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Amemiya S, Takao H, Abe O. Resting-State fMRI: Emerging Concepts for Future Clinical Application. J Magn Reson Imaging 2024; 59:1135-1148. [PMID: 37424140 DOI: 10.1002/jmri.28894] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023] Open
Abstract
Resting-state functional magnetic resonance imaging (rsfMRI) has been developed as a method of investigating spontaneous neural activity. Based on its low-frequency signal synchronization, rsfMRI has made it possible to identify multiple macroscopic structures termed resting-state networks (RSNs) on a single scan of less than 10 minutes. It is easy to implement even in clinical practice, in which assigning tasks to patients can be challenging. These advantages have accelerated the adoption and growth of rsfMRI. Recently, studies on the global rsfMRI signal have attracted increasing attention. Because it primarily arises from physiological events, less attention has hitherto been paid to the global signal than to the local network (i.e., RSN) component. However, the global signal is not a mere nuisance or a subsidiary component. On the contrary, it is quantitatively the dominant component that accounts for most of the variance in the rsfMRI signal throughout the brain and provides rich information on local hemodynamics that can serve as an individual-level diagnostic biomarker. Moreover, spatiotemporal analyses of the global signal have revealed that it is closely and fundamentally associated with the organization of RSNs, thus challenging the basic assumptions made in conventional rsfMRI analyses and views on RSNs. This review introduces new concepts emerging from rsfMRI spatiotemporal analyses focusing on the global signal and discusses how they may contribute to future clinical medicine. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Shiori Amemiya
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hidemasa Takao
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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2
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Roberts R, Hadi M, Ram C, Affan M. What the Diagnostic Neuroradiologist Needs to Know About Diseases of the Cerebral Veins. Semin Roentgenol 2024; 59:172-190. [PMID: 38880516 DOI: 10.1053/j.ro.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Rebecca Roberts
- Department of Neurology, University of Minnesota, Minneapolis, MN
| | - Mohiuddin Hadi
- Department of Radiology, University of Louisville, Louisville, KY
| | - Chithra Ram
- Department of Radiology, University of Louisville, Louisville, KY
| | - Muhammad Affan
- Department of Neurology, University of Minnesota, Minneapolis, MN.
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3
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Banerjee S, Banerjee S. Amyloid Beta-Mediated Neurovascular Toxicity in Alzheimer's Disease. Methods Mol Biol 2024; 2761:355-372. [PMID: 38427250 DOI: 10.1007/978-1-0716-3662-6_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The brain vascular system receives one-fifth of the total oxygen from the cardiac output, and this transport system is highly dependent on blood-brain barrier (BBB) integrity. The cerebral blood flow is controlled by neurovascular coupling through neurovascular units (NVUs). The NVU includes different types of cells, such as mural cells, astrocytes, pericytes, endothelial cells (ECs), and vascular smooth muscle cells (VSMCs). The cellular composition of NVU varies throughout the vascular tree. Amyloid β (Aβ) is abundantly present in the central nervous system, but the pathological accumulation of misfolded Aβ protein causes vascular damage, resulting in neurovascular dysfunction. Aβ aggregation can activate the astrocytes and endothelial cells. It is followed by pericyte degeneration which results in dysregulation of cerebral blood flow (CBF), neurovascular uncoupling, and BBB breakdown. Thus, understanding the cellular and molecular mechanisms of Aβ-induced neurovascular toxicity is crucial for determining normal and diseased brain function. This chapter discusses the components of NVU, neurovascular uncoupling, Aβ-induced cerebrovascular reactivity, and cerebral blood flow reduction in neurodegenerative disorders, with special emphasis on Alzheimer's disease.
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Affiliation(s)
- Sayani Banerjee
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Kolkata, India
| | - Sugato Banerjee
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Kolkata, India
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Raghavan V, Sobczyk O, Sayin ES, Poublanc J, Skanda A, Duffin J, Venkatraghavan L, Fisher JA, Mikulis DJ. Assessment of Cerebrovascular Reactivity Using CO 2 -BOLD MRI: A 15-Year, Single Center Experience. J Magn Reson Imaging 2023. [PMID: 38135486 DOI: 10.1002/jmri.29176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Cerebrovascular reactivity (CVR) is a measure of the change in cerebral blood flow (CBF) in response to a vasoactive challenge. It is a useful indicator of the brain's vascular health. PURPOSE To evaluate the factors that influence successful and unsuccessful CVR examinations using precise arterial and end-tidal partial pressure of CO2 control during blood oxygen level-dependent (BOLD) MRI. STUDY TYPE Retrospective. SUBJECTS Patients that underwent a CVR between October 2005 and May 2021 were studied (total of 1162 CVR examinations). The mean (±SD) age was 46.1 (±18.8) years, and 352 patients (43%) were female. FIELD STRENGTH/SEQUENCE 3 T; T1-weighted images, T2*-weighed two-dimensional gradient-echo sequence with standard echo-planar readout. ASSESSMENT Measurements were obtained following precise hypercapnic stimuli using BOLD MRI as a surrogate of CBF. Successful CVR examinations were defined as those where: 1) patients were able to complete CVR testing, and 2) a clinically useful CVR map was generated. Unsuccessful examinations were defined as those where patients were not able to complete the CVR examination or the CVR maps were judged to be unreliable due to, for example, excessive head motion, and poor PET CO2 targeting. STATISTICAL ANALYSIS Successful and unsuccessful CVR examinations between hypercapnic stimuli, and between different patterns of stimulus were compared with Chi-Square tests. Interobserver variability was determined by using the intraclass correlation coefficient (P < 0.05 is significant). RESULTS In total 1115 CVR tests in 662 patients were included in the final analysis. The success rate of generating CVR maps was 90.8% (1012 of 1115). Among the different hypercapnic stimuli, those containing a step plus a ramp protocol was the most successful (95.18%). Among the unsuccessful examinations (9.23%), most were patient related (89.3%), the most common of which was difficulty breathing. DATA CONCLUSION CO2 -BOLD MRI CVR studies are well tolerated with a high success rate. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Vishvak Raghavan
- School of Computer Science, McGill University, Montreal, Quebec, Canada
| | - Olivia Sobczyk
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada
| | - Ece Su Sayin
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada
| | - Abby Skanda
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Lashmi Venkatraghavan
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Joseph A Fisher
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada
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Voets NL, Bartsch AJ, Plaha P. Functional MRI applications for intra-axial brain tumours: uses and nuances in surgical practise. Br J Neurosurg 2023; 37:1544-1559. [PMID: 36148501 DOI: 10.1080/02688697.2022.2123893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/07/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Functional MRI (fMRI) has well-established uses to inform risks and plan maximally safe approaches in neurosurgery. In the field of brain tumour surgery, however, fMRI is currently in a state of clinical equipoise due to debate around both its sensitivity and specificity. MATERIALS AND METHODS In this review, we summarise the role and our experience of fMRI in neurosurgery for gliomas and metastases. We discuss nuances in the conduct and interpretation of fMRI that, based on our practise, most directly impact fMRI's usefulness in the neurosurgical setting. RESULTS Illustrated examples in which fMRI in our hands directly influences the neurosurgical treatment of brain tumours include evaluating the probability and nature of functional risks, especially for language functions. These presurgical risk assessments, in turn, help to predict the resectability of tumours, select or deselect patients for awake surgery, indicate the need for neurophysiological monitoring and guide the optimal use of intra-operative stimulation mapping. A further emerging application of fMRI is in measuring functional adaptation of functional networks after (partial) surgery, of potential use in the timing of further surgery. CONCLUSIONS In appropriately selected patients with a clearly defined surgical question, fMRI offers a valuable complementary tool in the pre-surgical evaluation of brain tumours. However, there is a great need for standards in the administration and analysis of fMRI as much as in the techniques that it is commonly evaluated against. Surprisingly little data exists that evaluates the accuracy of fMRI not just against complementary methods, but in terms of its ultimate clinical aim of minimising post-surgical morbidity.
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Affiliation(s)
- Natalie L Voets
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- GenesisCare Ltd, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andreas J Bartsch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Puneet Plaha
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Neurosurgery, University of Oxford, Oxford, UK
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Woodward OB, Driver I, Schwarz ST, Hart E, Wise R. Assessment of brainstem function and haemodynamics by MRI: challenges and clinical prospects. Br J Radiol 2023; 96:20220940. [PMID: 37721043 PMCID: PMC10607409 DOI: 10.1259/bjr.20220940] [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: 10/04/2022] [Revised: 04/25/2023] [Accepted: 05/24/2023] [Indexed: 09/19/2023] Open
Abstract
MRI offers techniques for non-invasively measuring a range of aspects of brain tissue function. Blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI) is widely used to assess neural activity, based on the brain's haemodynamic response, while arterial spin labelling (ASL) MRI is a non-invasive method of quantitatively mapping cerebral perfusion. Both techniques can be applied to measure cerebrovascular reactivity (CVR), an important marker of the health of the cerebrovascular system. BOLD, ASL and CVR have been applied to study a variety of disease processes and are already used in certain clinical circumstances. The brainstem is a critical component of the central nervous system and is implicated in a variety of disease processes. However, its function is difficult to study using MRI because of its small size and susceptibility to physiological noise. In this article, we review the physical and biological underpinnings of BOLD and ASL and their application to measure CVR, discuss the challenges associated with applying them to the brainstem and the opportunities for brainstem MRI in the research and clinical settings. With further optimisation, functional MRI techniques could feasibly be used to assess brainstem haemodynamics and neural activity in the clinical setting.
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Affiliation(s)
- Owen Bleddyn Woodward
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, United Kingdom
| | - Ian Driver
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, United Kingdom
| | | | - Emma Hart
- University of Bristol, Bristol, United Kingdom
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Wang DJJ, Hua J, Cao D, Ho ML. Neurofluids and the glymphatic system: anatomy, physiology, and imaging. Br J Radiol 2023; 96:20230016. [PMID: 37191063 PMCID: PMC10607419 DOI: 10.1259/bjr.20230016] [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: 01/04/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
First described in 2012, the glymphatic system is responsible for maintaining homeostasis within the central nervous system, including nutrient delivery, waste clearance, and consistency of the ionic microenvironment. It is comprised of glial cells and barrier systems that modulate neurofluid production, circulation, and exchange. Experimental interrogation of neurofluid dynamics is restricted to ex vivo and in vitro studies in animals and humans, therefore diagnostic imaging plays an important role in minimally invasive evaluation. This review article will synthesize current knowledge and theories regarding neurofluid circulation and implications for neuroimaging. First, we will discuss the anatomy of the neurogliovascular unit, including paravascular and perivascular pathways of fluid exchange. In addition, we will summarize the structure and function of barrier systems including the blood-brain, blood-cerebrospinal fluid, and brain-cerebrospinal fluid barriers. Next, we will mention physiologic factors that yield normal variations in neurofluid circulation, and how various disease pathologies can disrupt glymphatic drainage pathways. Lastly, we will cover the spectrum of diagnostic imaging and interventional techniques with relevance to glymphatic structure, flow, and function. We conclude by highlighting current barriers and future directions for translational imaging and applications to neurologic disorders.
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Affiliation(s)
- Danny JJ Wang
- Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | | | | | - Mai-Lan Ho
- Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio, United States
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8
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Agarwal S, Welker KM, Black DF, Little JT, DeLone DR, Messina SA, Passe TJ, Bettegowda C, Pillai JJ. Detection and Mitigation of Neurovascular Uncoupling in Brain Gliomas. Cancers (Basel) 2023; 15:4473. [PMID: 37760443 PMCID: PMC10527022 DOI: 10.3390/cancers15184473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Functional magnetic resonance imaging (fMRI) with blood oxygen level-dependent (BOLD) technique is useful for preoperative mapping of brain functional networks in tumor patients, providing reliable in vivo detection of eloquent cortex to help reduce the risk of postsurgical morbidity. BOLD task-based fMRI (tb-fMRI) is the most often used noninvasive method that can reliably map cortical networks, including those associated with sensorimotor, language, and visual functions. BOLD resting-state fMRI (rs-fMRI) is emerging as a promising ancillary tool for visualization of diverse functional networks. Although fMRI is a powerful tool that can be used as an adjunct for brain tumor surgery planning, it has some constraints that should be taken into consideration for proper clinical interpretation. BOLD fMRI interpretation may be limited by neurovascular uncoupling (NVU) induced by brain tumors. Cerebrovascular reactivity (CVR) mapping obtained using breath-hold methods is an effective method for evaluating NVU potential.
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Affiliation(s)
- Shruti Agarwal
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Kirk M. Welker
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
| | - David F. Black
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
| | - Jason T. Little
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
| | - David R. DeLone
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
| | - Steven A. Messina
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
| | - Theodore J. Passe
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Jay J. Pillai
- Division of Neuroradiology, Department of Radiology, Mayo Clinic Rochester & Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (K.M.W.); (D.F.B.); (J.T.L.); (D.R.D.); (S.A.M.); (T.J.P.)
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
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9
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Panigrahy A, Schmithorst V, Ceschin R, Lee V, Beluk N, Wallace J, Wheaton O, Chenevert T, Qiu D, Lee JN, Nencka A, Gagoski B, Berman JI, Yuan W, Macgowan C, Coatsworth J, Fleysher L, Cannistraci C, Sleeper LA, Hoskoppal A, Silversides C, Radhakrishnan R, Markham L, Rhodes JF, Dugan LM, Brown N, Ermis P, Fuller S, Cotts TB, Rodriguez FH, Lindsay I, Beers S, Aizenstein H, Bellinger DC, Newburger JW, Umfleet LG, Cohen S, Zaidi A, Gurvitz M. Design and Harmonization Approach for the Multi-Institutional Neurocognitive Discovery Study (MINDS) of Adult Congenital Heart Disease (ACHD) Neuroimaging Ancillary Study: A Technical Note. J Cardiovasc Dev Dis 2023; 10:381. [PMID: 37754810 PMCID: PMC10532244 DOI: 10.3390/jcdd10090381] [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: 07/19/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
Dramatic advances in the management of congenital heart disease (CHD) have improved survival to adulthood from less than 10% in the 1960s to over 90% in the current era, such that adult CHD (ACHD) patients now outnumber their pediatric counterparts. ACHD patients demonstrate domain-specific neurocognitive deficits associated with reduced quality of life that include deficits in educational attainment and social interaction. Our hypothesis is that ACHD patients exhibit vascular brain injury and structural/physiological brain alterations that are predictive of specific neurocognitive deficits modified by behavioral and environmental enrichment proxies of cognitive reserve (e.g., level of education and lifestyle/social habits). This technical note describes an ancillary study to the National Heart, Lung, and Blood Institute (NHLBI)-funded Pediatric Heart Network (PHN) "Multi-Institutional Neurocognitive Discovery Study (MINDS) in Adult Congenital Heart Disease (ACHD)". Leveraging clinical, neuropsychological, and biospecimen data from the parent study, our study will provide structural-physiological correlates of neurocognitive outcomes, representing the first multi-center neuroimaging initiative to be performed in ACHD patients. Limitations of the study include recruitment challenges inherent to an ancillary study, implantable cardiac devices, and harmonization of neuroimaging biomarkers. Results from this research will help shape the care of ACHD patients and further our understanding of the interplay between brain injury and cognitive reserve.
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Affiliation(s)
- Ashok Panigrahy
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, 45th Str., Penn Ave., Pittsburgh, PA 15201, USA
| | - Vanessa Schmithorst
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Rafael Ceschin
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Vince Lee
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Nancy Beluk
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Julia Wallace
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Olivia Wheaton
- HealthCore Inc., 480 Pleasant Str., Watertown, MA 02472, USA;
| | - Thomas Chenevert
- Department of Radiology, Michigan Medicine University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA;
- Congenital Heart Center, C. S. Mott Children’s Hospital, 1540 E Hospital Dr., Ann Arbor, MI 48109, USA
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Emory School of Medicine, 1364 Clifton Rd., Atlanta, GA 30322, USA;
| | - James N Lee
- Department of Radiology, The University of Utah, 50 2030 E, Salt Lake City, UT 84112, USA;
| | - Andrew Nencka
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA;
| | - Borjan Gagoski
- Department of Radiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA;
| | - Jeffrey I. Berman
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA;
| | - Weihong Yuan
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA;
- Department of Radiology, University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH 45267, USA
| | - Christopher Macgowan
- Department of Medical Biophysics, University of Toronto, 101 College Str. Suite 15-701, Toronto, ON M5G 1L7, Canada;
- The Hospital for Sick Children Division of Translational Medicine, 555 University Ave., Toronto, ON M5G 1X8, Canada
| | - James Coatsworth
- Department of Radiology, Medical University of South Carolina, 171 Ashley Ave., Room 372, Charleston, SC 29425, USA;
| | - Lazar Fleysher
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Christopher Cannistraci
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
| | - Arvind Hoskoppal
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Candice Silversides
- Department of Cardiology, University of Toronto, C. David Naylor Building, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada;
| | - Rupa Radhakrishnan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 University Blvd., Indianapolis, IN 46202, USA;
| | - Larry Markham
- Department of Cardiology, University of Indiana School of Medicine, 545 Barnhill Dr., Indianapolis, IN 46202, USA;
| | - John F. Rhodes
- Department of Cardiology, Medical University of South Carolina, 96 Jonathan Lucas Str. Ste. 601, MSC 617, Charleston, SC 29425, USA;
| | - Lauryn M. Dugan
- Department of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA; (L.M.D.); (N.B.)
| | - Nicole Brown
- Department of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA; (L.M.D.); (N.B.)
| | - Peter Ermis
- Department of Radiology, Texas Children’s Hospital, Houston, TX 77030, USA; (P.E.); (S.F.)
| | - Stephanie Fuller
- Department of Radiology, Texas Children’s Hospital, Houston, TX 77030, USA; (P.E.); (S.F.)
| | - Timothy Brett Cotts
- Departments of Internal Medicine and Pediatrics, Michigan Medicine University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA;
| | - Fred Henry Rodriguez
- Department of Cardiology, Emory School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA;
| | - Ian Lindsay
- Department of Cardiology, The University of Utah, 95 S 2000 E, Salt Lake City, UT 84112, USA;
| | - Sue Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Str., Pittsburgh, PA 15213, USA; (S.B.); (H.A.)
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Str., Pittsburgh, PA 15213, USA; (S.B.); (H.A.)
| | - David C. Bellinger
- Cardiac Neurodevelopmental Program, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA;
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
| | - Laura Glass Umfleet
- Department of Neuropsychology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA;
| | - Scott Cohen
- Heart and Vascular Center, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Ali Zaidi
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
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Pasquini L, Peck KK, Jenabi M, Holodny A. Functional MRI in Neuro-Oncology: State of the Art and Future Directions. Radiology 2023; 308:e222028. [PMID: 37668519 PMCID: PMC10546288 DOI: 10.1148/radiol.222028] [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: 08/10/2022] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 09/06/2023]
Abstract
Since its discovery in the early 1990s, functional MRI (fMRI) has been used to study human brain function. One well-established application of fMRI in the clinical setting is the neurosurgical planning of patients with brain tumors near eloquent cortical areas. Clinical fMRI aims to preoperatively identify eloquent cortices that serve essential functions in daily life, such as hand movement and language. The primary goal of neurosurgery is to maximize tumor resection while sparing eloquent cortices adjacent to the tumor. When a lesion presents in the vicinity of an eloquent cortex, surgeons may use fMRI to plan their best surgical approach by determining the proximity of the lesion to regions of activation, providing guidance for awake brain surgery and intraoperative brain mapping. The acquisition of fMRI requires patient preparation prior to imaging, determination of functional paradigms, monitoring of patient performance, and both processing and analysis of images. Interpretation of fMRI maps requires a strong understanding of functional neuroanatomy and familiarity with the technical limitations frequently present in brain tumor imaging, including neurovascular uncoupling, patient compliance, and data analysis. This review discusses clinical fMRI in neuro-oncology, relevant ongoing research topics, and prospective future developments in this exciting discipline.
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Affiliation(s)
- Luca Pasquini
- From the Neuroradiology Service, Department of Radiology (L.P.,
K.K.P., M.J., A.H.), Department of Medical Physics (K.K.P.), and Brain Tumor
Center (A.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York,
NY 10065; Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital,
La Sapienza University, Rome, Italy (L.P.); Department of Radiology, Weill
Medical College of Cornell University, New York, NY (A.H.); and Department of
Neuroscience, Weill Cornell Medicine Graduate School of Medical Sciences, New
York, NY (A.H.)
| | - Kyung K. Peck
- From the Neuroradiology Service, Department of Radiology (L.P.,
K.K.P., M.J., A.H.), Department of Medical Physics (K.K.P.), and Brain Tumor
Center (A.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York,
NY 10065; Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital,
La Sapienza University, Rome, Italy (L.P.); Department of Radiology, Weill
Medical College of Cornell University, New York, NY (A.H.); and Department of
Neuroscience, Weill Cornell Medicine Graduate School of Medical Sciences, New
York, NY (A.H.)
| | - Mehrnaz Jenabi
- From the Neuroradiology Service, Department of Radiology (L.P.,
K.K.P., M.J., A.H.), Department of Medical Physics (K.K.P.), and Brain Tumor
Center (A.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York,
NY 10065; Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital,
La Sapienza University, Rome, Italy (L.P.); Department of Radiology, Weill
Medical College of Cornell University, New York, NY (A.H.); and Department of
Neuroscience, Weill Cornell Medicine Graduate School of Medical Sciences, New
York, NY (A.H.)
| | - Andrei Holodny
- From the Neuroradiology Service, Department of Radiology (L.P.,
K.K.P., M.J., A.H.), Department of Medical Physics (K.K.P.), and Brain Tumor
Center (A.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York,
NY 10065; Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital,
La Sapienza University, Rome, Italy (L.P.); Department of Radiology, Weill
Medical College of Cornell University, New York, NY (A.H.); and Department of
Neuroscience, Weill Cornell Medicine Graduate School of Medical Sciences, New
York, NY (A.H.)
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Thomas G, McMahon KL, Finch E, Copland DA. Interindividual variability and consistency of language mapping paradigms for presurgical use. BRAIN AND LANGUAGE 2023; 243:105299. [PMID: 37413742 DOI: 10.1016/j.bandl.2023.105299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/08/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
Most functional MRI studies of language processing have focussed on group-level inference, but for clinical use, the aim is to predict outcomes at an individual patient level. This requires being able to identify atypical activation and understand how differences relate to language outcomes. A language mapping paradigm that selectively activates left hemisphere language regions in healthy individuals allows atypical activation in a patient to be more easily identified. We investigated the interindividual variability and consistency of language activation in 12 healthy participants using three tasks-verb generation, responsive naming, and sentence comprehension-for future presurgical use. Responsive naming produced the most consistent left-lateralised activation across participants in frontal and temporal regions that postsurgical voxel-based lesion-symptom mapping studies suggest are most critical for language outcomes. Studies with a long-term clinical aim of predicting language outcomes in neurosurgical patients and stroke patients should first establish paradigm validity at an individual level in healthy participants.
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Affiliation(s)
- Georgia Thomas
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia; Herston Imaging Research Facility, The University of Queensland, Brisbane, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Research and Innovation, West Moreton Health, Ipswich, Australia; Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
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12
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Williams RJ, Specht JL, Mazerolle EL, Lebel RM, MacDonald ME, Pike GB. Correspondence between BOLD fMRI task response and cerebrovascular reactivity across the cerebral cortex. Front Physiol 2023; 14:1167148. [PMID: 37228813 PMCID: PMC10203231 DOI: 10.3389/fphys.2023.1167148] [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: 02/16/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
BOLD sensitivity to baseline perfusion and blood volume is a well-acknowledged fMRI confound. Vascular correction techniques based on cerebrovascular reactivity (CVR) might reduce variance due to baseline cerebral blood volume, however this is predicated on an invariant linear relationship between CVR and BOLD signal magnitude. Cognitive paradigms have relatively low signal, high variance and involve spatially heterogenous cortical regions; it is therefore unclear whether the BOLD response magnitude to complex paradigms can be predicted by CVR. The feasibility of predicting BOLD signal magnitude from CVR was explored in the present work across two experiments using different CVR approaches. The first utilized a large database containing breath-hold BOLD responses and 3 different cognitive tasks. The second experiment, in an independent sample, calculated CVR using the delivery of a fixed concentration of carbon dioxide and a different cognitive task. An atlas-based regression approach was implemented for both experiments to evaluate the shared variance between task-invoked BOLD responses and CVR across the cerebral cortex. Both experiments found significant relationships between CVR and task-based BOLD magnitude, with activation in the right cuneus (R 2 = 0.64) and paracentral gyrus (R 2 = 0.71), and the left pars opercularis (R 2 = 0.67), superior frontal gyrus (R 2 = 0.62) and inferior parietal cortex (R 2 = 0.63) strongly predicted by CVR. The parietal regions bilaterally were highly consistent, with linear regressions significant in these regions for all four tasks. Group analyses showed that CVR correction increased BOLD sensitivity. Overall, this work suggests that BOLD signal response magnitudes to cognitive tasks are predicted by CVR across different regions of the cerebral cortex, providing support for the use of correction based on baseline vascular physiology.
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Affiliation(s)
- Rebecca J. Williams
- Faculty of Health, School of Human Services, Charles Darwin University, Darwin, NT, Australia
| | - Jacinta L. Specht
- Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Erin L. Mazerolle
- Departments of Psychology and Computer Science, St. Francis Xavier University, Antigonish, NS, Canada
| | - R. Marc Lebel
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- GE HealthCare, Calgary, AB, Canada
| | - M. Ethan MacDonald
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
- Department of Electrical and Software Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - G. Bruce Pike
- Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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13
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Zvolanek KM, Moia S, Dean JN, Stickland RC, Caballero-Gaudes C, Bright MG. Comparing end-tidal CO 2, respiration volume per time (RVT), and average gray matter signal for mapping cerebrovascular reactivity amplitude and delay with breath-hold task BOLD fMRI. Neuroimage 2023; 272:120038. [PMID: 36958618 DOI: 10.1016/j.neuroimage.2023.120038] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023] Open
Abstract
Cerebrovascular reactivity (CVR), defined as the cerebral blood flow response to a vasoactive stimulus, is an imaging biomarker with demonstrated utility in a range of diseases and in typical development and aging processes. A robust and widely implemented method to map CVR involves using a breath-hold task during a BOLD fMRI scan. Recording end-tidal CO2 (PETCO2) changes during the breath-hold task is recommended to be used as a reference signal for modeling CVR amplitude in standard units (%BOLD/mmHg) and CVR delay in seconds. However, obtaining reliable PETCO2 recordings requires equipment and task compliance that may not be achievable in all settings. To address this challenge, we investigated two alternative reference signals to map CVR amplitude and delay in a lagged general linear model (lagged-GLM) framework: respiration volume per time (RVT) and average gray matter BOLD response (GM-BOLD). In 8 healthy adults with multiple scan sessions, we compare spatial agreement of CVR maps from RVT and GM-BOLD to those generated with PETCO2. We define a threshold to determine whether a PETCO2 recording has "sufficient" quality for CVR mapping and perform these comparisons in 16 datasets with sufficient PETCO2 and 6 datasets with insufficient PETCO2. When PETCO2 quality is sufficient, both RVT and GM-BOLD produce CVR amplitude maps that are nearly identical to those from PETCO2 (after accounting for differences in scale), with the caveat they are not in standard units to facilitate between-group comparisons. CVR delays are comparable to PETCO2 with an RVT regressor but may be underestimated with the average GM-BOLD regressor. Importantly, when PETCO2 quality is insufficient, RVT and GM-BOLD CVR recover reasonable CVR amplitude and delay maps, provided the participant attempted the breath-hold task. Therefore, our framework offers a solution for achieving high quality CVR maps in both retrospective and prospective studies where sufficient PETCO2 recordings are not available and especially in populations where obtaining reliable measurements is a known challenge (e.g., children). Our results have the potential to improve the accessibility of CVR mapping and to increase the prevalence of this promising metric of vascular health.
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Affiliation(s)
- Kristina M Zvolanek
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA.
| | - Stefano Moia
- Basque Center on Cognition, Brain and Language, Donostia, Gipuzkoa, Spain; Medical Imaging Processing Lab (MIP:Lab), Neuro-X institute, EPFL, Geneva, Switzerland
| | - Joshua N Dean
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA
| | - Rachael C Stickland
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Molly G Bright
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA
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14
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Gleißner C, Kaczmarz S, Kufer J, Schmitzer L, Kallmayer M, Zimmer C, Wiestler B, Preibisch C, Göttler J. Hemodynamic MRI parameters to predict asymptomatic unilateral carotid artery stenosis with random forest machine learning. FRONTIERS IN NEUROIMAGING 2023; 1:1056503. [PMID: 37555162 PMCID: PMC10406220 DOI: 10.3389/fnimg.2022.1056503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/20/2022] [Indexed: 08/10/2023]
Abstract
BACKGROUND Internal carotid artery stenosis (ICAS) can cause stroke and cognitive decline. Associated hemodynamic impairments, which are most pronounced within individual watershed areas (iWSA) between vascular territories, can be assessed with hemodynamic-oxygenation-sensitive MRI and may help to detect severely affected patients. We aimed to identify the most sensitive parameters and volumes of interest (VOI) to predict high-grade ICAS with random forest machine learning. We hypothesized an increased predictive ability considering iWSAs and a decreased cognitive performance in correctly classified patients. MATERIALS AND METHODS Twenty-four patients with asymptomatic, unilateral, high-grade carotid artery stenosis and 24 age-matched healthy controls underwent MRI comprising pseudo-continuous arterial spin labeling (pCASL), breath-holding functional MRI (BH-fMRI), dynamic susceptibility contrast (DSC), T2 and T2* mapping, MPRAGE and FLAIR. Quantitative maps of eight perfusion, oxygenation and microvascular parameters were obtained. Mean values of respective parameters within and outside of iWSAs split into gray (GM) and white matter (WM) were calculated for both hemispheres and for interhemispheric differences resulting in 96 features. Random forest classifiers were trained on whole GM/WM VOIs, VOIs considering iWSAs and with additional feature selection, respectively. RESULTS The most sensitive features in decreasing order were time-to-peak (TTP), cerebral blood flow (CBF) and cerebral vascular reactivity (CVR), all of these inside of iWSAs. Applying iWSAs combined with feature selection yielded significantly higher receiver operating characteristics areas under the curve (AUC) than whole GM/WM VOIs (AUC: 0.84 vs. 0.90, p = 0.039). Correctly predicted patients presented with worse cognitive performances than frequently misclassified patients (Trail-making-test B: 152.5s vs. 94.4s, p = 0.034). CONCLUSION Random forest classifiers trained on multiparametric MRI data allow identification of the most relevant parameters and VOIs to predict ICAS, which may improve personalized treatments.
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Affiliation(s)
- Carina Gleißner
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Kaczmarz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- Philips GmbH Market DACH, Hamburg, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan Kufer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lena Schmitzer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
- Clinic for Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jens Göttler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
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Zerweck L, Hauser TK, Roder C, Blazhenets G, Khan N, Ernemann U, Meyer PT, Klose U. Evaluation of the cerebrovascular reactivity in patients with Moyamoya Angiopathy by use of breath-hold fMRI: investigation of voxel-wise hemodynamic delay correction in comparison to [ 15O]water PET. Neuroradiology 2023; 65:539-550. [PMID: 36434312 PMCID: PMC9905170 DOI: 10.1007/s00234-022-03088-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/12/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Patients with Moyamoya Angiopathy (MMA) require hemodynamic assessment to evaluate the risk of stroke. Hemodynamic evaluation by use of breath-hold-triggered fMRI (bh-fMRI) was proposed as a readily available alternative to the diagnostic standard [15O]water PET. Recent studies suggest voxel-wise hemodynamic delay correction in hypercapnia-triggered fMRI. The aim of this study was to evaluate the effect of delay correction of bh-fMRI in patients with MMA and to compare the results with [15O]water PET. METHODS bh-fMRI data sets of 22 patients with MMA were evaluated without and with voxel-wise delay correction within different shift ranges and compared to the corresponding [15O]water PET data sets. The effects were evaluated combined and in subgroups of data sets with most severely impaired CVR (apparent steal phenomenon), data sets with territorial time delay, and data sets with neither steal phenomenon nor delay between vascular territories. RESULTS The study revealed a high mean cross-correlation (r = 0.79, p < 0.001) between bh-fMRI and [15O]water PET. The correlation was strongly dependent on the choice of the shift range. Overall, no shift range revealed a significantly improved correlation between bh-fMRI and [15O]water PET compared to the correlation without delay correction. Delay correction within shift ranges with positive high high cutoff revealed a lower agreement between bh-fMRI and PET overall and in all subgroups. CONCLUSION Voxel-wise delay correction, in particular with shift ranges with high cutoff, should be used critically as it can lead to false-negative results in regions with impaired CVR and a lower correlation to the diagnostic standard [15O]water PET.
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Affiliation(s)
- Leonie Zerweck
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.
| | - Till-Karsten Hauser
- grid.411544.10000 0001 0196 8249Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Constantin Roder
- grid.411544.10000 0001 0196 8249Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Ganna Blazhenets
- grid.5963.9Department of Nuclear Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nadia Khan
- grid.411544.10000 0001 0196 8249Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany ,grid.412341.10000 0001 0726 4330Moyamoya Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Ulrike Ernemann
- grid.411544.10000 0001 0196 8249Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Philipp T. Meyer
- grid.5963.9Department of Nuclear Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Uwe Klose
- grid.411544.10000 0001 0196 8249Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
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16
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Vedaei F, Alizadeh M, Tantawi M, Romo V, Mohamed FB, Wu C. Vascular and neuronal effects of general anesthesia on the brain: An fMRI study. J Neuroimaging 2023; 33:109-120. [PMID: 36097249 DOI: 10.1111/jon.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND PURPOSE A number of functional magnetic resonance imaging (fMRI) studies rely on application of anesthetic agents during scanning that can modulate and complicate interpretation of the measured hemodynamic blood oxygenation level-dependent (BOLD) response. The purpose of the present study was to investigate the effect of general anesthesia on two main components of BOLD signal including neuronal activity and vascular response. METHODS Breath-holding (BH) fMRI was conducted in wakefulness and under anesthesia states in 9 patients with drug-resistant epilepsy who needed to get scanned under anesthesia during laser interstitial thermal therapy. BOLD and BOLD cerebrovascular reactivity (BOLD-CVR) maps were compared using t-test between two states to assess the effect of anesthesia on neuronal activity and vascular factors (p < .05). RESULTS Overall, our findings revealed an increase in BOLD-CVR and decrease in BOLD response under anesthesia in several brain regions. The results proposed that the modulatory mechanism of anesthetics on neuronal and vascular components of BOLD signal may work in different ways. CONCLUSION This experiment for the first human study showed that anesthesia may play an important role in dissociation between neuronal and vascular responses contributed to hemodynamic BOLD signal using BH fMRI imaging that may assist the implication of general anesthesia and interpretation of outcomes in clinical setting.
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Affiliation(s)
- Faezeh Vedaei
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mahdi Alizadeh
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mohamed Tantawi
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Victor Romo
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Feroze B Mohamed
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chengyuan Wu
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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17
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Shams S, Prokopiou P, Esmaelbeigi A, Mitsis GD, Chen JJ. Modeling the dynamics of cerebrovascular reactivity to carbon dioxide in fMRI under task and resting-state conditions. Neuroimage 2023; 265:119758. [PMID: 36442732 DOI: 10.1016/j.neuroimage.2022.119758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022] Open
Abstract
Conventionally, cerebrovascular reactivity (CVR) is estimated as the amplitude of the hemodynamic response to vascular stimuli, most commonly carbon dioxide (CO2). While the CVR amplitude has established clinical utility, the temporal characteristics of CVR (dCVR) have been increasingly explored and may yield even more pathology-sensitive parameters. This work is motivated by the current need to evaluate the feasibility of dCVR modeling in various experimental conditions. In this work, we present a comparison of several recently published/utilized model-based deconvolution (response estimation) approaches for estimating the CO2 response function h(t), including maximum a posteriori likelihood (MAP), inverse logit (IL), canonical correlation analysis (CCA), and basis expansion (using Gamma and Laguerre basis sets). To aid the comparison, we devised a novel simulation framework that incorporates a wide range of SNRs, ranging from 10 to -7 dB, representative of both task and resting-state CO2 changes. In addition, we built ground-truth h(t) into our simulation framework, overcoming the conventional limitation that the true h(t) is unknown. Moreover, to best represent realistic noise found in fMRI scans, we extracted noise from in-vivo resting-state scans. Furthermore, we introduce a simple optimization of the CCA method (CCAopt) and compare its performance to these existing methods. Our findings suggest that model-based methods can accurately estimate dCVR even amidst high noise (i.e. resting-state), and in a manner that is largely independent of the underlying model assumptions for each method. We also provide a quantitative basis for making methodological choices, based on the desired dCVR parameters, the estimation accuracy and computation time. The BEL method provided the highest accuracy and robustness, followed by the CCAopt and IL methods. Of the three, the CCAopt method has the lowest computational requirements. These findings lay the foundation for wider adoption of dCVR estimation in CVR mapping.
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Affiliation(s)
- Seyedmohammad Shams
- Rotman Research Institute, Baycrest Health Sciences, Canada; Department of Neurology, Henry Ford Health, USA
| | - Prokopis Prokopiou
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - J Jean Chen
- Rotman Research Institute, Baycrest Health Sciences, Canada; Department of Bioengineering, McGill University, Canada; Department of Medical Biophysics, University of Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Canada.
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18
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Glass Umfleet L, Pommy J, Cohen AD, Allen M, Obarski S, Mason L, Berres H, Franczak M, Wang Y. Decreased Cerebrovascular Reactivity in Mild Cognitive Impairment Phenotypes. J Alzheimers Dis 2023; 94:1503-1513. [PMID: 37424462 DOI: 10.3233/jad-221156] [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: 07/11/2023]
Abstract
BACKGROUND Cerebrovascular health plays an important role in cognitive health in older adults. Cerebrovascular reactivity (CVR), a measure of cerebrovascular health, changes in both normal and pathological aging, and is increasingly being conceptualized as contributory to cognitive decline. Interrogation of this process will yield new insights into cerebrovascular correlates of cognition and neurodegeneration. OBJECTIVE The current study examines CVR using advanced MRI in prodromal dementia states (amnestic and non-amnestic mild cognitive impairment phenotypes; aMCI and naMCI, respectively) and older adult controls. METHODS CVR was assessed in 41 subjects (20 controls, 11 aMCI, 10 naMCI) using multiband multi-echo breath-holding task functional magnetic resonance imaging. Imaging data were preprocessed and analyzed using AFNI. All participants also completed a battery of neuropsychological tests. T-tests and ANOVA/ANCOVA analyses were conducted to compare controls to MCI groups on CVR and cognitive metrics. Partial correlation analyses between CVR derived from regions-of-interest (ROIs) and different cognitive functions were conducted. RESULTS CVR was found to be significantly lower in aMCI and naMCI patients compared to controls. naMCI showed intermediate patterns between aMCI and controls (though aMCI and naMCI groups did not significantly differ). CVR of ROIs were positively correlated with neuropsychological measures of processing speed, executive functioning, and memory. CONCLUSION The findings highlight regional CVR differences in MCI phenotypes compared to controls, where aMCI may have lower CVR than naMCI. Our results suggest possible cerebrovascular abnormalities associated with MCI phenotypes.
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Affiliation(s)
| | - Jessica Pommy
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alexander D Cohen
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Shawn Obarski
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lilly Mason
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Halle Berres
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Yang Wang
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA
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Yeh MY, Chen HS, Hou P, Kumar VA, Johnson JM, Noll KR, Prabhu SS, Ferguson SD, Schomer DF, Peng HH, Liu HL. Cerebrovascular Reactivity Mapping Using Resting-State Functional MRI in Patients With Gliomas. J Magn Reson Imaging 2022; 56:1863-1871. [PMID: 35396789 DOI: 10.1002/jmri.28194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recently, a data-driven regression analysis method was developed to utilize the resting-state (rs) blood oxygenation level-dependent signal for cerebrovascular reactivity (CVR) mapping (rs-CVR), which was previously optimized by comparing with the CO2 inhalation-based method in health subjects and patients with neurovascular diseases. PURPOSE To investigate the agreement of rs-CVR and the CVR mapping with breath-hold MRI (bh-CVR) in patients with gliomas. STUDY TYPE Retrospective. POPULATION Twenty-five patients (12 males, 13 females; mean age ± SD, 48 ± 13 years) with gliomas. FIELD STRENGTH/SEQUENCE Dynamic T2*-weighted gradient-echo echo-planar imaging during a breath-hold paradigm and during the rs on a 3-T scanner. ASSESSMENT rs-CVR with various frequency ranges and resting-state fluctuation amplitude (RSFA) were assessed. The agreement between each rs-based CVR measurement and bh-CVR was determined by voxel-wise correlation and Dice coefficient in the whole brain, gray matter, and the lesion region of interest (ROI). STATISTICAL TESTS Voxel-wise Pearson correlation, Dice coefficient, Fisher Z-transformation, repeated-measure analysis of variance and post hoc test with Bonferroni correction, and nonparametric repeated-measure Friedman test and post hoc test with Bonferroni correction were used. Significance was set at P < 0.05. RESULTS Compared with bh-CVR, the highest correlations were found at the frequency bands of 0.04-0.08 Hz and 0.02-0.04 Hz for rs-CVR in both whole brain and the lesion ROI. RSFA had significantly lower correlations than did rs-CVR of 0.02-0.04 Hz and a wider frequency range (0-0.1164 Hz). Significantly higher correlations and Dice coefficient were found in normal tissues than in the lesion ROI for all three methods. DATA CONCLUSION The optimal frequency ranges for rs-CVR are determined by comparing with bh-CVR in patients with gliomas. The rs-CVR method outperformed the RSFA. Significantly higher correlation and Dice coefficient between rs- and bh-CVR were found in normal tissue than in the lesion. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Mei-Yu Yeh
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Henry S Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason M Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Donald F Schomer
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hsu-Hsia Peng
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Muir M, Gadot R, Prinsloo S, Michener H, Traylor J, Athukuri P, Tummala S, Kumar VA, Prabhu SS. Comparative study of preoperative functional imaging combined with tractography for prediction of iatrogenic motor deficits. J Neurosurg 2022:1-8. [DOI: 10.3171/2022.10.jns221684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE
Robust preoperative imaging can improve the extent of resection in patients with brain tumors while minimizing postoperative neurological morbidity. Both structural and functional imaging techniques can provide helpful preoperative information. A recent study found that transcranial magnetic stimulation (TMS) tractography has significant predictive value for permanent deficits. The present study directly compares the predictive value of TMS tractography and task-based functional MRI (fMRI) tractography in the same cohort of glioma patients.
METHODS
Clinical outcome data were collected from charts of patients with motor eloquent glioma and preoperative fMRI and TMS studies. The primary outcome was a new or worsened motor deficit present at the 3-month postoperative follow-up, which was termed a "permanent deficit." Postoperative MR images were overlaid onto preoperative plans to determine which imaging features were resected. Multiple fractional anisotropic thresholds (FATs) were screened for both TMS and fMRI tractography. The predictive value of the various thresholds was modeled using receiver operating characteristic curve analysis.
RESULTS
Forty patients were included in this study. Six patients (15%) sustained permanent postoperative motor deficits. A significantly greater predictive value was found for TMS tractography than for fMRI tractography regardless of the FAT. Despite 35% of patients showing clinically relevant neuroplasticity captured by TMS, only 2.5% of patients showed a blood oxygen level–dependent signal displaced from the precentral gyrus. Comparing the best-performing FAT for both modalities, TMS seeded tractography showed superior predictive value across all metrics: sensitivity, specificity, positive predictive value, and negative predictive value.
CONCLUSIONS
The results from this study indicate that the prediction of permanent deficits with TMS tractography is superior to that with fMRI tractography, possibly because TMS tractography captures clinically relevant neuroplasticity. However, future large-scale prospective studies are needed to fully illuminate the proper role of each modality in comprehensive presurgical workups for patients with motor-eloquent tumors.
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Affiliation(s)
| | | | | | | | - Jeffrey Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Sudhakar Tummala
- Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston; and
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21
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Wei Z, Li Y, Hou X, Han Z, Xu J, McMahon MT, Duan W, Liu G, Lu H. Quantitative cerebrovascular reactivity MRI in mice using acetazolamide challenge. Magn Reson Med 2022; 88:2233-2241. [PMID: 35713368 PMCID: PMC9574885 DOI: 10.1002/mrm.29353] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/24/2022] [Accepted: 05/23/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE To develop a quantitative MRI method to estimate cerebrovascular reactivity (CVR) in mice. METHODS We described an MRI procedure to measure cerebral vasodilatory response to acetazolamide (ACZ), a vasoactive agent previously used in human clinical imaging. Vascular response was determined by cerebral blood flow (CBF) measured with phase-contrast or pseudo-continuous arterial spin labeling MRI. Vasodilatory input intensity was determined by plasma ACZ level using high-performance liquid chromatography. We verified the source of the CVR MRI signal by comparing ACZ injection to phosphate-buffered saline injection and noninjection experiments. Dose dependence and feasibility of regional CVR measurement were also investigated. RESULTS Cerebral blood flow revealed an exponential increase following intravenous ACZ injection, with a time constant of 1.62 min. In contrast, phosphate-buffered saline or noninjection exhibited a slow linear CBF increase, consistent with a gradual accumulation of anesthetic agent, isoflurane, used in this study. When comparing different ACZ doses, injections of 30, 60, 120, and 180 mg/kg yielded a linear increase in plasma ACZ concentration (p < 0.0001). On the other hand, CBF changes under these doses were not different from each other (p = 0.50). The pseudo-continuous arterial spin labeling MRI with multiple postlabeling delays revealed similar vascular responses at different postlabeling delay values. There was a regional difference in CVR (p = 0.005), with isocortex (0.81 ± 0.17%/[μg/ml]) showing higher CVR than deep-brain regions. Mice receiving multiple ACZ injections lived for a minimum of 6 months after the study without noticeable aberrant behavior or appearance. CONCLUSIONS We demonstrated the proof-of-principle of a new quantitative CVR mapping technique in mice.
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Affiliation(s)
- Zhiliang Wei
- Russell H. Morgan Department of Radiology and Radiological Science, 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
| | - Yuguo Li
- Russell H. Morgan Department of Radiology and Radiological Science, 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
| | - Xirui Hou
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zheng Han
- Russell H. Morgan Department of Radiology and Radiological Science, 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
| | - Jiadi Xu
- Russell H. Morgan Department of Radiology and Radiological Science, 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
| | - Michael T. McMahon
- Russell H. Morgan Department of Radiology and Radiological Science, 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
| | - Wenzhen Duan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of medicine, Baltimore, Maryland, USA
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of medicine, Baltimore, Maryland, USA
| | - Guanshu Liu
- Russell H. Morgan Department of Radiology and Radiological Science, 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
| | - Hanzhang Lu
- Russell H. Morgan Department of Radiology and Radiological Science, 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
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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22
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Choi EJ, Westmacott R, Kirkham FJ, Robertson A, Muthusami P, Shroff M, Moharir M, Williams T, Dirks P, MacGregor D, Slim M, Pulcine E, Bhathal I, Kaseka ML, Kassner A, Logan W, deVeber G, Dlamini N. Fronto-Parietal and White Matter Haemodynamics Predict Cognitive Outcome in Children with Moyamoya Independent of Stroke. Transl Stroke Res 2022; 13:757-773. [PMID: 35338434 DOI: 10.1007/s12975-022-01003-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
Moyamoya disease is a major arteriopathy characterised by progressive steno-occlusion of the arteries of the circle of Willis. Studies in adults with moyamoya suggest an association between abnormal fronto-parietal and white matter regional haemodynamics and cognitive impairments, even in the absence of focal infarction. However, these associations have not been investigated in children with moyamoya. We examined the relationship between regional haemodynamics and ratings of intellectual ability and executive function, using hypercapnic challenge blood oxygen level-dependent magnetic resonance imaging of cerebrovascular reactivity in a consecutive cohort of children with confirmed moyamoya. Thirty children were included in the final analysis (mean age: 12.55 ± 3.03 years, 17 females, 15 idiopathic moyamoya and 15 syndromic moyamoya). Frontal haemodynamics were abnormal in all regardless of stroke history and comorbidity, but occipital lobe haemodynamics were also abnormal in children with syndromic moyamoya. Executive function deficits were noted in both idiopathic and syndromic moyamoya, whereas intellectual ability was impaired in syndromic moyamoya, even in the absence of stroke. Analysis of the relative effect of regional abnormal haemodynamics on cognitive outcomes demonstrated that executive dysfunction was predominantly explained by right parietal and white matter haemodynamics independent of stroke and comorbidity, while posterior circulation haemodynamics predicted intellectual ability. These results suggest that parietal and posterior haemodynamics play a compensatory role in overcoming frontal vulnerability and cognitive impairment.
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Affiliation(s)
- Eun Jung Choi
- Neurosciences and Mental Health Program, Stroke Imaging Laboratory for Children, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Westmacott
- Department of Neuropsychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Fenella J Kirkham
- Developmental Neurosciences and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Amanda Robertson
- Neurosciences and Mental Health Program, Stroke Imaging Laboratory for Children, The Hospital for Sick Children, Toronto, ON, Canada
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Prakash Muthusami
- Diagnostic Imaging, The Hospital for Sick Children, ON, Toronto, Canada
- Medical Imaging, University of Toronto, ON, Toronto, Canada
| | - Manohar Shroff
- Diagnostic Imaging, The Hospital for Sick Children, ON, Toronto, Canada
- Medical Imaging, University of Toronto, ON, Toronto, Canada
| | - Mahendranath Moharir
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tricia Williams
- Department of Neuropsychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Dirks
- Department of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daune MacGregor
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mahmoud Slim
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Pulcine
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ishvinder Bhathal
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Matsanga Leyila Kaseka
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea Kassner
- Medical Imaging, University of Toronto, ON, Toronto, Canada
- Department of Translational Medicine, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, ON, Toronto, Canada
| | - William Logan
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gabrielle deVeber
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Neurosciences and Mental Health Program, Stroke Imaging Laboratory for Children, The Hospital for Sick Children, Toronto, ON, Canada.
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada.
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23
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Wang R, Poublanc J, Crawley AP, Sobczyk O, Kneepkens S, Mcketton L, Tator C, Wu R, Mikulis DJ. Cerebrovascular reactivity changes in acute concussion: a controlled cohort study. Quant Imaging Med Surg 2021; 11:4530-4542. [PMID: 34737921 DOI: 10.21037/qims-20-1296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Abstract
Background Evidence suggests that cerebrovascular reactivity (CVR) increases within the first week after the incidence of concussion, indicating a disruption of normal autoregulation. We sought to extend these findings by investigating the effects of acute concussion on the speed of CVR response and by visualizing global and regional impairments in individual patients with acute concussion. Methods Twelve patients aged 18-40 years who experienced concussion less than a week before this prospective study were included. Twelve age and sex-matched healthy subjects constituted the control group. In all subjects, CVR was assessed using blood oxygenation level-dependent (BOLD) echo-planar imaging with a 3.0T MRI scanner, in combination with changes in end-tidal partial pressure of CO2 (PETCO2). In each subject, we calculated the CVR amplitude and CVR response time in the gray and white matter using a step and ramp PETCO2 challenge. In addition, a separate group of 39 healthy controls who underwent the same evaluation was used to create atlases with voxel-wise mean and standard deviation of CVR amplitude and CVR response time. This allowed us to convert each metric of the 12 patients with concussion and the 12 healthy controls into z-score maps. These maps were then used to generate and compare z-scores for each of the two groups. Group differences were calculated using an unpaired t-test. Results All studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study subjects. No differences in CO2 stimulus and O2 targeting were observed between the two participant groups during BOLD MRI. With regard to the gray matter, the CVR magnitude step (P=0.117) and ramp + 10 (P=0.085) were not significantly different between patients with concussion and healthy controls. However, the tau value was significantly lower in patients with concussion than in the healthy controls (P=0.04). With regard to the white matter, the CVR magnitude step (P=0.003) and ramp + 10 (P=0.031) were significantly higher and the tau value (P=0.024) was significantly shorter in patients with concussion than in healthy controls. After z-score transformation, the z tau value was significantly lower in patients with concussion than in healthy controls (Grey matter P=0.021, White matter P=0.003). Comparison of the three parameters, z ramp + 10, z step, and z tau, between the two groups showed that z step (Grey matter P=0.035, White matter P=0.005) was the most sensitive parameter and that z ramp + 10 (Grey matter P=0.073, White matter P=0.126) was the least sensitive parameter. Conclusions Concussion is associated with patient-specific abnormalities in BOLD cerebrovascular responsiveness that occur in the setting of normal global CVR. This study demonstrates that the measurement of CVR using BOLD MRI and precise CO2 control is a safe, reliable, reproducible, and clinically useful method for evaluating the state of patients with concussion. It has the potential to be an important tool for assessing the severity and duration of symptoms after concussion.
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Affiliation(s)
- Runrun Wang
- Joint Department of Medical Imaging, University Health Network, The Toronto Western Hospital, The University of Toronto, Toronto, Ontario, Canada.,Department of Neurology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan, China.,Department of Medical Imaging, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Julien Poublanc
- Joint Department of Medical Imaging, University Health Network, The Toronto Western Hospital, The University of Toronto, Toronto, Ontario, Canada
| | - Adrian P Crawley
- Joint Department of Medical Imaging, University Health Network, The Toronto Western Hospital, The University of Toronto, Toronto, Ontario, Canada
| | - Olivia Sobczyk
- Joint Department of Medical Imaging, University Health Network, The Toronto Western Hospital, The University of Toronto, Toronto, Ontario, Canada
| | - Sander Kneepkens
- Joint Department of Medical Imaging, University Health Network, The Toronto Western Hospital, The University of Toronto, Toronto, Ontario, Canada
| | - Larissa Mcketton
- Joint Department of Medical Imaging, University Health Network, The Toronto Western Hospital, The University of Toronto, Toronto, Ontario, Canada
| | - Charles Tator
- Department of Surgery, Division of Neurosurgery, University Health Network, The Toronto Western Hospital, The University of Toronto, Toronto, Ontario, Canada
| | - Renhua Wu
- Department of Medical Imaging, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - David J Mikulis
- Joint Department of Medical Imaging, University Health Network, The Toronto Western Hospital, The University of Toronto, Toronto, Ontario, Canada
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24
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Chan ST, Ordway C, Calvanio RJ, Buonanno FS, Rosen BR, Kwong KK. Cerebrovascular Responses to O 2-CO 2 Exchange Ratio under Brief Breath-Hold Challenge in Patients with Chronic Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:2851-2861. [PMID: 34210158 PMCID: PMC8820289 DOI: 10.1089/neu.2021.0166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Breath-by-breath oxygen-carbon dioxide (O2-CO2) exchange ratio (bER) is a respiratory gas exchange (RGE) metric, which is the ratio of the changes in the partial pressure of O2 (ΔPO2) to CO2 (ΔPCO2) between end-inspiration and end-expiration, has been demonstrated to characterize the cerebrovascular responses to breath-hold challenge in healthy individuals. We aimed to explore whether bER could characterize cerebrovascular responses in patients with chronic mild traumatic brain injury (mTBI) under breath-hold challenge. We also investigated the correlation between bER and the severity of post-concussion symptoms. Blood-oxygenation-level-dependent (BOLD) images were acquired using functional magnetic resonance imaging (fMRI) on 10 patients with chronic mTBI and 10 controls without brain injury history when performing a breath-hold task. Time series of RGE metrics of ΔPO2, ΔPCO2, and bER were computed, and their cross-correlation with regional change in BOLD (ΔBOLD) was calculated. Symptom burden was assessed using the Rivermead Post Concussion Questionnaire (RPQ), and its correlation with RGE changes was also measured. Compared with controls, a diffuse decrease in the correlation between regional ΔBOLD and bER was found in the brain of patients with mTBI (pfdr < 0.05). No significant difference was found between patients and controls for the correlation of regional ΔBOLD with ΔPO2 and ΔPCO2. Symptom severity indicated by RPQ scores increased with a decrease in the averaged changes of bER (ρ = 0.79, p = 0.01) and ΔPO2 (ρ = 0.70, p = 0.03) in breath-hold epochs. Our imaging and symptom severity findings suggest that bER can be used to characterize cerebrovascular responses to breath hold in patients with mTBI. The RGE may contribute to the post-concussive symptom severity.
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Affiliation(s)
- Suk-Tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Cora Ordway
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Ronald J. Calvanio
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Bruce R. Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Kenneth K. Kwong
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
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25
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Hemodynamic evaluation of patients with Moyamoya Angiopathy: comparison of resting-state fMRI to breath-hold fMRI and [ 15O]water PET. Neuroradiology 2021; 64:553-563. [PMID: 34570251 PMCID: PMC8850258 DOI: 10.1007/s00234-021-02814-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/09/2021] [Indexed: 11/27/2022]
Abstract
Purpose Patients with Moyamoya Angiopathy (MMA) require hemodynamic evaluation to assess the risk of stroke. Assessment of cerebral blood flow with [15O]water PET and acetazolamide challenge is the diagnostic standard for the evaluation of the cerebral perfusion reserve (CPR). Estimation of the cerebrovascular reactivity (CVR) by use of breath-hold-triggered fMRI (bh-fMRI) as an index of CPR has been proposed as a reliable and more readily available approach. Recent findings suggest the use of resting-state fMRI (rs-fMRI) which requires minimum patient compliance. The aim of this study was to compare rs-fMRI to bh-fMRI and [15O]water PET in patients with MMA. Methods Patients with MMA underwent rs-fMRI and bh-fMRI in the same MRI session. Maps of the CVR gained by both modalities were compared retrospectively by calculating the correlation between the mean CVR of 12 volumes of interest. Additionally, the rs-maps of a subgroup of patients were compared to CPR-maps gained by [15O]water PET. Results The comparison of the rs-maps and the bh-maps of 24 patients revealed a good correlation (Pearson’s r = 0.71 ± 0.13; preoperative patients: Pearson’s r = 0.71 ± 0.17; postoperative patients: Pearson’s r = 0.71 ± 0.11). The comparison of 7 rs-fMRI data sets to the corresponding [15O]water PET data sets also revealed a high level of agreement (Pearson’s r = 0.80 ± 0.19). Conclusion The present analysis indicates that rs-fMRI might be a promising non-invasive method with almost no patient cooperation needed to evaluate the CVR. Further prospective studies are required.
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Morales H. Current and Future Challenges of Functional MRI and Diffusion Tractography in the Surgical Setting: From Eloquent Brain Mapping to Neural Plasticity. Semin Ultrasound CT MR 2021; 42:474-489. [PMID: 34537116 DOI: 10.1053/j.sult.2021.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Decades ago, Spetzler (1986) and Sawaya (1998) provided a rough brain segmentation of the eloquent areas of the brain, aimed to help surgical decisions in cases of vascular malformations and tumors, respectively. Currently in clinical use, their criteria are in need of revision. Defining functions (eg, sensorimotor, language and visual) that should be preserved during surgery seems a straightforward task. In practice, locating the specific areas that could cause a permanent vs transient deficit is not an easy task. This is particularly true for the associative cortex and cognitive domains such as language. The old model, with Broca's and Wernicke's areas at the forefront, has been superseded by a dual-stream model of parallel language processing; named ventral and dorsal pathways. This complicated network of cortical hubs and subcortical white matter pathways needing preservation during surgery is a work in progress. Preserving not only cortical regions but most importantly preserving the connections, or white matter fiber bundles, of core regions in the brain is the new paradigm. For instance, the arcuate fascicululs and inferior fronto-occipital fasciculus are key components of the dorsal and ventral language pathways, respectively; and their damage result in permanent language deficits. Interestedly, the damage of the temporal portions of these bundles -where there is a crossroad with other multiple bundles-, appears to be more important (permanent) than the damage of the frontal portions - where plasticity and contralateral activation could help. Although intraoperative direct cortical and subcortical stimulation have contributed largely, advanced MR techniques such as functional MRI (fMRI) and diffusion tractography (DT), are at the epi-center of our current understanding. Nevertheless, these techniques posse important challenges: such as neurovascular uncoupling or venous bias on fMRI; and appropriate anatomical validation or accurate representation of crossing fibers on DT. These limitations should be well understood and taken into account in clinical practice. Unifying multidisciplinary research and clinical efforts is desirable, so these techniques could contribute more efficiently not only to locate eloquent areas but to improve outcomes and our understanding of neural plasticity. Finally, although there are constant anatomical and functional regions at the individual level, there is a known variability at the inter-individual level. This concept should strengthen the importance of a personalized approach when evaluating these regions on fMRI and DT. It should strengthen the importance of personalized treatments as well, aimed to meet tailored needs and expectations.
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Affiliation(s)
- Humberto Morales
- Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH.
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27
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Fesharaki NJ, Mathew AB, Mathis JR, Huddleston WE, Reuss JL, Pillai JJ, DeYoe EA. Effects of Thresholding on Voxel-Wise Correspondence of Breath-Hold and Resting-State Maps of Cerebrovascular Reactivity. Front Neurosci 2021; 15:654957. [PMID: 34504411 PMCID: PMC8421787 DOI: 10.3389/fnins.2021.654957] [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: 01/18/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
Functional magnetic resonance imaging for presurgical brain mapping enables neurosurgeons to identify viable tissue near a site of operable pathology which might be at risk of surgery-induced damage. However, focal brain pathology (e.g., tumors) may selectively disrupt neurovascular coupling while leaving the underlying neurons functionally intact. Such neurovascular uncoupling can result in false negatives on brain activation maps thereby compromising their use for surgical planning. One way to detect potential neurovascular uncoupling is to map cerebrovascular reactivity using either an active breath-hold challenge or a passive resting-state scan. The equivalence of these two methods has yet to be fully established, especially at a voxel level of resolution. To quantitatively compare breath-hold and resting-state maps of cerebrovascular reactivity, we first identified threshold settings that optimized coverage of gray matter while minimizing false responses in white matter. When so optimized, the resting-state metric had moderately better gray matter coverage and specificity. We then assessed the spatial correspondence between the two metrics within cortical gray matter, again, across a wide range of thresholds. Optimal spatial correspondence was strongly dependent on threshold settings which if improperly set tended to produce statistically biased maps. When optimized, the two CVR maps did have moderately good correspondence with each other (mean accuracy of 73.6%). Our results show that while the breath-hold and resting-state maps may appear qualitatively similar they are not quantitatively identical at a voxel level of resolution.
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Affiliation(s)
- Nooshin J Fesharaki
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, United States.,Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Amy B Mathew
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jedidiah R Mathis
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Wendy E Huddleston
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - James L Reuss
- Prism Clinical Imaging, Inc., Milwaukee, WI, United States
| | - Jay J Pillai
- Neuroradiology Division, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Edgar A DeYoe
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
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fMRI Retinotopic Mapping in Patients with Brain Tumors and Space-Occupying Brain Lesions in the Area of the Occipital Lobe. Cancers (Basel) 2021; 13:cancers13102439. [PMID: 34069930 PMCID: PMC8157607 DOI: 10.3390/cancers13102439] [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: 04/29/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Functional magnetic resonance imaging (fMRI) in patients with brain tumors enables the visualization of eloquent cortical areas and can be used for planning surgical interventions and assessing the risk of postoperative functional deficits. While preoperative fMRI paradigms used to determine the localization of speech-critical or motor areas dominate the literature, there are hardly any studies that investigate the retinotopic organization of the visual field in patients with occipital lesions or tumors. The aim of this study was to evaluate the effect of a brain tumor or space-occupying brain lesions on the retinotopic organization of the occipital cortex, the activation of and the functional connectivity between cortical areas involved in visual processing. We found a high degree of similarity in the activation profiles of patients and healthy controls, indicating that the retinotopic organization of the visual cortex can reliably be described by fMRI retinotopic mapping as part of the preoperative examination of patients with tumors and space-occupying brain lesions. Abstract Functional magnetic resonance imaging (fMRI) is a valuable tool in the clinical routine of neurosurgery when planning surgical interventions and assessing the risk of postoperative functional deficits. Here, we examined how the presence of a brain tumor or lesion in the area of the occipital lobe affects the results of fMRI retinotopic mapping. fMRI data were evaluated on a retrospectively selected sample of 12 patients with occipital brain tumors, 7 patients with brain lesions and 19 control subjects. Analyses of the cortical activation, percent signal change, cluster size of the activated voxels and functional connectivity were carried out using Statistical Parametric Mapping (SPM12) and the CONN and Marsbar toolboxes. We found similar but reduced patterns of cortical activation and functional connectivity between the two patient groups compared to a healthy control group. Here, we found that retinotopic organization was well-preserved in the patients and was comparable to that of the age-matched controls. The results also showed that, compared to the tumor patients, the lesion patients showed higher percent signal changes but lower values in the cluster sizes of the activated voxels in the calcarine fissure region. Our results suggest that the lesion patients exhibited results that were more similar to those of the control subjects in terms of the BOLD signal, whereas the extent of the activation was comparable to that of the tumor patients.
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Jalilianhasanpour R, Beheshtian E, Ryan D, Luna LP, Agarwal S, Pillai JJ, Sair HI, Gujar SK. Role of Functional Magnetic Resonance Imaging in the Presurgical Mapping of Brain Tumors. Radiol Clin North Am 2021; 59:377-393. [PMID: 33926684 DOI: 10.1016/j.rcl.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
When planning for brain tumor resection, a balance between maximizing resection and minimizing injury to eloquent brain parenchyma is paramount. The advent of blood oxygenation level-dependent functional magnetic resonance (fMR) imaging has allowed researchers and clinicians to reliably measure physiologic fluctuations in brain oxygenation related to neuronal activity with good spatial resolution. fMR imaging can offer a unique insight into preoperative planning for brain tumors by identifying eloquent areas of the brain affected or spared by the neoplasm. This article discusses the fMR imaging techniques and their applications in neurosurgical planning.
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Affiliation(s)
- Rozita Jalilianhasanpour
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Elham Beheshtian
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Daniel Ryan
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Licia P Luna
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Shruti Agarwal
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Jay J Pillai
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Haris I Sair
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA
| | - Sachin K Gujar
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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30
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Distinct Cerebrovascular Reactivity Patterns for Brain Radiation Necrosis. Cancers (Basel) 2021; 13:cancers13081840. [PMID: 33924308 PMCID: PMC8069508 DOI: 10.3390/cancers13081840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Current imaging-based discrimination between radiation necrosis versus recurrent glioblastoma contrast-enhancing lesions remains imprecise but is paramount for prognostic and therapeutic evaluation. We examined whether patients with radiation necrosis exhibit distinct patterns of blood oxygenation-level dependent fMRI cerebrovascular reactivity (BOLD-CVR) as the first step to better distinguishing patients with radiation necrosis from recurrent glioblastoma compared with patients with newly diagnosed glioblastoma before surgery and radiotherapy. Methods: Eight consecutive patients with primary and secondary brain tumors and a multidisciplinary clinical and radiological diagnosis of radiation necrosis, and fourteen patients with a first diagnosis of glioblastoma underwent BOLD-CVR mapping. For all these patients, the contrast-enhancing lesion was derived from high-resolution T1-weighted MRI and rendered the volume-of-interest (VOI). From this primary VOI, additional 3 mm concentric expanding VOIs up to 30 mm were created for a detailed perilesional BOLD-CVR tissue analysis between the two groups. Receiver operating characteristic curves assessed the discriminative properties of BOLD-CVR for both groups. Results: Mean intralesional BOLD-CVR values were markedly lower in radiation necrosis than in glioblastoma contrast-enhancing lesions (0.001 ± 0.06 vs. 0.057 ± 0.05; p = 0.04). Perilesionally, a characteristic BOLD-CVR pattern was observed for radiation necrosis and glioblastoma patients, with an improvement of BOLD-CVR values in the radiation necrosis group and persisting lower perilesional BOLD-CVR values in glioblastoma patients. The ROC analysis discriminated against both groups when these two parameters were analyzed together (area under the curve: 0.85, 95% CI: 0.65-1.00). Conclusions: In this preliminary analysis, distinctive intralesional and perilesional BOLD-cerebrovascular reactivity patterns are found for radiation necrosis.
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31
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Sebök M, van Niftrik CHB, Muscas G, Pangalu A, Seystahl K, Weller M, Regli L, Fierstra J. Hypermetabolism and impaired cerebrovascular reactivity beyond the standard MRI-identified tumor border indicate diffuse glioma extended tissue infiltration. Neurooncol Adv 2021; 3:vdab048. [PMID: 34056603 PMCID: PMC8156976 DOI: 10.1093/noajnl/vdab048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Diffuse gliomas exhibit diffuse infiltrative growth, often beyond the magnetic resonance imaging (MRI)-detectable tumor lesion. Within this lesion, hypermetabolism and impaired cerebrovascular reactivity (CVR) are found, but its exact distribution pattern into the peritumoral environment is unknown. Our aim was to better characterize the extent of diffuse glioma tissue infiltration, beyond the visible lesion (ie, beyond the T1-contrast-enhancing lesion and/or T2/FLAIR-defined tumor border), with metabolic positron emission tomography (PET), and functional MRI CVR (blood oxygenation-level-dependent CVR [BOLD-CVR]) mapping. Methods From a prospective glioma database, 18 subjects (19 datasets) with diffuse glioma (n = 2 with anaplastic astrocytoma, n = 10 with anaplastic oligodendroglioma, and n = 7 with glioblastoma) underwent a BOLD-CVR and metabolic PET study between February 2016 and September 2019, 7 of them at primary diagnosis and 12 at tumor recurrence. In addition, 19 matched healthy controls underwent an identical BOLD-CVR study. The tumor lesion was defined using high-resolution anatomical MRI. Volumes of interest starting from the tumor lesion outward up to 30 mm were created for a detailed peritumoral PET and BOLD-CVR tissue analysis. Student’s t test was used for statistical analysis. Results Patients with diffuse glioma exhibit impaired BOLD-CVR 12 mm beyond the tumor lesion (P = .02) with normalization of BOLD-CVR values after 24 mm. Metabolic PET shows a difference between the affected and contralateral hemisphere of 6 mm (P = .05) with PET values normalization after 12 mm. Conclusion We demonstrate hypermetabolism and impaired CVR beyond the standard MRI-defined tumor border, suggesting active tumor infiltration in the peritumoral environment.
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Affiliation(s)
- Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Giovanni Muscas
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Careggi University Hospital, Florence, Italy
| | - Athina Pangalu
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katharina Seystahl
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
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32
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Sleight E, Stringer MS, Marshall I, Wardlaw JM, Thrippleton MJ. Cerebrovascular Reactivity Measurement Using Magnetic Resonance Imaging: A Systematic Review. Front Physiol 2021; 12:643468. [PMID: 33716793 PMCID: PMC7947694 DOI: 10.3389/fphys.2021.643468] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022] Open
Abstract
Cerebrovascular reactivity (CVR) magnetic resonance imaging (MRI) probes cerebral haemodynamic changes in response to a vasodilatory stimulus. CVR closely relates to the health of the vasculature and is therefore a key parameter for studying cerebrovascular diseases such as stroke, small vessel disease and dementias. MRI allows in vivo measurement of CVR but several different methods have been presented in the literature, differing in pulse sequence, hardware requirements, stimulus and image processing technique. We systematically reviewed publications measuring CVR using MRI up to June 2020, identifying 235 relevant papers. We summarised the acquisition methods, experimental parameters, hardware and CVR quantification approaches used, clinical populations investigated, and corresponding summary CVR measures. CVR was investigated in many pathologies such as steno-occlusive diseases, dementia and small vessel disease and is generally lower in patients than in healthy controls. Blood oxygen level dependent (BOLD) acquisitions with fixed inspired CO2 gas or end-tidal CO2 forcing stimulus are the most commonly used methods. General linear modelling of the MRI signal with end-tidal CO2 as the regressor is the most frequently used method to compute CVR. Our survey of CVR measurement approaches and applications will help researchers to identify good practice and provide objective information to inform the development of future consensus recommendations.
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Affiliation(s)
- Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael S. Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom,*Correspondence: Michael S. Stringer
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
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33
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Solis-Barquero SM, Echeverria-Chasco R, Calvo-Imirizaldu M, Cacho-Asenjo E, Martinez-Simon A, Vidorreta M, Dominguez PD, García de Eulate R, Fernandez-Martinez M, Fernández-Seara MA. Breath-Hold Induced Cerebrovascular Reactivity Measurements Using Optimized Pseudocontinuous Arterial Spin Labeling. Front Physiol 2021; 12:621720. [PMID: 33679436 PMCID: PMC7925895 DOI: 10.3389/fphys.2021.621720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
A pseudocontinuous arterial spin labeling (PCASL) sequence combined with background suppression and single-shot accelerated 3D RARE stack-of-spirals was used to evaluate cerebrovascular reactivity (CVR) induced by breath-holding (BH) in ten healthy volunteers. Four different models designed using the measured change in PETCO2 induced by BH were compared, for CVR quantification. The objective of this comparison was to understand which regressor offered a better physiological model to characterize the cerebral blood flow response under BH. The BH task started with free breathing of 42 s, followed by interleaved end-expiration BHs of 21 s, for ten cycles. The total scan time was 12 min and 20 s. The accelerated readout allowed the acquisition of PCASL data with better temporal resolution than previously used, without compromising the post-labeling delay. Elevated CBF was observed in most cerebral regions under hypercapnia, which was delayed with respect to the BH challenge. Significant statistical differences in CVR were obtained between the different models in GM (p < 0.0001), with ramp models yielding higher values than boxcar models and between the two tissues, GM and WM, with higher values in GM, in all the models (p < 0.0001). The adjustment of the ramp amplitude during each BH cycle did not improve the results compared with a ramp model with a constant amplitude equal to the mean PETCO2 change during the experiment.
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Affiliation(s)
| | - Rebeca Echeverria-Chasco
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | | | - Elena Cacho-Asenjo
- Department of Anesthesia, Perioperative Medicine and Critical Care, Clínica Universidad de Navarra, Pamplona, Spain
| | - Antonio Martinez-Simon
- Department of Anesthesia, Perioperative Medicine and Critical Care, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Pablo D Dominguez
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | | | | | - María A Fernández-Seara
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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34
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Kaczmarz S, Göttler J, Petr J, Hansen MB, Mouridsen K, Zimmer C, Hyder F, Preibisch C. Hemodynamic impairments within individual watershed areas in asymptomatic carotid artery stenosis by multimodal MRI. J Cereb Blood Flow Metab 2021; 41:380-396. [PMID: 32237952 PMCID: PMC7812517 DOI: 10.1177/0271678x20912364] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Improved understanding of complex hemodynamic impairments in asymptomatic internal carotid artery stenosis (ICAS) is crucial to better assess stroke risks. Multimodal MRI is ideal for measuring brain hemodynamics and has the potential to improve diagnostics and treatment selections. We applied MRI-based perfusion and oxygenation-sensitive imaging in ICAS with the hypothesis that the sensitivity to hemodynamic impairments will improve within individual watershed areas (iWSA). We studied cerebral blood flow (CBF), cerebrovascular reactivity (CVR), relative cerebral blood volume (rCBV), relative oxygen extraction fraction (rOEF), oxygen extraction capacity (OEC) and capillary transit-time heterogeneity (CTH) in 29 patients with asymptomatic, unilateral ICAS (age 70.3 ± 7.0 y) and 30 age-matched healthy controls. In ICAS, we found significant impairments of CBF, CVR, rCBV, OEC, and CTH (strongest lateralization ΔCVR = -24%), but not of rOEF. Although the spatial overlap of compromised hemodynamic parameters within each patient varied in a complex manner, most pronounced changes of CBF, CVR and rCBV were detected within iWSAs (strongest effect ΔCVR = +117%). At the same time, CTH impairments were iWSA independent, indicating widespread dysfunction of capillary-level oxygen diffusivity. In summary, complementary MRI-based perfusion and oxygenation parameters offer deeper perspectives on complex microvascular impairments in individual patients. Furthermore, knowledge about iWSAs improves the sensitivity to hemodynamic impairments.
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Affiliation(s)
- Stephan Kaczmarz
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany.,MRRC, Yale University, New Haven, CT, USA
| | - Jens Göttler
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany.,MRRC, Yale University, New Haven, CT, USA.,Department of Radiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Jan Petr
- PET Center, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Mikkel Bo Hansen
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Kim Mouridsen
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Claus Zimmer
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | | | - Christine Preibisch
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany.,Clinic for Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
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35
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Pinto J, Bright MG, Bulte DP, Figueiredo P. Cerebrovascular Reactivity Mapping Without Gas Challenges: A Methodological Guide. Front Physiol 2021; 11:608475. [PMID: 33536935 PMCID: PMC7848198 DOI: 10.3389/fphys.2020.608475] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023] Open
Abstract
Cerebrovascular reactivity (CVR) is defined as the ability of vessels to alter their caliber in response to vasoactive factors, by means of dilating or constricting, in order to increase or decrease regional cerebral blood flow (CBF). Importantly, CVR may provide a sensitive biomarker for pathologies where vasculature is compromised. Furthermore, the spatiotemporal dynamics of CVR observed in healthy subjects, reflecting regional differences in cerebral vascular tone and response, may also be important in functional MRI studies based on neurovascular coupling mechanisms. Assessment of CVR is usually based on the use of a vasoactive stimulus combined with a CBF measurement technique. Although transcranial Doppler ultrasound has been frequently used to obtain global flow velocity measurements, MRI techniques are being increasingly employed for obtaining CBF maps. For the vasoactive stimulus, vasodilatory hypercapnia is usually induced through the manipulation of respiratory gases, including the inhalation of increased concentrations of carbon dioxide. However, most of these methods require an additional apparatus and complex setups, which not only may not be well-tolerated by some populations but are also not widely available. For these reasons, strategies based on voluntary breathing fluctuations without the need for external gas challenges have been proposed. These include the task-based methodologies of breath holding and paced deep breathing, as well as a new generation of methods based on spontaneous breathing fluctuations during resting-state. Despite the multitude of alternatives to gas challenges, existing literature lacks definitive conclusions regarding the best practices for the vasoactive modulation and associated analysis protocols. In this work, we perform an extensive review of CVR mapping techniques based on MRI and CO2 variations without gas challenges, focusing on the methodological aspects of the breathing protocols and corresponding data analysis. Finally, we outline a set of practical guidelines based on generally accepted practices and available data, extending previous reports and encouraging the wider application of CVR mapping methodologies in both clinical and academic MRI settings.
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Affiliation(s)
- Joana Pinto
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Molly G. Bright
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Daniel P. Bulte
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Patrícia Figueiredo
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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36
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Shafi R, Poublanc J, Venkatraghavan L, Crawley AP, Sobczyk O, McKetton L, Bayley M, Chandra T, Foster E, Ruttan L, Comper P, Tartaglia MC, Tator CH, Duffin J, Mutch WA, Fisher J, Mikulis DJ. A Promising Subject-Level Classification Model for Acute Concussion Based on Cerebrovascular Reactivity Metrics. J Neurotrauma 2020; 38:1036-1047. [PMID: 33096952 DOI: 10.1089/neu.2020.7272] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Concussion imaging research has primarily focused on neuronal disruption with lesser emphasis directed toward vascular dysfunction. However, blood flow metrics may be more sensitive than measures of neuronal integrity. Vascular dysfunction can be assessed by measuring cerebrovascular reactivity (CVR)-the change in cerebral blood flow per unit change in vasodilatory stimulus. CVR metrics, including speed and magnitude of flow responses to a standardized well-controlled vasoactive stimulus, are potentially useful for assessing individual subjects following concussion given that blood flow dysregulation is known to occur with traumatic brain injury. We assessed changes in CVR metrics to a standardized vasodilatory stimulus during the acute phase of concussion. Using a case control design, 20 concussed participants and 20 healthy controls (HCs) underwent CVR assessment measuring blood oxygen-level dependent (BOLD) magnetic resonance imaging using precise changes in end-tidal partial pressure of CO2 (PETCO2). Metrics were calculated for the whole brain, gray matter (GM), and white matter (WM) using sex-stratification. A leave-one-out receiver operating characteristic (ROC) analysis classified concussed from HCs based on CVR metrics. CVR magnitude was greater and speed of response faster in concussed participants relative to HCs, with WM showing higher classification accuracy compared with GM. ROC analysis for WM-CVR metrics revealed an area under the curve of 0.94 in males and 0.90 in females for speed and magnitude of response respectively. These greater than normal responses to a vasodilatory stimulus warrant further investigation to compare the predictive ability of CVR metrics against structural injury metrics for diagnosis and prognosis in acute concussion.
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Affiliation(s)
- Reema Shafi
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Lashmi Venkatraghavan
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adrian P Crawley
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Olivia Sobczyk
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Larissa McKetton
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Tharshini Chandra
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Evan Foster
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Lesley Ruttan
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Canadian Concussion Center, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Paul Comper
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Tanz Center for Research in Neurodegenerative Diseases, Toronto, Ontario, Canada.,Canadian Concussion Center, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Charles H Tator
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Canadian Concussion Center, Toronto Western Hospital, Toronto, Ontario, Canada
| | - James Duffin
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - W Alan Mutch
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph Fisher
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Canadian Concussion Center, Toronto Western Hospital, Toronto, Ontario, Canada
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Abstract
Neurovascular uncoupling (NVU) is one of the most important confounds of blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMR imaging) in the setting of focal brain lesions such as brain tumors. This article reviews the assessment of NVU related to focal brain lesions with emphasis on the use of cerebrovascular reactivity mapping measurement methods and resting state BOLD fMR imaging metrics in the detection of NVU, as well as the use of amplitude of low-frequency fluctuation metrics to mitigate the effects of NVU on clinical fMR imaging activation.
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Affiliation(s)
- Shruti Agarwal
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Haris I Sair
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jay J Pillai
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
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38
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Moia S, Stickland RC, Ayyagari A, Termenon M, Caballero-Gaudes C, Bright MG. Voxelwise optimization of hemodynamic lags to improve regional CVR estimates in breath-hold fMRI. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1489-1492. [PMID: 33018273 DOI: 10.1109/embc44109.2020.9176225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cerebrovascular Reactivity (CVR), the responsiveness of blood vessels to a vasodilatory stimulus, is an important indicator of cerebrovascular health. Assessing CVR with fMRI, we can measure the change in the Blood Oxygen Level Dependent (BOLD) response induced by a change in CO2 pressure (%BOLD/mmHg). However, there exists a temporal offset between the recorded CO2 pressure and the local BOLD response, due to both measurement and physiological delays. If this offset is not corrected for, voxel-wise CVR values will not be accurate. In this paper, we propose a framework for mapping hemodynamic lag in breath-hold fMRI data. As breath-hold tasks drive task-correlated head motion artifacts in BOLD fMRI data, our framework for lag estimation fits a model that includes polynomial terms and head motion parameters, as well as a shifted variant of the CO2 regressor (±9 s in 0.3 s increments), and the hemodynamic lag at each voxel is the shift producing the maximum total model R2 within physiological constraints. This approach is evaluated in 8 subjects with multi-echo fMRI data, resulting in robust maps of hemodynamic delay that show consistent regional variation across subjects, and improved contrast-to-noise compared to methods where motion regression is ignored or performed earlier in preprocessing.Clinical Relevance- We map hemodynamic lag using breathhold fMRI, providing insight into vascular transit times and improving the regional accuracy of cerebrovascular reactivity measurements.
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39
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Ni L, Zhang B, Yang D, Qin R, Xu H, Ma J, Shao P, Xu Y. Lower Cerebrovascular Reactivity Contributed to White Matter Hyperintensity-Related Cognitive Impairment: A Resting-State Functional MRI Study. J Magn Reson Imaging 2020; 53:703-711. [PMID: 32996183 DOI: 10.1002/jmri.27376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Impaired cerebrovascular reactivity (CVR) plays an important role in the pathophysiology of white matter hyperintensities (WMHs). The pathogenesis of CVR in the development of WMH-related cognitive impairment (CI) remains poorly understood. PURPOSE To detect the CVR status in WMH subjects with/without CI by using a resting-state blood oxygenation level-dependent (BOLD) approach and to explore the mediating relationships among CVR, WMH, and cognitive level. STUDY TYPE Prospective. SUBJECTS Subjects with moderate to severe WMH (with CI [WMH-CI], n = 68; without CI [WMH-no-CI, n = 63) as well as normal controls (NCs, n = 87). FIELD STRENGTH/SEQUENCE 3.0T with gradient-recalled echoplanar imaging and 3D fluid-attenuated inversion recovery. ASSESSMENT The CVR, WMH volume, and cognitive level were assessed. The CVR map was derived using BOLD signal obtained from resting-state functional MRI data. STATISTICAL TESTS CVR maps were compared among the three groups. Partial correlation analyses were performed to correlate impaired CVR with WMH volume and cognitive test scores. Mediation analysis was conducted to determine whether WMH acted as a mediating factor between CVR and cognitive function. RESULTS Compared with the NC group, both WMH groups showed reduced CVR in the left hemisphere (P < 0.05). The WMH-CI group showed further decreased CVR in the left frontal area, when compared with the WMH-no-CI group (P < 0.05). In the WMH-CI group, the lower CVR in left frontal area was a strong indicator of poor performance on general cognition (r = 0.311), executive function (r = 0.362), and information processing speed (r = 0.399) (all P < 0.05). Periventricular WMH (PWMH) volume mediated these correlations, the β and 95% bootstrap confidence intervals were (0.5097, [0.1498,1.1385]), (-0.4081, [-1.0256,-0.1363]), and (-0.5576, [-1.4666,-0.1538]), respectively. DATA CONCLUSION WMH-CI subjects showed a greater reduction of CVR derived from a resting-state BOLD approach in the left frontal area than WMH-no-CI subjects. Cognition was highly dependent on the integrity of cerebrovascular reactivity and mediated by PWMH burden. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ling Ni
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Dan Yang
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ruomeng Qin
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hengheng Xu
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Junyi Ma
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Pengfei Shao
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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40
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Abstract
Magnetic resonance imaging (MRI) has been the cornerstone of imaging of brain tumors in the past 4 decades. Conventional MRI remains the workhorse for neuro-oncologic imaging, not only for basic information such as location, extent, and navigation but also able to provide information regarding proliferation and infiltration, angiogenesis, hemorrhage, and more. More sophisticated MRI sequences have extended the ability to assess and quantify these features; for example, permeability and perfusion acquisitions can assess blood-brain barrier disruption and angiogenesis, diffusion techniques can assess cellularity and infiltration, and spectroscopy can address metabolism. Techniques such as fMRI and diffusion fiber tracking can be helpful in diagnostic planning for resection and radiation therapy, and more sophisticated iterations of these techniques can extend our understanding of neurocognitive effects of these tumors and associated treatment responses and effects. More recently, MRI has been used to go beyond such morphological, physiological, and functional characteristics to assess the tumor microenvironment. The current review highlights multiple recent and emerging approaches in MRI to characterize the tumor microenvironment.
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41
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Bright MG, Whittaker JR, Driver ID, Murphy K. Vascular physiology drives functional brain networks. Neuroimage 2020; 217:116907. [PMID: 32387624 PMCID: PMC7339138 DOI: 10.1016/j.neuroimage.2020.116907] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 04/27/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022] Open
Abstract
We present the first evidence for vascular regulation driving fMRI signals in specific functional brain networks. Using concurrent neuronal and vascular stimuli, we collected 30 BOLD fMRI datasets in 10 healthy individuals: a working memory task, flashing checkerboard stimulus, and CO2 inhalation challenge were delivered in concurrent but orthogonal paradigms. The resulting imaging data were averaged together and decomposed using independent component analysis, and three "neuronal networks" were identified as demonstrating maximum temporal correlation with the neuronal stimulus paradigms: Default Mode Network, Task Positive Network, and Visual Network. For each of these, we observed a second network component with high spatial overlap. Using dual regression in the original 30 datasets, we extracted the time-series associated with these network pairs and calculated the percent of variance explained by the neuronal or vascular stimuli using a normalized R2 parameter. In each pairing, one network was dominated by the appropriate neuronal stimulus, and the other was dominated by the vascular stimulus as represented by the end-tidal CO2 time-series recorded in each scan. We acquired a second dataset in 8 of the original participants, where no CO2 challenge was delivered and CO2 levels fluctuated naturally with breathing variations. Although splitting of functional networks was not robust in these data, performing dual regression with the network maps from the original analysis in this new dataset successfully replicated our observations. Thus, in addition to responding to localized metabolic changes, the brain's vasculature may be regulated in a coordinated manner that mimics (and potentially supports) specific functional brain networks. Multi-modal imaging and advances in fMRI acquisition and analysis could facilitate further study of the dual nature of functional brain networks. It will be critical to understand network-specific vascular function, and the behavior of a coupled vascular-neural network, in future studies of brain pathology.
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Affiliation(s)
- Molly G Bright
- Department of Physical Therapy and Human Movement Science, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA; Department of Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, 60201, USA.
| | - Joseph R Whittaker
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
| | - Ian D Driver
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, CF10 3AT, United Kingdom
| | - Kevin Murphy
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
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42
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Wu PH, Rodríguez-Soto AE, Rodgers ZB, Englund EK, Wiemken A, Langham MC, Detre JA, Schwab RJ, Guo W, Wehrli FW. MRI evaluation of cerebrovascular reactivity in obstructive sleep apnea. J Cereb Blood Flow Metab 2020; 40:1328-1337. [PMID: 31307289 PMCID: PMC7238371 DOI: 10.1177/0271678x19862182] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obstructive sleep apnea (OSA) is characterized by intermittent obstruction of the airways during sleep. Cerebrovascular reactivity (CVR) is an index of cerebral vessels' ability to respond to a vasoactive stimulus, such as increased CO2. We hypothesized that OSA alters CVR, expressed as a breath-hold index (BHI) defined as the rate of change in CBF or BOLD signal during a controlled breath-hold stimulus mimicking spontaneous apneas by being both hypercapnic and hypoxic. In 37 OSA and 23 matched non sleep apnea (NSA) subjects, we obtained high temporal resolution CBF and BOLD MRI data before, during, and between five consecutive BH stimuli of 24 s, each averaged to yield a single BHI value. Greater BHI was observed in OSA relative to NSA as derived from whole-brain CBF (78.6 ± 29.6 vs. 60.0 ± 20.0 mL/min2/100 g, P = 0.010) as well as from flow velocity in the superior sagittal sinus (0.48 ± 0.18 vs. 0.36 ± 0.10 cm/s2, P = 0.014). Similarly, BOLD-based BHI was greater in OSA in whole brain (0.19 ± 0.08 vs. 0.15 ± 0.03%/s, P = 0.009), gray matter (0.22 ± 0.09 vs. 0.17 ± 0.03%/s, P = 0.011), and white matter (0.14 ± 0.06 vs. 0.10 ± 0.02%/s, P = 0.010). The greater CVR is not currently understood but may represent a compensatory mechanism of the brain to maintain oxygen supply during intermittent apneas.
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Affiliation(s)
- Pei-Hsin Wu
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Ana E Rodríguez-Soto
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Zachary B Rodgers
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Erin K Englund
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Andrew Wiemken
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Michael C Langham
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Wensheng Guo
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
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43
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Muscas G, van Niftrik CHB, Sebök M, Seystahl K, Piccirelli M, Stippich C, Weller M, Regli L, Fierstra J. Hemodynamic investigation of peritumoral impaired blood oxygenation-level dependent cerebrovascular reactivity in patients with diffuse glioma. Magn Reson Imaging 2020; 70:50-56. [PMID: 32302735 DOI: 10.1016/j.mri.2020.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The presence of peritumorally impaired blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) has been unequivocally demonstrated in patients with diffuse glioma, and may have value to better identify tumor infiltration zone. Since BOLD-CVR does not measure hemodynamic changes directly, we performed additional MR perfusion studies to better characterize the peritumoral hemodynamic environment. METHODS Seventeen patients with WHO grade III and IV diffuse glioma underwent high resolution advanced hemodynamic MR imaging including BOLD-CVR and MR perfusion. The obtained multiparametric hemodynamic factors (i.e., regional cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), mean transit time (MTT), time-to-peak (TTP) and BOLD-CVR, were analyzed within 10 concentric expanding 3 mm volumes of interest (VOIs) up to 30 mm from the tumor tissue mask. RESULTS BOLD-CVR impairment was found within the tumor tissue mask and the peritumoral VOIs up to 21 mm as compared to the contralateral flipped CVR analysis (p<0.05). In the affected hemisphere, we observed positive spatial correlations including all VOIs between BOLD-CVR and rCBV values (r=0.27; p<0.001), rCBF (r=0.42; p<0.001) and a negative correlation between BOLD-CVR and TTP (r=-0.47; p<0.001). CONCLUSIONS Peritumorally impaired BOLD-CVR is associated with concomitant hemodynamic alterations with severity correlating to tumor volume. The distribution of these multiparametric hemodynamic MRI patterns may be considered for future studies characterizing the hemodynamic peritumoral environment, thereby better identifying the extent of tumor infiltration.
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Affiliation(s)
- Giovanni Muscas
- Department of Neurosurgery, University Hospital of Zurich and University of Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland; Department of Neurosurgery, Careggi University Hospital, Florence, Italy
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital of Zurich and University of Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Martina Sebök
- Department of Neurosurgery, University Hospital of Zurich and University of Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Katharina Seystahl
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marco Piccirelli
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland; Department of Neuroradiology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - Christoph Stippich
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland; Department of Neuroradiology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital of Zurich and University of Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital of Zurich and University of Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
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44
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Abstract
OBJECTIVE. Functional MRI (fMRI) is clinically used for localization of eloquent cortex before surgical intervention, most commonly motor and language function in patients with tumors or epilepsy. In the pediatric population, special considerations for fMRI relate to limited examination tolerance, small head size, developing anatomy and physiology, and diverse potential abnormalities. In this article, we will highlight pearls and pitfalls of clinical pediatric fMRI including blood oxygenation level-dependent imaging principles, patient preparation, study acquisition, data postprocessing, and examination interpretation. CONCLUSION. Clinical fMRI is indicated for presurgical localization of eloquent cortex in patients with tumors, epilepsy, or other neurologic conditions and requires a solid understanding of technical considerations and data processing. In children, special approaches are needed for patient preparation as well as study design, acquisition, and interpretation. Radiologists should be cognizant of developmental neuroanatomy, causes of neuropathology, and capacity for neuroplasticity in the pediatric population.
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45
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Nishida S, Aso T, Takaya S, Takahashi Y, Kikuchi T, Funaki T, Yoshida K, Okada T, Kunieda T, Togashi K, Fukuyama H, Miyamoto S. Resting-state Functional Magnetic Resonance Imaging Identifies Cerebrovascular Reactivity Impairment in Patients With Arterial Occlusive Diseases: A Pilot Study. Neurosurgery 2020; 85:680-688. [PMID: 30247676 DOI: 10.1093/neuros/nyy434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/16/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The development of noninvasive approaches for identifying hypoperfused brain tissue at risk is of major interest. Recently, the temporal-shift (TS) maps estimated from resting-state blood oxygenation level-dependent (BOLD) signals have been proposed for determining hemodynamic state. OBJECTIVE To examine the equivalency of the TS map and the cerebrovascular reactivity (CVR) map derived from acetazolamide-challenged single-photon emission computed tomography (SPECT) in identifying hemodynamic impairment in patients with arterial occlusive diseases. METHODS Twenty-three patients with arterial occlusive diseases who underwent SPECT were studied. With a recursive TS analysis of low-frequency fluctuation of the BOLD signal, a TS map relative to the global signal was created for each patient. The voxel-by-voxel correlation coefficient was calculated to examine the image similarity between TS and SPECT-based cerebral blood flow (CBF) or CVR maps in each patient. Furthermore, simple linear regression analyses were performed to examine the quantitative relationship between the TS of BOLD signals and CVR in each cerebrovascular territory. RESULTS The within-patient, voxel-by-voxel comparison revealed that the TS map was more closely correlated with SPECT-CVR map ([Z(r)] = 0.42 ± 0.18) than SPECT-CBF map ([Z(r)] = 0.058 ± 0.11; P < .001, paired t-test). The regression analysis showed a significant linear association between the TS of BOLD signals and CVR in the anterior circulation where the reduction of CVR was evident in the patient group. CONCLUSION BOLD TS analysis has potential as a noninvasive alternative to current methods based on CVR for identification of tissue at risk of ischemic stroke.
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Affiliation(s)
- Sei Nishida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan.,Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan
| | - Toshihiko Aso
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan.,Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan
| | - Shigetoshi Takaya
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan.,Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan.,Senri Rehabilitation Hospital, Mino City, Osaka Prefecture, Japan
| | - Yuki Takahashi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan.,Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan
| | - Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan
| | - Tomohisa Okada
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan.,Department of Radiology, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan.,Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon City, Ehime Prefecture, Japan
| | - Kaori Togashi
- Department of Radiology, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan
| | - Hidenao Fukuyama
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto Prefecture, Japan
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Chan ST, Evans KC, Song TY, Selb J, van der Kouwe A, Rosen BR, Zheng YP, Ahn A, Kwong KK. Cerebrovascular reactivity assessment with O2-CO2 exchange ratio under brief breath hold challenge. PLoS One 2020; 15:e0225915. [PMID: 32208415 PMCID: PMC7092994 DOI: 10.1371/journal.pone.0225915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypercapnia during breath holding is believed to be the dominant driver behind the modulation of cerebral blood flow (CBF). However, increasing evidence show that mild hypoxia and mild hypercapnia in breath hold (BH) could work synergistically to enhance CBF response. We hypothesized that breath-by-breath O2-CO2 exchange ratio (bER), defined as the ratio of the change in partial pressure of oxygen (ΔPO2) to that of carbon dioxide (ΔPCO2) between end inspiration and end expiration, would be able to better correlate with the global and regional cerebral hemodynamic responses (CHR) to BH challenge. We aimed to investigate whether bER is a more useful index than end-tidal PCO2 to characterize cerebrovascular reactivity (CVR) under BH challenge. METHODS We used transcranial Doppler ultrasound (TCD) to evaluate CHR under BH challenge by measuring cerebral blood flow velocity (CBFv) in the middle cerebral arteries. Regional changes in CHR to BH and exogenous CO2 challenges were mapped with blood oxygenation level dependent (BOLD) signal changes using functional magnetic resonance imaging (fMRI). We correlated respiratory gas exchange (RGE) metrics (bER, ΔPO2, ΔPCO2, end-tidal PCO2 and PO2, and time of breaths) with CHR (CBFv and BOLD) to BH challenge. Temporal features and frequency characteristics of RGE metrics and their coherence with CHR were examined. RESULTS CHR to brief BH epochs and free breathing were coupled with both ΔPO2 and ΔPCO2. We found that bER was superior to either ΔPO2 or ΔPCO2 alone in coupling with the changes of CBFv and BOLD signals under breath hold challenge. The regional CVR results derived by regressing BOLD signal changes on bER under BH challenge resembled those derived by regressing BOLD signal changes on end-tidal PCO2 under exogenous CO2 challenge. CONCLUSION Our findings provide a novel insight on the potential of using bER to better quantify CVR changes under BH challenge.
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Affiliation(s)
- Suk-tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Karleyton C. Evans
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Tian-yue Song
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Juliette Selb
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Andre van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Bruce R. Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Yong-ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Andrew Ahn
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Kenneth K. Kwong
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
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Peng SL, Yang HC, Chen CM, Shih CT. Short- and long-term reproducibility of BOLD signal change induced by breath-holding at 1.5 and 3 T. NMR IN BIOMEDICINE 2020; 33:e4195. [PMID: 31885110 DOI: 10.1002/nbm.4195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
Cerebrovascular reactivity (CVR) can give insight into the cerebrovascular function. CVR can be estimated by measuring a blood-oxygen-level-dependent (BOLD) response combined with breath-holding (BH). The reproducibility of this technique has been addressed and existing studies have focused on short-term reproducibility using a 3 T magnetic resonance imaging (MRI) system. However, little is known about the long-term reproducibility of this procedure and the corresponding reproducibility using a 1.5 T MRI system. Here, we systematically examined the short- and long-term reproducibility of BOLD responses to BH across field strengths. Nine subjects participated in three MRI sessions separated by 30 minutes (sessions 1 and 2: short term) and 68-92 days (sessions 1 and 3, long term) at both 1.5 and 3 T MRI. Our findings revealed that significant differences between field strengths were detected in the activated gray matter volume and BOLD signal change (both P < 0.001), with smaller magnitudes at 1.5 T. However, activation patterns were reproducible, independent of the time interval, brain region or field strength. All interscan coefficient of variation values were below the 33% fiducial limit, and the intraclass correlation coefficient values were above 0.4, which is usually considered the acceptability limit in functional studies. These findings suggest that the response of BOLD signal to BH for assessing CVR is reproducible over time at 1.5 and 3 T. This technique can be considered a tool for monitoring longitudinal changes in patients with cerebrovascular diseases, and its use should be encouraged for clinical 1.5 T MRI systems.
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Affiliation(s)
- Shin-Lei Peng
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Hui-Chieh Yang
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Chun-Ming Chen
- Department of Radiology, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Ting Shih
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
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Sun H, Vachha B, Laino ME, Jenabi M, Flynn JR, Zhang Z, Holodny AI, Peck KK. Decreased Hand Motor Resting-State Functional Connectivity in Patients with Glioma: Analysis of Factors including Neurovascular Uncoupling. Radiology 2020; 294:610-621. [PMID: 31934827 DOI: 10.1148/radiol.2019190089] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Resting-state functional MRI holds substantial potential for clinical application, but limitations exist in current understanding of how tumors exert local effects on resting-state functional MRI readings. Purpose To investigate the association between tumors, tumor characteristics, and changes in resting-state connectivity, to explore neurovascular uncoupling as a mechanism underlying these changes, and to evaluate seeding methodologies as a clinical tool. Materials and Methods Institutional review board approval was obtained for this HIPAA-compliant observational retrospective study of patients with glioma who underwent MRI and resting-state functional MRI between January 2016 and July 2017. Interhemispheric symmetry of connectivity was assessed in the hand motor region, incorporating tumor position, perfusion, grade, and connectivity generated from seed-based correlation. Statistical analysis was performed by using one-tailed t tests, Wilcoxon rank sum tests, one-way analysis of variance, Pearson correlation, and Spearman rank correlation, with significance at P < .05. Results Data in a total of 45 patients with glioma (mean age, 51.3 years ± 14.3 [standard deviation]) were compared with those in 10 healthy control subjects (mean age, 50.3 years ± 17.2). Patients showed loss of symmetry in measures of hand motor resting-state connectivity compared with control subjects (P < .05). Tumor distance from the ipsilateral hand motor (IHM) region correlated with the degree (R = 0.38, P = .01) and strength (R = 0.33, P = .03) of resting-state connectivity. In patients with World Health Organization grade IV glioblastomas 40 mm or less from the IHM region, loss of symmetry in strength of resting-state connectivity was correlated with tumor perfusion (R = 0.74, P < .01). In patients with gliomas 40 mm or less from the IHM region, seeding the nontumor hemisphere yielded less asymmetric hand motor resting-state connectivity than seeding the tumor hemisphere (connectivity seeded:contralateral = 1.34 nontumor vs 1.38 tumor hemisphere seeded; P = .03, false discovery rate threshold = 0.01). Conclusion Hand motor resting-state connectivity was less symmetrical in a tumor distance-dependent manner in patients with glioma. Differences in resting-state connectivity may be false-negative results driven by a neurovascular uncoupling mechanism. Seeding from the nontumor hemisphere may attenuate asymmetry in patients with tumors near ipsilateral hand motor cortices. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Herie Sun
- From the Departments of Radiology (H.S., B.V., M.E.L., M.J., A.I.H., K.K.P.), Medical Physics (K.K.P.), and Epidemiology-Biostatistics (J.R.F., