globule Rouge GR-Ex, Paris, France; Université des Antilles, Laboratoire ACTES (EA 3596), Pointe-à-Pitre, Guadeloupe.
| | - Lydia Divialle-Doumdo
- CHU de Pointe-à-Pitre, Unité transversale de la Drépanocytose, Pointe-à-Pitre, Guadeloupe.
| | - Marie-Dominique Hardy-Dessources
- Université des Antilles, Inserm, Unité Biologie Intégrée du Globule Rouge, Laboratoire d'Excellence du Globule Rouge GR-Ex, Paris, France.
| | - Marie Petras
- CHU de Pointe-à-Pitre, Unité transversale de la Drépanocytose, Pointe-à-Pitre, Guadeloupe.
| | - Benoît Tressières
- Centre Investigation Clinique Antilles Guyane, Inserm/DGOS CIC 1424, Pointe-à-Pitre, Guadeloupe
| | - Vanessa Tarer
- CHU de Pointe-à-Pitre, Unité transversale de la Drépanocytose, Pointe-à-Pitre, Guadeloupe.
| | - Olivier Hue
- Université des Antilles, Laboratoire ACTES (EA 3596), Pointe-à-Pitre, Guadeloupe.
| | - Maryse Etienne-Julan
- CHU de Pointe-à-Pitre, Unité transversale de la Drépanocytose, Pointe-à-Pitre, Guadeloupe.
| | - Philippe Connes
- Université des Antilles, Inserm, Unité Biologie Intégrée du Globule Rouge, Laboratoire d'Excellence du Globule Rouge GR-Ex, Paris, France; Institut Universitaire de France (IUF), Paris, France; Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Villeurbanne, France.
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32
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Cahill LS, Gazdzinski LM, Tsui AK, Zhou YQ, Portnoy S, Liu E, Mazer CD, Hare GM, Kassner A, Sled JG. Functional and anatomical evidence of cerebral tissue hypoxia in young sickle cell anemia mice. J Cereb Blood Flow Metab 2017; 37:994-1005. [PMID: 27165012 PMCID: PMC5363475 DOI: 10.1177/0271678x16649194] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cerebral ischemia is a significant source of morbidity in children with sickle cell anemia; however, the mechanism of injury is poorly understood. Increased cerebral blood flow and low hemoglobin levels in children with sickle cell anemia are associated with increased stroke risk, suggesting that anemia-induced tissue hypoxia may be an important factor contributing to subsequent morbidity. To better understand the pathophysiology of brain injury, brain physiology and morphology were characterized in a transgenic mouse model, the Townes sickle cell model. Relative to age-matched controls, sickle cell anemia mice demonstrated: (1) decreased brain tissue pO2 and increased expression of hypoxia signaling protein in the perivascular regions of the cerebral cortex; (2) elevated basal cerebral blood flow , consistent with adaptation to anemia-induced tissue hypoxia; (3) significant reduction in cerebrovascular blood flow reactivity to a hypercapnic challenge; (4) increased diameter of the carotid artery; and (5) significant volume changes in white and gray matter regions in the brain, as assessed by ex vivo magnetic resonance imaging. Collectively, these findings support the hypothesis that brain tissue hypoxia contributes to adaptive physiological and anatomic changes in Townes sickle cell mice. These findings may help define the pathophysiology for stroke in children with sickle cell anemia.
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Affiliation(s)
- Lindsay S Cahill
- 1 Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa M Gazdzinski
- 1 Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Albert Ky Tsui
- 2 Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yu-Qing Zhou
- 1 Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon Portnoy
- 1 Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elaine Liu
- 2 Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - C David Mazer
- 2 Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,3 Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Mt Hare
- 2 Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,3 Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Kassner
- 4 Department of Medical Imaging, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John G Sled
- 1 Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,5 Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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Donahue MJ, Juttukonda MR, Watchmaker JM. Noise concerns and post-processing procedures in cerebral blood flow (CBF) and cerebral blood volume (CBV) functional magnetic resonance imaging. Neuroimage 2016; 154:43-58. [PMID: 27622397 DOI: 10.1016/j.neuroimage.2016.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/22/2016] [Accepted: 09/03/2016] [Indexed: 01/19/2023] Open
Abstract
Functional neuroimaging with blood oxygenation level-dependent (BOLD) contrast has emerged as the most popular method for evaluating qualitative changes in brain function in humans. At typical human field strengths (1.5-3.0T), BOLD contrast provides a measure of changes in transverse water relaxation rates in and around capillary and venous blood, and as such provides only a surrogate marker of brain function that depends on dynamic changes in hemodynamics (e.g., cerebral blood flow and volume) and metabolism (e.g., oxygen extraction fraction and the cerebral metabolic rate of oxygen consumption). Alternative functional neuroimaging methods that are specifically sensitive to these constituents of the BOLD signal are being developed and applied in a growing number of clinical and neuroscience applications of quantitative cerebral physiology. These methods require additional considerations for interpreting and quantifying their contrast responsibly. Here, an overview of two popular methods, arterial spin labeling and vascular space occupancy, is presented specifically in the context of functional neuroimaging. Appropriate post-processing and experimental acquisition strategies are summarized with the motivation of reducing sensitivity to noise and unintended signal sources and improving quantitative accuracy of cerebral hemodynamics.
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Affiliation(s)
- Manus J Donahue
- Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA; Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA; Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Meher R Juttukonda
- Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jennifer M Watchmaker
- Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
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Jordan LC, Gindville MC, Scott AO, Juttukonda MR, Strother MK, Kassim AA, Chen SC, Lu H, Pruthi S, Shyr Y, Donahue MJ. Non-invasive imaging of oxygen extraction fraction in adults with sickle cell anaemia. Brain 2016; 139:738-50. [PMID: 26823369 DOI: 10.1093/brain/awv397] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/30/2015] [Indexed: 11/12/2022] Open
Abstract
Sickle cell anaemia is a monogenetic disorder with a high incidence of stroke. While stroke screening procedures exist for children with sickle cell anaemia, no accepted screening procedures exist for assessing stroke risk in adults. The purpose of this study is to use novel magnetic resonance imaging methods to evaluate physiological relationships between oxygen extraction fraction, cerebral blood flow, and clinical markers of cerebrovascular impairment in adults with sickle cell anaemia. The specific goal is to determine to what extent elevated oxygen extraction fraction may be uniquely present in patients with higher levels of clinical impairment and therefore may represent a candidate biomarker of stroke risk. Neurological evaluation, structural imaging, and the non-invasive T2-relaxation-under-spin-tagging magnetic resonance imaging method were applied in sickle cell anaemia (n = 34) and healthy race-matched control (n = 11) volunteers without sickle cell trait to assess whole-brain oxygen extraction fraction, cerebral blood flow, degree of vasculopathy, severity of anaemia, and presence of prior infarct; findings were interpreted in the context of physiological models. Cerebral blood flow and oxygen extraction fraction were elevated (P < 0.05) in participants with sickle cell anaemia (n = 27) not receiving monthly blood transfusions (interquartile range cerebral blood flow = 46.2-56.8 ml/100 g/min; oxygen extraction fraction = 0.39-0.50) relative to controls (interquartile range cerebral blood flow = 40.8-46.3 ml/100 g/min; oxygen extraction fraction = 0.33-0.38). Oxygen extraction fraction (P < 0.0001) but not cerebral blood flow was increased in participants with higher levels of clinical impairment. These data provide support for T2-relaxation-under-spin-tagging being able to quickly and non-invasively detect elevated oxygen extraction fraction in individuals with sickle cell anaemia with higher levels of clinical impairment. Our results support the premise that magnetic resonance imaging-based assessment of elevated oxygen extraction fraction might be a viable screening tool for evaluating stroke risk in adults with sickle cell anaemia.
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Affiliation(s)
- Lori C Jordan
- 1 Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa C Gindville
- 1 Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Allison O Scott
- 2 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Meher R Juttukonda
- 2 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Megan K Strother
- 2 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adetola A Kassim
- 3 Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sheau-Chiann Chen
- 4 Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hanzhang Lu
- 5 Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sumit Pruthi
- 2 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yu Shyr
- 4 Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J Donahue
- 2 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA 6 Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA 7 Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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35
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Mechanisms linking red blood cell disorders and cardiovascular diseases. BIOMED RESEARCH INTERNATIONAL 2015; 2015:682054. [PMID: 25710019 PMCID: PMC4331396 DOI: 10.1155/2015/682054] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 11/14/2014] [Accepted: 11/23/2014] [Indexed: 01/07/2023]
Abstract
The present paper aims to review the main pathophysiological links between red blood cell disorders and cardiovascular diseases, provides a brief description of the latest studies in this area, and considers implications for clinical practice and therapy. Anemia is associated with a special risk in proatherosclerotic conditions and heart disease and became a new therapeutic target. Guidelines must be updated for the management of patients with red blood cell disorders and cardiovascular diseases, and targets for hemoglobin level should be established. Risk scores in several cardiovascular diseases should include red blood cell count and RDW. Complete blood count and hemorheological parameters represent useful, inexpensive, widely available tools for the management and prognosis of patients with coronary heart disease, heart failure, hypertension, arrhythmias, and stroke. Hypoxia and iron accumulation cause the most important cardiovascular effects of sickle cell disease and thalassemia. Patients with congenital chronic hemolytic anemia undergoing splenectomy should be monitored, considering thromboembolic and cardiovascular risk.
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Milionis H, Papavasileiou V, Eskandari A, D'Ambrogio-Remillard S, Ntaios G, Michel P. Anemia on admission predicts short- and long-term outcomes in patients with acute ischemic stroke. Int J Stroke 2014; 10:224-30. [PMID: 25427291 DOI: 10.1111/ijs.12397] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/05/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND It is still debatable whether anemia predicts stroke outcome. AIM To describe the characteristics of patients with acute ischemic stroke (AIS) and anemia and identify whether hemoglobin status on admission is a prognostic factor of AIS outcome. METHODS All 2439 patients of the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) between January 2003 and June 2011 were selected. Demographics, risk factors, prestroke treatment, clinical, radiological and metabolic variables in patients with and without anemia according to the definition of the World Health Organization were compared. Functional disability and mortality were recorded up to 12 months from admission. RESULTS Anemic patients (17.5%) were older, had lower body mass index, higher rates of coronary artery disease (CAD), atrial fibrillation, diabetes mellitus and peripheral artery disease. Anemia was associated with more severe stroke manifestations, lower systolic and diastolic blood pressure measurements, worse estimated glomerular filtration rate and elevated C-reactive protein concentrations upon admission and with increased modified Rankin scores during the follow-up. Anemic patients had higher 7-day, 3-month and 12-month mortality, which was associated with hemoglobin status and other factors, including age, CAD, stroke severity, and baseline C-reactive levels. Hemoglobin levels were inversely associated with recurrent stroke and mortality throughout the 12-month follow-up. CONCLUSION Anemia is common among AIS patients and is associated with cardiovascular comorbidities. Low hemoglobin status independently predicts short and long-term mortality.
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Affiliation(s)
- Haralampos Milionis
- Neurology Service, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland; Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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37
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Helton KJ, Glass JO, Reddick WE, Paydar A, Zandieh AR, Dave R, Smeltzer MP, Wu S, Hankins J, Aygun B, Ogg RJ. Comparing segmented ASL perfusion of vascular territories using manual versus semiautomated techniques in children with sickle cell anemia. J Magn Reson Imaging 2014; 41:439-46. [PMID: 24920128 DOI: 10.1002/jmri.24559] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/12/2013] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Elevated cerebral blood flow (CBF) in sickle cell anemia (SCA) is an adaptive pathophysiologic response associated with decreased vascular reserve and increased risk for ischemia. We compared manual (M) and semiautomated (SA) vascular territory delineation to facilitate standardized evaluation of CBF in children with SCA. MATERIALS AND METHODS ASL perfusion values from 21 children were compared for gray matter and white matter (WM) in vascular territories defined by M and SA delineation. SA delineated CBF was compared with clinical and hematologic variables acquired within 4 weeks of the MRI. RESULTS CBF measurements from M (MCA 82 left, 79 right) and SA (MCA 81 left, 81 right) delineated territories were highly correlated (R = 0.99, P < 0.0001). Bland-Altman plots had close-fitting limits of agreement of -1.8 to -3.5 lower limit and 0 to 1.8 upper limit. SA vascular territory delineation was comparable to the expert delineation with a kappa index of 0.62-0.85 and was considerably faster. Median territorial CBF values did not differ by gender or age. WM perfusion in the posterior cerebral artery territories was positively correlated with degree of hemolysis (R = 0.58, P = 0.01 left, 0.73, P < 0.001 right) and negatively correlated with hemoglobin (R = -0.48; P = 0.03 left; -0.47; P = 0.04 right) and hemoglobin F (R = -0.42; P = .09 left; -0.47; P = 0.049 right). CONCLUSION We established the validity of the SA method, which in our experience was much faster than the M method for delineation of vascular territories. Associations between CBF and hematologic variables may demonstrate pathophysiologic changes that contribute to clinical variation in CBF.
