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Power LC, Mirro AE, Binkley MM, Wang J, Guilliams KP, Lewis JB, Ford AL, Shimony JS, An H, Lee JM, Fields ME. Reversibility of Cognitive Deficits and Functional Connectivity With Transfusion in Children With Sickle Cell Disease. Neurology 2024; 102:e209429. [PMID: 38710015 PMCID: PMC11177587 DOI: 10.1212/wnl.0000000000209429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/28/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES People with sickle cell disease (SCD) are at risk of cognitive dysfunction independent of stroke. Diminished functional connectivity in select large-scale networks and white matter integrity reflect the neurologic consequences of SCD. Because chronic transfusion therapy is neuroprotective in preventing stroke and strengthening executive function abilities in people with SCD, we hypothesized that red blood cell (RBC) transfusion facilitates the acute reversal of disruptions in functional connectivity while white matter integrity remains unaffected. METHODS Children with SCD receiving chronic transfusion therapy underwent a brain MRI measuring white matter integrity with diffusion tensor imaging and resting-state functional connectivity within 3 days before and after transfusion of RBCs. Cognitive assessments with the NIH Toolbox were acquired after transfusion and then immediately before the following transfusion cycle. RESULTS Sixteen children with a median age of 12.5 years were included. Global assessments of functional connectivity using homotopy (p = 0.234) or modularity (p = 0.796) did not differ with transfusion. Functional connectivity within the frontoparietal network significantly strengthened after transfusion (median intranetwork Z-score 0.21 [0.17-0.30] before transfusion, 0.29 [0.20-0.36] after transfusion, p < 0.001), while there was not a significant change seen within the sensory motor, visual, auditory, default mode, dorsal attention, or cingulo-opercular networks. Corresponding to the change within the frontoparietal network, there was a significant improvement in executive function abilities after transfusion (median executive function composite score 87.7 [81.3-90.7] before transfusion, 90.3 [84.3-93.7] after transfusion, p = 0.021). Participants with stronger connectivity in the frontoparietal network before transfusion had a significantly greater improvement in the executive function composite score with transfusion (r = 0.565, 95% CI 0.020-0.851, p = 0.044). While functional connectivity and executive abilities strengthened with transfusion, there was not a significant change in white matter integrity as assessed by fractional anisotropy and mean diffusivity within 16 white matter tracts or globally with tract-based spatial statistics. DISCUSSION Strengthening of functional connectivity with concomitant improvement in executive function abilities with transfusion suggests that functional connectivity MRI could be used as a biomarker for acutely reversible neurocognitive injury as novel therapeutics are developed for people with SCD.
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Affiliation(s)
- Landon C Power
- From the Department of Pediatrics (L.C.P., A.E.M., M.M.B., K.P.G., M.E.F.), Center for Biostatistics and Data Science (J.W.), Department of Neurology (K.P.G., J.B.L., A.L.F., J.-M.L., M.E.F.), Mallinckrodt Institute of Radiology (K.P.G., A.L.F., J.S.S., H.A., J.-M.L.), and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Amy E Mirro
- From the Department of Pediatrics (L.C.P., A.E.M., M.M.B., K.P.G., M.E.F.), Center for Biostatistics and Data Science (J.W.), Department of Neurology (K.P.G., J.B.L., A.L.F., J.-M.L., M.E.F.), Mallinckrodt Institute of Radiology (K.P.G., A.L.F., J.S.S., H.A., J.-M.L.), and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Micahel M Binkley
- From the Department of Pediatrics (L.C.P., A.E.M., M.M.B., K.P.G., M.E.F.), Center for Biostatistics and Data Science (J.W.), Department of Neurology (K.P.G., J.B.L., A.L.F., J.-M.L., M.E.F.), Mallinckrodt Institute of Radiology (K.P.G., A.L.F., J.S.S., H.A., J.-M.L.), and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Jinli Wang
- From the Department of Pediatrics (L.C.P., A.E.M., M.M.B., K.P.G., M.E.F.), Center for Biostatistics and Data Science (J.W.), Department of Neurology (K.P.G., J.B.L., A.L.F., J.-M.L., M.E.F.), Mallinckrodt Institute of Radiology (K.P.G., A.L.F., J.S.S., H.A., J.-M.L.), and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Kristin P Guilliams
- From the Department of Pediatrics (L.C.P., A.E.M., M.M.B., K.P.G., M.E.F.), Center for Biostatistics and Data Science (J.W.), Department of Neurology (K.P.G., J.B.L., A.L.F., J.-M.L., M.E.F.), Mallinckrodt Institute of Radiology (K.P.G., A.L.F., J.S.S., H.A., J.-M.L.), and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Josiah B Lewis
- From the Department of Pediatrics (L.C.P., A.E.M., M.M.B., K.P.G., M.E.F.), Center for Biostatistics and Data Science (J.W.), Department of Neurology (K.P.G., J.B.L., A.L.F., J.-M.L., M.E.F.), Mallinckrodt Institute of Radiology (K.P.G., A.L.F., J.S.S., H.A., J.-M.L.), and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Andria L Ford
- From the Department of Pediatrics (L.C.P., A.E.M., M.M.B., K.P.G., M.E.F.), Center for Biostatistics and Data Science (J.W.), Department of Neurology (K.P.G., J.B.L., A.L.F., J.-M.L., M.E.F.), Mallinckrodt Institute of Radiology (K.P.G., A.L.F., J.S.S., H.A., J.-M.L.), and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Joshua S Shimony
- From the Department of Pediatrics (L.C.P., A.E.M., M.M.B., K.P.G., M.E.F.), Center for Biostatistics and Data Science (J.W.), Department of Neurology (K.P.G., J.B.L., A.L.F., J.-M.L., M.E.F.), Mallinckrodt Institute of Radiology (K.P.G., A.L.F., J.S.S., H.A., J.-M.L.), and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Hongyu An
- From the Department of Pediatrics (L.C.P., A.E.M., M.M.B., K.P.G., M.E.F.), Center for Biostatistics and Data Science (J.W.), Department of Neurology (K.P.G., J.B.L., A.L.F., J.-M.L., M.E.F.), Mallinckrodt Institute of Radiology (K.P.G., A.L.F., J.S.S., H.A., J.-M.L.), and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Jin-Moo Lee
- From the Department of Pediatrics (L.C.P., A.E.M., M.M.B., K.P.G., M.E.F.), Center for Biostatistics and Data Science (J.W.), Department of Neurology (K.P.G., J.B.L., A.L.F., J.-M.L., M.E.F.), Mallinckrodt Institute of Radiology (K.P.G., A.L.F., J.S.S., H.A., J.-M.L.), and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Melanie E Fields
- From the Department of Pediatrics (L.C.P., A.E.M., M.M.B., K.P.G., M.E.F.), Center for Biostatistics and Data Science (J.W.), Department of Neurology (K.P.G., J.B.L., A.L.F., J.-M.L., M.E.F.), Mallinckrodt Institute of Radiology (K.P.G., A.L.F., J.S.S., H.A., J.-M.L.), and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
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Brothers RO, Turrentine KB, Akbar M, Triplett S, Zhao H, Urner TM, Goldman-Yassen A, Jones RA, Knight-Scott J, Milla SS, Bai S, Tang A, Brown RC, Buckley EM. The influence of voxelotor on cerebral blood flow and oxygen extraction in pediatric sickle cell disease. Blood 2024; 143:2145-2151. [PMID: 38364110 DOI: 10.1182/blood.2023022011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
ABSTRACT Voxelotor is an inhibitor of sickle hemoglobin polymerization that is used to treat sickle cell disease. Although voxelotor has been shown to improve anemia, the clinical benefit on the brain remains to be determined. This study quantified the cerebral hemodynamic effects of voxelotor in children with sickle cell anemia (SCA) using noninvasive diffuse optical spectroscopies. Specifically, frequency-domain near-infrared spectroscopy combined with diffuse correlation spectroscopy were used to noninvasively assess regional oxygen extraction fraction (OEF), cerebral blood volume, and an index of cerebral blood flow (CBFi). Estimates of CBFi were first validated against arterial spin-labeled magnetic resonance imaging (ASL-MRI) in 8 children with SCA aged 8 to 18 years. CBFi was significantly positively correlated with ASL-MRI-measured blood flow (R2 = 0.651; P = .015). Next, a single-center, open-label pilot study was completed in 8 children with SCA aged 4 to 17 years on voxelotor, monitored before treatment initiation and at 4, 8, and 12 weeks (NCT05018728). By 4 weeks, both OEF and CBFi significantly decreased, and these decreases persisted to 12 weeks (both P < .05). Decreases in CBFi were significantly correlated with increases in blood hemoglobin (Hb) concentration (P = .025), whereas the correlation between decreases in OEF and increases in Hb trended toward significance (P = .12). Given that previous work has shown that oxygen extraction and blood flow are elevated in pediatric SCA compared with controls, these results suggest that voxelotor may reduce cerebral hemodynamic impairments. This trial was registered at www.ClinicalTrials.gov as #NCT05018728.
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Affiliation(s)
- Rowan O Brothers
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Katherine B Turrentine
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Mariam Akbar
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Sydney Triplett
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Hongting Zhao
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Tara M Urner
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Adam Goldman-Yassen
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta and Emory University, Atlanta, GA
| | - Richard A Jones
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Jack Knight-Scott
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Sarah S Milla
- Department of Pediatric Radiology, Children's Hospital Colorado, Aurora, CO
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Shasha Bai
- Pediatric Biostatistics Core, Emory University School of Medicine, Atlanta, GA
| | - Amy Tang
- Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - R Clark Brown
- Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Erin M Buckley
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
- Department of Pediatrics, Emory University, Atlanta, GA
- Children's Research Scholar, Children's Healthcare of Atlanta, Atlanta, GA
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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 2024:271678X241237072. [PMID: 38436254 DOI: 10.1177/0271678x241237072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 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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Le LNN, Wheeler GJ, Holy EN, Donnay CA, Blockley NP, Yee AH, Ng KL, Fan AP. Cortical oxygen extraction fraction using quantitative BOLD MRI and cerebral blood flow during vasodilation. Front Physiol 2023; 14:1231793. [PMID: 37869717 PMCID: PMC10588655 DOI: 10.3389/fphys.2023.1231793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction: We aimed to demonstrate non-invasive measurements of regional oxygen extraction fraction (OEF) from quantitative BOLD MRI modeling at baseline and after pharmacological vasodilation. We hypothesized that OEF decreases in response to vasodilation with acetazolamide (ACZ) in healthy conditions, reflecting compensation in regions with increased cerebral blood flow (CBF), while cerebral metabolic rate of oxygen (CMRO2) remained unchanged. We also aimed to assess the relationship between OEF and perfusion in the default mode network (DMN) regions that have shown associations with vascular risk factors and cerebrovascular reactivity in different neurological conditions. Material and methods: Eight healthy subjects (47 ± 13 years, 6 female) were scanned on a 3 T scanner with a 32-channel head coil before and after administration of 15 mg/kg ACZ as a pharmacological vasodilator. The MR imaging acquisition protocols included: 1) A Gradient Echo Slice Excitation Profile Imaging Asymmetric Spin Echo scan to quantify OEF, deoxygenated blood volume, and reversible transverse relaxation rate (R2 ') and 2) a multi-post labeling delay arterial spin labeling scan to measure CBF. To assess changes in each parameter due to vasodilation, two-way t-tests were performed for all pairs (baseline versus vasodilation) in the DMN brain regions with Bonferroni correction for multiple comparisons. The relationships between CBF versus OEF and CBF versus R2' were analyzed and compared across DMN regions using linear, mixed-effect models. Results: During vasodilation, CBF significantly increased in the medial frontal cortex (P = 0.004 ), posterior cingulate gyrus (pCG) (P = 0.004 ), precuneus cortex (PCun) (P = 0.004 ), and occipital pole (P = 0.001 ). Concurrently, a significant decrease in OEF was observed only in the pCG (8.8%, P = 0.003 ) and PCun (8.7 % , P = 0.001 ). CMRO2 showed a trend of increased values after vasodilation, but these differences were not significant after correction for multiple comparisons. Although R2' showed a slightly decreasing trend, no statistically significant changes were found in any regions in response to ACZ. The CBF response to ACZ exhibited a stronger negative correlation with OEF (β = - 0.104 ± 0.027 ; t = - 3.852 , P < 0.001 ), than with R2' (β = - 0.016 ± 0.006 ; t = - 2.692 , P = 0.008 ). Conclusion: Quantitative BOLD modeling can reliably measure OEF across multiple physiological conditions and captures vascular changes with higher sensitivity than R2' values. The inverse correlation between OEF and CBF across regions in DMN, suggests that these two measurements, in response to ACZ vasodilation, are reliable indicators of tissue health in this healthy cohort.
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Affiliation(s)
- Linh N. N. Le
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, United States
| | - Gregory J. Wheeler
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, United States
| | - Emily N. Holy
- Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Corinne A. Donnay
- Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Nicholas P. Blockley
- School of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Alan H. Yee
- Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Kwan L. Ng
- Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Audrey P. Fan
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, United States
- Department of Neurology, University of California, Davis, Davis, CA, United States
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Karkoska KA, Gollamudi J, Hyacinth HI. Molecular and environmental contributors to neurological complications in sickle cell disease. Exp Biol Med (Maywood) 2023; 248:1319-1332. [PMID: 37688519 PMCID: PMC10625341 DOI: 10.1177/15353702231187646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy in which affected hemoglobin polymerizes under hypoxic conditions resulting in red cell distortion and chronic hemolytic anemia. SCD affects millions of people worldwide, primarily in Sub-Saharan Africa and the Indian subcontinent. Due to vaso-occlusion of sickled red cells within the microvasculature, SCD affects virtually every organ system and causes significant morbidity and early mortality. The neurological complications of SCD are particularly devastating and diverse, ranging from overt stroke to covert cerebral injury, including silent cerebral infarctions and blood vessel tortuosity. However, even individuals without evidence of neuroanatomical changes in brain imaging have evidence of cognitive deficits compared to matched healthy controls likely due to chronic cerebral hypoxemia and neuroinflammation. In this review, we first examined the biological contributors to SCD-related neurological complications and then discussed the equally important socioenvironmental contributors. We then discuss the evidence for neuroprotection from the two primary disease-modifying therapies, chronic monthly blood transfusions and hydroxyurea, and end with several experimental therapies designed to specifically target these complications.
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Affiliation(s)
- Kristine A Karkoska
- Division of Hematology & Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45219-0525, USA
| | - Jahnavi Gollamudi
- Division of Hematology & Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45219-0525, USA
| | - Hyacinth I Hyacinth
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0525, USA
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Chen Y, Wang Y, Phuah CL, Fields ME, Guilliams KP, Fellah S, Reis MN, Binkley MM, An H, Lee JM, McKinstry RC, Jordan LC, DeBaun MR, Ford AL. Toward Automated Detection of Silent Cerebral Infarcts in Children and Young Adults With Sickle Cell Anemia. Stroke 2023; 54:2096-2104. [PMID: 37387218 PMCID: PMC10526691 DOI: 10.1161/strokeaha.123.042683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Silent cerebral infarcts (SCI) in sickle cell anemia (SCA) are associated with future strokes and cognitive impairment, warranting early diagnosis and treatment. Detection of SCI, however, is limited by their small size, especially when neuroradiologists are unavailable. We hypothesized that deep learning may permit automated SCI detection in children and young adults with SCA as a tool to identify the presence and extent of SCI in clinical and research settings. METHODS We utilized UNet-a deep learning model-for fully automated SCI segmentation. We trained and optimized UNet using brain magnetic resonance imaging from the SIT trial (Silent Infarct Transfusion). Neuroradiologists provided the ground truth for SCI diagnosis, while a vascular neurologist manually delineated SCI on fluid-attenuated inversion recovery and provided the ground truth for SCI segmentation. UNet was optimized for the highest spatial overlap between automatic and manual delineation (dice similarity coefficient). The optimized UNet was externally validated using an independent single-center prospective cohort of SCA participants. Model performance was evaluated through sensitivity and accuracy (%correct cases) for SCI diagnosis, dice similarity coefficient, intraclass correlation coefficient (metric of volumetric agreement), and Spearman correlation. RESULTS The SIT trial (n=926; 31% with SCI; median age, 8.9 years) and external validation (n=80; 50% with SCI; age, 11.5 years) cohorts had small median lesion volumes of 0.40 and 0.25 mL, respectively. Compared with the neuroradiology diagnosis, UNet predicted SCI presence with 100% sensitivity and 74% accuracy. In magnetic resonance imaging with SCI, UNet reached a moderate spatial agreement (dice similarity coefficient, 0.48) and high volumetric agreement (intraclass correlation coefficient, 0.76; ρ=0.72; P<0.001) between automatic and manual segmentations. CONCLUSIONS UNet, trained using a large pediatric SCA magnetic resonance imaging data set, sensitively detected small SCI in children and young adults with SCA. While additional training is needed, UNet may be integrated into the clinical workflow as a screening tool, aiding in SCI diagnosis.
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Affiliation(s)
- Yasheng Chen
- Department of Neurology (Y.C., Y.W., C.-L.P., S.F., M.M.B., H.A., J.-M.L., A.L.F.), Washington University School of Medicine, St. Louis, MO
| | - Yan Wang
- Department of Neurology (Y.C., Y.W., C.-L.P., S.F., M.M.B., H.A., J.-M.L., A.L.F.), Washington University School of Medicine, St. Louis, MO
| | - Chia-Ling Phuah
- Department of Neurology (Y.C., Y.W., C.-L.P., S.F., M.M.B., H.A., J.-M.L., A.L.F.), Washington University School of Medicine, St. Louis, MO
| | - Melanie E Fields
- Division of Pediatric Hematology/Oncology (M.E.F.), Washington University School of Medicine, St. Louis, MO
| | - Kristin P Guilliams
- Division of Pediatric Neurology (K.P.G.), Washington University School of Medicine, St. Louis, MO
| | - Slim Fellah
- Department of Neurology (Y.C., Y.W., C.-L.P., S.F., M.M.B., H.A., J.-M.L., A.L.F.), Washington University School of Medicine, St. Louis, MO
| | - Martin N Reis
- Mallinckrodt Institute of Radiology (M.N.R., H.A., J.-M.L., R.C.M., A.L.F.), Washington University School of Medicine, St. Louis, MO
| | - Michael M Binkley
- Department of Neurology (Y.C., Y.W., C.-L.P., S.F., M.M.B., H.A., J.-M.L., A.L.F.), Washington University School of Medicine, St. Louis, MO
| | - Hongyu An
- Department of Neurology (Y.C., Y.W., C.-L.P., S.F., M.M.B., H.A., J.-M.L., A.L.F.), Washington University School of Medicine, St. Louis, MO
- Mallinckrodt Institute of Radiology (M.N.R., H.A., J.-M.L., R.C.M., A.L.F.), Washington University School of Medicine, St. Louis, MO
| | - Jin-Moo Lee
- Department of Neurology (Y.C., Y.W., C.-L.P., S.F., M.M.B., H.A., J.-M.L., A.L.F.), Washington University School of Medicine, St. Louis, MO
- Mallinckrodt Institute of Radiology (M.N.R., H.A., J.-M.L., R.C.M., A.L.F.), Washington University School of Medicine, St. Louis, MO
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology (M.N.R., H.A., J.-M.L., R.C.M., A.L.F.), Washington University School of Medicine, St. Louis, MO
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University of Medicine, Nashville, TN (L.C.J.)
| | - Michael R DeBaun
- Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN (M.R.D.)
| | - Andria L Ford
- Department of Neurology (Y.C., Y.W., C.-L.P., S.F., M.M.B., H.A., J.-M.L., A.L.F.), Washington University School of Medicine, St. Louis, MO
- Mallinckrodt Institute of Radiology (M.N.R., H.A., J.-M.L., R.C.M., A.L.F.), Washington University School of Medicine, St. Louis, MO
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Jones RS, Donahue MJ, Davis LT, Pruthi S, Waddle SL, Custer C, Patel NJ, DeBaun MR, Kassim AA, Rodeghier M, Jordan LC. Silent infarction in sickle cell disease is associated with brain volume loss in excess of infarct volume. Front Neurol 2023; 14:1112865. [PMID: 37064181 PMCID: PMC10102616 DOI: 10.3389/fneur.2023.1112865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/10/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction Sickle cell disease (SCD) increases cerebral infarct risk, but reported effects on brain volume have varied. More detailed information using larger cohorts and contemporary methods could motivate the use of longitudinal brain volume assessment in SCD as an automated marker of disease stability or future progression. The purpose of this study was to rigorously evaluate whether children and young adults with SCD have reduced gray matter volume (GMV) and white matter volume (WMV) compared to healthy controls using high-resolution MRI. We tested the hypotheses that (i) elevated CBF, a marker of cerebral hemodynamic compensation in SCD, is associated with global and regional brain atrophy, and (ii) silent cerebral infarct burden is associated with brain atrophy in excess of infarct volume. Methods Healthy controls (n = 49) and SCD participants without overt stroke (n = 88) aged 7-32 years completed 3 T brain MRI; pseudocontinuous arterial spin labeling measured CBF. Multivariable linear regressions assessed associations of independent variables with GMV, WMV, and volumes of cortical/subcortical regions. Results Reduced hemoglobin was associated with reductions in both GMV (p = 0.032) and WMV (p = 0.005); reduced arterial oxygen content (CaO2) was also associated with reductions in GMV (p = 0.035) and WMV (p = 0.006). Elevated gray matter CBF was associated with reduced WMV (p = 0.018). Infarct burden was associated with reductions in WMV 30-fold greater than the infarct volume itself (p = 0.005). Increased GM CBF correlated with volumetric reductions of the insula and left and right caudate nuclei (p = 0.017, 0.017, 0.036, respectively). Infarct burden was associated with reduced left and right nucleus accumbens, right thalamus, and anterior corpus callosum volumes (p = 0.002, 0.002, 0.009, 0.002, respectively). Discussion We demonstrate that anemia and decreased CaO2 are associated with reductions in GMV and WMV in SCD. Increased CBF and infarct burden were also associated with reduced volume in subcortical structures. Global WMV deficits associated with infarct burden far exceed infarct volume itself. Hemodynamic compensation via increased cerebral blood flow in SCD seems inadequate to prevent brain volume loss. Our work highlights that silent cerebral infarcts are just a portion of the brain injury that occurs in SCD; brain volume is another potential biomarker of brain injury in SCD.
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Affiliation(s)
- R. Sky Jones
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Manus J. Donahue
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, United States
| | - L. Taylor Davis
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sumit Pruthi
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Spencer L. Waddle
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Chelsea Custer
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Niral J. Patel
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Michael R. DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Nashville, TN, United States
| | - Adetola A. Kassim
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Lori C. Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
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8
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Li H, Wang C, Yu X, Luo Y, Wang H. Measurement of Cerebral Oxygen Extraction Fraction Using Quantitative BOLD Approach: A Review. PHENOMICS (CHAM, SWITZERLAND) 2023; 3:101-118. [PMID: 36939794 PMCID: PMC9883382 DOI: 10.1007/s43657-022-00081-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
Quantification of brain oxygenation and metabolism, both of which are indicators of the level of brain activity, plays a vital role in understanding the cerebral perfusion and the pathophysiology of brain disorders. Magnetic resonance imaging (MRI), a widely used clinical imaging technique, which is very sensitive to magnetic susceptibility, has the possibility of substituting positron emission tomography (PET) in measuring oxygen metabolism. This review mainly focuses on the quantitative blood oxygenation level-dependent (qBOLD) method for the evaluation of oxygen extraction fraction (OEF) in the brain. Here, we review the theoretic basis of qBOLD, as well as existing acquisition and quantification methods. Some published clinical studies are also presented, and the pros and cons of qBOLD method are discussed as well.
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Affiliation(s)
- Hongwei Li
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433 China
| | - Chengyan Wang
- Human Phenome Institute, Fudan University, Shanghai, 201203 China
| | - Xuchen Yu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433 China
| | - Yu Luo
- Department of Radiology, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200434 China
| | - He Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433 China
- Human Phenome Institute, Fudan University, Shanghai, 201203 China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, (Fudan University), Ministry of Education, Shanghai, 200433 China
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9
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Ramos K, Guilliams KP, Fields ME. The Development of Neuroimaging Biomarkers for Cognitive Decline in Sickle Cell Disease. Hematol Oncol Clin North Am 2022; 36:1167-1186. [PMID: 36400537 PMCID: PMC9973749 DOI: 10.1016/j.hoc.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sickle cell disease (SCD) is complicated by neurologic complications including vasculopathy, hemorrhagic or ischemic overt stroke, silent cerebral infarcts and cognitive dysfunction. Patients with SCD, even in the absence of vasculopathy or stroke, have experience cognitive dysfunction that progresses with age. Transcranial Doppler ultrasound and structural brain MRI are currently used for primary and secondary stroke prevention, but laboratory or imaging biomarkers do not currently exist that are specific to the risk of cognitive dysfunction in patients with SCD. Recent investigations have used advanced MR sequences assessing cerebral hemodynamics, white matter microstructure and functional connectivity to better understand the pathophysiology of cognitive decline in SCD, with the long-term goal of developing neuroimaging biomarkers to be used in risk prediction algorithms and to assess the efficacy of treatment options for patients with SCD.
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Affiliation(s)
- Kristie Ramos
- Department of Pediatrics, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Kristin P Guilliams
- Department of Pediatrics, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA; Department of Neurology, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Melanie E Fields
- Department of Pediatrics, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA; Department of Neurology, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
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10
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González-Zacarías C, Choi S, Vu C, Xu B, Shen J, Joshi AA, Leahy RM, Wood JC. Chronic anemia: The effects on the connectivity of white matter. Front Neurol 2022; 13:894742. [PMID: 35959402 PMCID: PMC9362738 DOI: 10.3389/fneur.2022.894742] [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: 03/12/2022] [Accepted: 06/29/2022] [Indexed: 01/26/2023] Open
Abstract
Chronic anemia is commonly observed in patients with hemoglobinopathies, mainly represented by disorders of altered hemoglobin (Hb) structure (sickle cell disease, SCD) and impaired Hb synthesis (e.g. thalassemia syndromes, non-SCD anemia). Both hemoglobinopathies have been associated with white matter (WM) alterations. Novel structural MRI research in our laboratory demonstrated that WM volume was diffusely lower in deep, watershed areas proportional to anemia severity. Furthermore, diffusion tensor imaging analysis has provided evidence that WM microstructure is disrupted proportionally to Hb level and oxygen saturation. SCD patients have been widely studied and demonstrate lower fractional anisotropy (FA) in the corticospinal tract and cerebellum across the internal capsule and corpus callosum. In the present study, we compared 19 SCD and 15 non-SCD anemia patients with a wide range of Hb values allowing the characterization of the effects of chronic anemia in isolation of sickle Hb. We performed a tensor analysis to quantify FA changes in WM connectivity in chronic anemic patients. We calculated the volumetric mean of FA along the pathway of tracks connecting two regions of interest defined by BrainSuite's BCI-DNI atlas. In general, we found lower FA values in anemic patients; indicating the loss of coherence in the main diffusion direction that potentially indicates WM injury. We saw a positive correlation between FA and hemoglobin in these same regions, suggesting that decreased WM microstructural integrity FA is highly driven by chronic hypoxia. The only connection that did not follow this pattern was the connectivity within the left middle-inferior temporal gyrus. Interestingly, more reductions in FA were observed in non-SCD patients (mainly along with intrahemispheric WM bundles and watershed areas) than the SCD patients (mainly interhemispheric).
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Affiliation(s)
- Clio González-Zacarías
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States,Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States,Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States,Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States,Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Chau Vu
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Botian Xu
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Jian Shen
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Anand A. Joshi
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States
| | - Richard M. Leahy
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - John C. Wood
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States,*Correspondence: John C. Wood
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11
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Stotesbury H, Kawadler JM, Clayden JD, Saunders DE, Hood AM, Koelbel M, Sahota S, Rees DC, Wilkey O, Layton M, Pelidis M, Inusa BPD, Howard J, Chakravorty S, Clark CA, Kirkham FJ. Quantification of Silent Cerebral Infarction on High-Resolution FLAIR and Cognition in Sickle Cell Anemia. Front Neurol 2022; 13:867329. [PMID: 35847220 PMCID: PMC9277177 DOI: 10.3389/fneur.2022.867329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/27/2022] [Indexed: 01/18/2023] Open
Abstract
Research in sickle cell anemia (SCA) has used, with limited race-matched control data, binary categorization of patients according to the presence or absence of silent cerebral infarction (SCI). SCI have primarily been identified using low-resolution MRI, with radiological definitions varying in lesion length and the requirement for abnormality on both fluid attenuated inversion recovery (FLAIR) and T1-weighted images. We aimed to assess the effect of published SCI definitions on global, regional, and lobar lesion metrics and their value in predicting cognition. One hundred and six patients with SCA and 48 controls aged 8-30 years underwent 3T MRI with a high-resolution FLAIR sequence and Wechsler cognitive assessment. Prevalence, number, and volume of lesions were calculated using a semi-automated pipeline for SCI defined as: (1) Liberal: any length (L-SCI); (2) Traditional: >3 mm in greatest dimension (T-SCI); (3) Restrictive; >3 mm in greatest dimension with a corresponding T1-weighted hypo-intensity (R-SCI). Globally, as hypothesized, there were large effects of SCI definition on lesion metrics in patients and controls, with prevalence varying from 24-42% in patients, and 4-23% in controls. However, contrary to hypotheses, there was no effect of any global metric on cognition. Regionally, there was a consistent distribution of SCI in frontal and parietal deep and juxta-cortical regions across definitions and metrics in patients, but no consistent distribution in controls. Effects of regional SCI metrics on cognitive performance were of small magnitude; some were paradoxical. These findings expose the challenges associated with the widespread use of SCI presence as a biomarker of white-matter injury and cognitive dysfunction in cross-sectional high-resolution MRI studies in patients with SCA. The findings indicate that with high-resolution MRI: (1) radiological definitions have a large effect on resulting lesion groups, numbers, and volumes; (2) there is a non-negligible prevalence of lesions in young healthy controls; and (3) at the group-level, there is no cross-sectional association between global lesion metrics and general cognitive impairment irrespective of lesion definition and metric. With high-resolution multi-modal MRI, the dichotomy of presence or absence of SCI does not appear to be a sensitive biomarker for the detection of functionally significant pathology; the search for appropriate endpoints for clinical treatment trials should continue.
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Affiliation(s)
- Hanne Stotesbury
- 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
| | - Jonathan D Clayden
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Dawn E Saunders
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Anna M Hood
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Melanie Koelbel
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sati Sahota
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | - Olu Wilkey
- North Middlesex University Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Layton
- Haematology, Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
| | - Maria Pelidis
- Department of Haematology and Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baba P D Inusa
- Department of Haematology and Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jo Howard
- Department of Haematology and Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Chris 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
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12
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Stotesbury H, Hales PW, Koelbel M, Hood AM, Kawadler JM, Saunders DE, Sahota S, Rees DC, Wilkey O, Layton M, Pelidis M, Inusa BPD, Howard J, Chakravorty S, Clark CA, Kirkham FJ. Venous cerebral blood flow quantification and cognition in patients with sickle cell anemia. J Cereb Blood Flow Metab 2022; 42:1061-1077. [PMID: 34986673 PMCID: PMC9121533 DOI: 10.1177/0271678x211072391] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 12/28/2022]
Abstract
Prior studies have described high venous signal qualitatively using arterial spin labelling (ASL) in patients with sickle cell anemia (SCA), consistent with arteriovenous shunting. We aimed to quantify the effect and explored cross-sectional associations with arterial oxygen content (CaO2), disease-modifying treatments, silent cerebral infarction (SCI), and cognitive performance. 94 patients with SCA and 42 controls underwent cognitive assessment and MRI with single- and multi- inflow time (TI) ASL sequences. Cerebral blood flow (CBF) and bolus arrival time (BAT) were examined across gray and white matter and high-signal regions of the sagittal sinus. Across gray and white matter, increases in CBF and reductions in BAT were observed in association with reduced CaO2 in patients, irrespective of sequence. Across high-signal sagittal sinus regions, CBF was also increased in association with reduced CaO2 using both sequences. However, BAT was increased rather than reduced in patients across these regions, with no association with CaO2. Using the multiTI sequence in patients, increases in CBF across white matter and high-signal sagittal sinus regions were associated with poorer cognitive performance. These novel findings highlight the utility of multiTI ASL in illuminating, and identifying objectively quantifiable and functionally significant markers of, regional hemodynamic stress in patients with SCA.
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Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Patrick W Hales
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Melanie Koelbel
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Anna M Hood
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Dawn E Saunders
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Sati Sahota
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - David C Rees
- Radiology, Great Ormond Hospital for Children NHS Trust, London, UK
| | | | - Mark Layton
- North Middlesex University Hospital NHS Foundation Trust, London, UK
| | - Maria Pelidis
- Haematology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Baba PD Inusa
- Haematology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jo Howard
- Haematology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | | | - Chris A Clark
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
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13
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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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14
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Jiang D, Lu H. Cerebral oxygen extraction fraction MRI: Techniques and applications. Magn Reson Med 2022; 88:575-600. [PMID: 35510696 PMCID: PMC9233013 DOI: 10.1002/mrm.29272] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/20/2022] [Accepted: 03/29/2022] [Indexed: 12/20/2022]
Abstract
The human brain constitutes 2% of the body's total mass but uses 20% of the oxygen. The rate of the brain's oxygen utilization can be derived from a knowledge of cerebral blood flow and the oxygen extraction fraction (OEF). Therefore, OEF is a key physiological parameter of the brain's function and metabolism. OEF has been suggested to be a useful biomarker in a number of brain diseases. With recent advances in MRI techniques, several MRI-based methods have been developed to measure OEF in the human brain. These MRI OEF techniques are based on the T2 of blood, the blood signal phase, the magnetic susceptibility of blood-containing voxels, the effect of deoxyhemoglobin on signal behavior in extravascular tissue, and the calibration of the BOLD signal using gas inhalation. Compared to 15 O PET, which is considered the "gold standard" for OEF measurement, MRI-based techniques are non-invasive, radiation-free, and are more widely available. This article provides a review of these emerging MRI-based OEF techniques. We first briefly introduce the role of OEF in brain oxygen homeostasis. We then review the methodological aspects of different categories of MRI OEF techniques, including their signal mechanisms, acquisition methods, and data analyses. The strengths and limitations of the techniques are discussed. Finally, we review key applications of these techniques in physiological and pathological conditions.
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Affiliation(s)
- Dengrong Jiang
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Maryland, USA
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15
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Stotesbury H, Hales PW, Hood AM, Koelbel M, Kawadler JM, Saunders DE, Sahota S, Rees DC, Wilkey O, Layton M, Pelidis M, Inusa BPD, Howard J, Chakravorty S, Clark CA, Kirkham FJ. Individual Watershed Areas in Sickle Cell Anemia: An Arterial Spin Labeling Study. Front Physiol 2022; 13:865391. [PMID: 35592036 PMCID: PMC9110791 DOI: 10.3389/fphys.2022.865391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/22/2022] [Indexed: 12/25/2022] Open
Abstract
Previous studies have pointed to a role for regional cerebral hemodynamic stress in neurological complications in patients with sickle cell anemia (SCA), with watershed regions identified as particularly at risk of ischemic tissue injury. Using single- and multi-inflow time (TI) arterial spin labeling sequences (ASL) in 94 patients with SCA and 42 controls, the present study sought to investigate cerebral blood flow (CBF) and bolus arrival times (BAT) across gray matter, white matter with early arrival times, and in individual watershed areas (iWSAs). In iWSAs, associations between hemodynamic parameters, lesion burden, white matter integrity, and general cognitive performance were also explored. In patients, increases in CBF and reductions in BAT were observed in association with reduced arterial oxygen content across gray matter and white matter with early arrival times using both sequences (all p < 0.001, d = -1.55--2.21). Across iWSAs, there was a discrepancy between sequences, with estimates based on the single-TI sequence indicating higher CBF in association with reduced arterial oxygen content in SCA patients, and estimates based on the multi-TI sequence indicating no significant between-group differences or associations with arterial oxygen content. Lesion burden was similar between white matter with early arrival times and iWSAs in both patients and controls, and using both sequences, only trend-level associations between iWSA CBF and iWSA lesion burden were observed in patients. Further, using the multi-TI sequence in patients, increased iWSA CBF was associated with reduced iWSA microstructural tissue integrity and slower processing speed. Taken together, the results highlight the need for researchers to consider BAT when estimating CBF using single-TI sequences. Moreover, the findings demonstrate the feasibility of multi-TI ASL for objective delineation of iWSAs and for detection of regional hemodynamic stress that is associated with reduced microstructural tissue integrity and slower processing speed. This technique may hold promise for future studies and treatment trials.
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Affiliation(s)
- Hanne Stotesbury
- Imaging and Biophysics Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Patrick W. Hales
- Imaging and Biophysics Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Anna M. Hood
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Melanie Koelbel
- Imaging and Biophysics Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Jamie M. Kawadler
- Imaging and Biophysics Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Dawn E. Saunders
- Radiology, Great Ormond Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Sati Sahota
- Imaging and Biophysics Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - David C. Rees
- Paediatric Haematology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Olu Wilkey
- Paediatric Haematology and Oncology, North Middlesex University Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Layton
- Haematology, Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
| | - Maria Pelidis
- Department of Haematology and Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Baba P. D. Inusa
- Department of Haematology and Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jo Howard
- Department of Haematology and Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Subarna Chakravorty
- Paediatric Haematology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Chris A. Clark
- Imaging and Biophysics Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Fenella J. Kirkham
- Clinical Neurosciences Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
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Leigh R, Luby M. Not-So-Normal-Appearing White Matter. Neurology 2021; 97:409-410. [PMID: 34172538 DOI: 10.1212/wnl.0000000000012405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Richard Leigh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD .,National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Marie Luby
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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