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Affiliation(s)
- Kathleen J Helton
- Department of Radiological Sciences, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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38
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Deus-Silva L, Bonilha L, Damasceno BP, Costa ALF, Yasuda CL, Costa FF, Santos AO, Etchebehere ECSC, Oquendo-Nogueira R, Fockink R, de Freitas CF, Camargo EE, Li LM, Cendes F, Saad ST. Brain Perfusion Impairment in Neurologically Asymptomatic Adult Patients with Sickle-Cell Disease Shown by Voxel-Based Analysis of SPECT Images. Front Neurol 2013; 4:207. [PMID: 24391625 PMCID: PMC3869238 DOI: 10.3389/fneur.2013.00207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 12/08/2013] [Indexed: 11/13/2022] Open
Abstract
Cerebrovascular lesions are frequently observed in patients with sickle-cell disease (SCD) and these structural lesions are preceded by insidious perfusion deficits. Our aim was to investigate the presence of brain perfusion deficits in neurologically asymptomatic SCD patients, especially affecting microvessels. For this study, 42 SCD patients [33 sickle-cell anemia (HbSS), 6 sickle hemoglobin C disease (HbSC), and 3 sickle β-thalassemia disease (HbSβ)] with mean hematocrit of 25.1 (±4.85; 15.6–38.5) underwent brain perfusion single photon emission computerized tomography (SPECT) using the tracer 99mTc-ECD. Images from SCD patients were compared to images of a healthy control group (29 females and 20 males, mean age 31 ± 8; range 25–49 years). Images underwent voxel-wise comparison of regional tracer uptake using paired t-test to estimate the probability of each voxel to have an increased or decreased tracer uptake. When compared to controls, SCD patients exhibited significantly reduced tracer uptake in basal ganglia and thalami, the anterior frontal region and the watershed region of the temporo-parietal-occipital transition (p < 0.05). Our study showed that neurologically asymptomatic adult SCD patients exhibit a pattern of reduced 99mTc-ECD tracer uptake demonstrated by SPECT. Early diagnosis of this cerebral vasculopathy has prognostic implications and can be determinant in considering therapeutic alternatives to avoid increasing brain lesion load and progressive disability.
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Affiliation(s)
| | - Leonardo Bonilha
- Division of Neurology, Department of Neurosciences, Medical University of South Carolina , Charleston, SC , USA
| | | | - Andre L F Costa
- Department of Neurology, University of Campinas , Campinas , Brazil ; Department of Orthodontics, City University of São Paulo , São Paulo , Brazil
| | | | - Fernando F Costa
- Hematology and Hemotherapy Center, University of Campinas , Campinas , Brazil
| | - Allan O Santos
- Division of Nuclear Medicine, Department of Radiology, University of Campinas , Campinas , Brazil
| | - Elba C S C Etchebehere
- Division of Nuclear Medicine, Department of Radiology, University of Campinas , Campinas , Brazil
| | - Regis Oquendo-Nogueira
- Division of Nuclear Medicine, Department of Radiology, University of Campinas , Campinas , Brazil
| | - Renata Fockink
- Division of Nuclear Medicine, Department of Radiology, University of Campinas , Campinas , Brazil
| | | | - Edwaldo E Camargo
- Division of Nuclear Medicine, Department of Radiology, University of Campinas , Campinas , Brazil
| | - Li M Li
- Department of Neurology, University of Campinas , Campinas , Brazil
| | - Fernando Cendes
- Department of Neurology, University of Campinas , Campinas , Brazil
| | - Sara T Saad
- Hematology and Hemotherapy Center, University of Campinas , Campinas , Brazil
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Arkuszewski M, Krejza J, Chen R, Melhem ER. Sickle cell anemia: reference values of cerebral blood flow determined by continuous arterial spin labeling MRI. Neuroradiol J 2013; 26:191-200. [PMID: 23859242 PMCID: PMC5228728 DOI: 10.1177/197140091302600209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/02/2013] [Indexed: 11/16/2022] Open
Abstract
Sickle cell anemia (SCA) is a chronic illness associated with progressive deterioration in patients' quality of life. The major complications of SCA are cerebrovascular accidents (CVA) such as asymptomatic cerebral infarct or overt stroke. The risk of CVA may be related to chronic disturbances in cerebral blood flow (CBF), but the thresholds of "normal" steady-state CBF are not well established. The reference tolerance limits of CBF can be useful to estimate the risk of CVA in asymptomatic children with SCA, who are negative for hyperemia or evidence of arterial narrowing. Continuous arterial spin labeling (CASL) MR perfusion allows for non-invasive quantification of global and regional CBF. To establish such reference tolerance limits we performed CASL MR examinations on a 3-Tesla MR scanner in a carefully selected cohort of 42 children with SCA (mean age, 8.1±3.3 years; range limits, 2.3-14.4 years; 24 females), who were not on chronic transfusion therapy, had no history of overt stroke or transient ischemic attack, were free of signs and symptoms of focal vascular territory ischemic brain injury, did not have intracranial arterial narrowing on MR angiography and were at low risk for stroke as determined by transcranial Doppler ultrasonography.
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Affiliation(s)
- M Arkuszewski
- Department of Radiology, Division of Neuroradiology, University of Pennsylvania, Philadelphia, PA, USA.
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40
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Connes P, Verlhac S, Bernaudin F. Advances in understanding the pathogenesis of cerebrovascular vasculopathy in sickle cell anaemia. Br J Haematol 2013; 161:484-98. [DOI: 10.1111/bjh.12300] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Philippe Connes
- UMR Inserm 665; Academic Hospital of Pointe à Pitre; Pointe à Pitre Guadeloupe
- Laboratory ACTES EA3596; Department of Physiology; University of Antilles-Guyane; Pointe à Pitre Guadeloupe
- Laboratory of Excellence GR-Ex “The red cell: from genesis to death”; PRES Sorbonne Paris Cité; Paris France
| | - Suzanne Verlhac
- Medical Imaging; Centre Hospitalier Intercommunal; Creteil France
| | - Françoise Bernaudin
- Department of Paediatrics; Referral Centre for Sickle Cell Disease; Centre Hospitalier Intercommunal; Creteil France
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41
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Waltz X, Pichon A, Mougenel D, Lemonne N, Lalanne-Mistrih ML, Sinnapah S, Tarer V, Tressières B, Lamarre Y, Etienne-Julan M, Hue O, Hardy-Dessources MD, Connes P. Hemorheological alterations, decreased cerebral microvascular oxygenation and cerebral vasomotion compensation in sickle cell patients. Am J Hematol 2012; 87:1070-3. [PMID: 22911571 DOI: 10.1002/ajh.23318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 07/20/2012] [Indexed: 11/07/2022]
Abstract
Sickle cell anemia (SS) is characterized by a reduced cerebral microvascular oxygen saturation (cerebral TOI), which is not associated with hemoglobin concentration. Cerebral TOI has never been studied in sickle cell-hemoglobin C disease (SC). We focused on the relationships between hemorheological alterations and cerebral TOI in sickle cell patients with no cerebral vasculopathy and on the usefulness of TOI variability to assess the cerebral vasomotion activity. The blood rheological profile, the level of cerebral TOI (spatial resolved spectroscopy) and the cerebral TOI variability, which reflects vasomotion activity, were compared between 20 healthy subjects (AA), 21 SC patients, and 21 SS patients. Cerebral TOI exhibited the following order: AA > SC > SS. The low cerebral TOI in SS patients was related to red blood cell aggregation and deformability properties. The cerebral TOI variability of SS and SC patients was increased above healthy values and vasomotion activity was negatively associated with the reduced cerebral TOI in SS patients. We demonstrated that (1) blood rheology could be involved in the reduced cerebral TOI in SS patients but not in SC patients; (2) vasomotion activity is increased in SS and SC patients to compensate for the reduced cerebral TOI.
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Affiliation(s)
- Xavier Waltz
- UMR Inserm 665, Pointe-à-Pitre, F-97159 Guadeloupe, Université des Antilles et de la Guyane, Pointe-à-Pitre, F-97157, France
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42
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Baron JC, Jones T. Oxygen metabolism, oxygen extraction and positron emission tomography: Historical perspective and impact on basic and clinical neuroscience. Neuroimage 2012; 61:492-504. [DOI: 10.1016/j.neuroimage.2011.12.036] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/08/2011] [Accepted: 12/15/2011] [Indexed: 10/14/2022] Open
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43
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Jordan LC, Casella JF, DeBaun MR. Prospects for primary stroke prevention in children with sickle cell anaemia. Br J Haematol 2012; 157:14-25. [PMID: 22224940 DOI: 10.1111/j.1365-2141.2011.09005.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This review will focus on the strengths and limitations associated with the current standard of care for primary prevention of ischaemic strokes in children with sickle cell anaemia (SCA) - transcranial Doppler ultrasound (TCD) screening followed by regular blood transfusion therapy when TCD measurement is above a threshold defined by a randomized clinical trial (RCT). The theoretical basis for potential alternative strategies for primary prevention of neurological injury in SCA is also discussed. These strategies will include, but will not be limited to: immunizations to prevent bacterial infections, particularly in low income countries; management of elevated blood pressure; and targeted strategies to increase baseline haemoglobin levels with therapies such as hyroxycarbamide or potentially definitive haematopoietic stem cell transplant.
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Affiliation(s)
- Lori C Jordan
- Department of Neurology, Division of Pediatric Neurology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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44
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Gevers S, Nederveen AJ, Fijnvandraat K, van den Berg SM, van Ooij P, Heijtel DF, Heijboer H, Nederkoorn PJ, Engelen M, van Osch MJ, Majoie CB. Arterial spin labeling measurement of cerebral perfusion in children with sickle cell disease. J Magn Reson Imaging 2011; 35:779-87. [PMID: 22095695 DOI: 10.1002/jmri.23505] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 10/21/2011] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the applicability of arterial spin labeling (ASL) cerebral blood flow (CBF) measurements in children with sickle cell disease (SCD). MATERIALS AND METHODS We included 12 patients and five controls. Conventional magnetic resonance imaging (MRI) (T2, fluid attenuated inversion recovery [FLAIR], and MR angiography) was performed to diagnose silent infarcts, vasculopathy, or leukoencephalopathy. Pseudo-continuous ASL was performed to measure CBF using two postlabeling delays to identify transit-time effects. Perfusion estimates were corrected for hematocrit and blood velocity in the labeling plane and compared to phase-contrast MR. CBF asymmetries between the flow maps of the left and right internal carotid arteries were tested for significance using paired t-tests. Significant asymmetries were expressed in terms of an asymmetry ratio (AR = absolute difference/mean). An AR >10% was considered clinically relevant. RESULTS Mean CBF was higher in patients than in controls. Agreement between CBF and flow improved after applying hematocrit and velocity corrections. At a 2100 msec postlabeling delay one patient had a clinically relevant asymmetry. No association was observed between CBF asymmetries and silent infarcts. CONCLUSION Care must be taken in the interpretation of ASL-CBF measurements in SCD patients. A long postlabeling delay with blood velocity correction anticipates overestimation of CBF asymmetries.
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Affiliation(s)
- Sanna Gevers
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
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45
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Musallam KM, Nasreddine W, Beydoun A, Hourani R, Hankir A, Koussa S, Haidar M, Taher AT. Brain positron emission tomography in splenectomized adults with β-thalassemia intermedia: uncovering yet another covert abnormality. Ann Hematol 2011; 91:235-41. [DOI: 10.1007/s00277-011-1291-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 07/01/2011] [Indexed: 12/15/2022]
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46
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Ibaraki M, Shinohara Y, Nakamura K, Miura S, Kinoshita F, Kinoshita T. Interindividual variations of cerebral blood flow, oxygen delivery, and metabolism in relation to hemoglobin concentration measured by positron emission tomography in humans. J Cereb Blood Flow Metab 2010; 30:1296-305. [PMID: 20160738 PMCID: PMC2949226 DOI: 10.1038/jcbfm.2010.13] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Regional cerebral blood flow (CBF) and oxygen metabolism can be measured by positron emission tomography (PET) with (15)O-labeled compounds. Hemoglobin (Hb) concentration of blood, a primary determinant of arterial oxygen content (C(a)O(2)), influences cerebral circulation. We investigated interindividual variations of CBF, cerebral blood volume (CBV), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO(2)) in relation to Hb concentration in healthy human volunteers (n=17) and in patients with unilateral steno-occlusive disease (n=44). For the patients, data obtained only from the contralateral hemisphere (normal side) were analyzed. The CBF and OEF were inversely correlated with Hb concentration, but CMRO(2) was independent of Hb concentration. Oxygen delivery defined as a product of C(a)O(2) and CBF (C(a)O(2) CBF) increased with a rise of Hb concentration. The analysis with a simple oxygen model showed that oxygen diffusion parameter (L) was constant over the range of Hb concentration, indicating that a homeostatic mechanism controlling CBF is necessary to maintain CMRO(2). The current findings provide important knowledge to understand the control mechanism of cerebral circulation and to interpret the (15)O PET data in clinical practice.
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Affiliation(s)
- Masanobu Ibaraki
- Department of Radiology and Nuclear Medicine, Akita Research Institute of Brain and Blood Vessels, 6-10 Senshu-Kubota Machi, Akita, Japan.
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Abstract
PURPOSE Stroke and subclinical "silent infarcts" are major causes of morbidity in children with Sickle Cell Disease (SCD). Ischemic strokes are more common in younger children while hemorrhagic strokes are more frequent in adults. The goal of neuroimaging in acute stroke is to document whether the stroke is ischemic or hemorrhagic, to assess the extent of parenchymal abnormalities and to determine the presence of other cerebrovascular lesions. Computed Tomography (CT) is the primary modality for the assessment of acute stroke patients because of its 24/7 availability and ability to exclude hemorrhagic causes. Magnetic resonance imaging (MRI) and MR angiography (MRA) are recommended to determine precisely extent of infarction and detect cerebrovascular abnormalities. The goal of neuroimaging in patients with hemorrhagic stroke is to identify an arteriovenous malformation or aneurysm(s) amenable to surgery or catheter intervention.The risk of first stroke is very high in asymptomatic children with intracranial arterial mean velocities over 200 cm/s on transcranial Doppler (TCD) examination. The risk can be substantially reduced if chronic blood transfusions are timely implemented. Large cerebral vessel disease detected by TCD can be confirmed or excluded by MRI/MRA. Those with evidence of parenchymal and/or cerebrovascular lesions should be followed by preventive therapy. In patients with neurologic symptoms and negative MRI/MRA findings Positron Emission Tomography or single photon emission CT is recommended. There are no specific neuroimaging findings that suggest that blood transfusions can be safely halted in children with SCD.
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48
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Huang WY, Chen IC, Meng L, Weng WC, Peng TI. The influence of anemia on clinical presentation and outcome of patients with first-ever atherosclerosis-related ischemic stroke. J Clin Neurosci 2009; 16:645-9. [PMID: 19285409 DOI: 10.1016/j.jocn.2008.08.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 08/18/2008] [Accepted: 08/21/2008] [Indexed: 11/16/2022]
Abstract
There is considerable debate regarding whether anemia qualifies as a prognostic factor for stroke. The purpose of this study was twofold: first, to assess the influence of anemia on vascular risk factors and clinical presentations in patients with first-ever atherosclerosis-related ischemic stroke and, second, to evaluate whether anemia may be of prognostic importance. A total of 774 consecutive patients with first-ever atherosclerosis-related ischemic stroke were prospectively investigated. Vascular risk factors, clinical presentations and outcomes were recorded and compared between those patients with and without anemia. Stroke recurrence and mortality were recorded at the 3-year follow-up. Of the study population, 168 (21.7%) were anemic. Multivariate analysis revealed that patients with anemia were more likely to be older than 70 years (p<0.001) and have chronic renal insufficiency (p<0.001). After a mean follow-up period of 958 days, 21 (12.5%) and 24 (4.0%) of the patients in the anemic and control groups, respectively, died. Within 3 years of initial onset, the mortality rate was significantly higher in patients with anemia (p=0.021). The Kaplan-Meier analysis for patients with and without anemia showed different survival curves (Log-rank test p<0.001). Within 3 years of the onset of first-ever atherosclerosis-related ischemic stroke, patients who had anemia at the time of the initial admission had an associated higher mortality rate. The stroke risk factors of being older than 70 years and having chronic renal insufficiency were more frequently observed in those patients with anemia.
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Affiliation(s)
- Wen-Yi Huang
- Department of Neurology, Keelung Chang-Gung Memorial Hospital, 222, Maijin Road, Anle Chiu, Keelung 204, Taiwan.
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49
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Helton KJ, Paydar A, Glass J, Weirich EM, Hankins J, Li CS, Smeltzer MP, Wang WC, Ware RE, Ogg RJ. Arterial spin-labeled perfusion combined with segmentation techniques to evaluate cerebral blood flow in white and gray matter of children with sickle cell anemia. Pediatr Blood Cancer 2009; 52:85-91. [PMID: 18937311 PMCID: PMC4480678 DOI: 10.1002/pbc.21745] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Changes in cerebral perfusion are an important feature of the pathophysiology of sickle cell anemia (SCA); cerebrovascular ischemia occurs frequently and leads to neurocognitive deficits, silent infarcts, and overt stroke. Non-invasive MRI methods to measure cerebral blood flow (CBF) by arterial spin labeling (ASL) afford new opportunities to characterize disease- and therapy-induced changes in cerebral hemodynamics in patients with SCA. Recent studies have documented elevated gray matter (GM) CBF in untreated children with SCA, but no measurements of white matter (WM) CBF have been reported. PROCEDURES Pulsed ASL with automated brain image segmentation-classification techniques were used to determine the CBF in GM, WM, and abnormal white matter (ABWM) of 21 children with SCA, 18 of whom were receiving hydroxyurea therapy. RESULTS GM and WM CBF were highly associated (R(2) = 0.76, P < 0.0001) and the GM to WM CBF ratio was 1.6 (95% confidence interval: 1.43-1.83). Global GM CBF in our treated cohort was 87 +/- 24 mL/min/100 g, a value lower than previously reported in untreated patients with SCA. CBF was elevated in normal appearing WM (43 +/- 14 mL/min/100 g) but decreased in ABWM (6 +/- 12 mL/min/100 g), compared to published normal pediatric controls. Hemispheric asymmetry in CBF was noted in most patients. CONCLUSIONS These perfusion measurements suggest that hydroxyurea may normalize GM CBF in children with SCA, but altered perfusion in WM may persist. This novel combined approach for CBF quantification will facilitate prospective studies of cerebral vasculopathy in SCA, particularly regarding the effects of treatments such as hydroxyurea.
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Affiliation(s)
- Kathleen J. Helton
- Correspondence to: Kathleen J. Helton, M.D., Department of Radiological Sciences, Mail Stop 210, St. Jude Children's Research Hospital, 332 North Lauderdale Street, Memphis, TN 38105, Phone: (901) 495-2412, FAX: (901) 495-3962,
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50
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Nybo M, Kristensen SR, Mickley H, Jensen JK. The influence of anaemia on stroke prognosis and its relation to N-terminal pro-brain natriuretic peptide. Eur J Neurol 2007; 14:477-82. [PMID: 17437604 DOI: 10.1111/j.1468-1331.2006.01591.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Anaemia is a negative prognostic factor for patients with heart failure and impaired renal function, but its role in stroke patients is unknown. Furthermore, anaemia has been shown to influence the level of N-terminal pro-brain natriuretic peptide (NT-proBNP), but this is only investigated in patients with heart failure, not in stroke patients. Two-hundred-and-fifty consecutive, well-defined ischemic stroke patients were investigated. Mortality was recorded at 6 months follow-up. Anaemia was diagnosed in 37 patients (15%) in whom stroke severity was worse than in the non-anaemic group, whilst the prevalence of renal affection, smoking and heart failure was lower. At 6 months follow-up, 23 patients were dead, and anaemia had an odds ratio of 4.7 when adjusted for age, Scandinavian Stroke Scale and a combined variable of heart and/or renal failure and/or elevation of troponin T using logistic regression. The median NT-proBNP level in the anaemic group was significantly higher than in the non-anaemic group, and in a multivariate linear regression model, anaemia remained an independent predictor of NT-proBNP. Conclusively, anaemia was found to be a negative prognostic factor for ischemic stroke patients. Furthermore, anaemia influenced the NT-proBNP level in ischemic stroke patients, an important aspect when interpreting NT-proBNP in these patients.
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Affiliation(s)
- M Nybo
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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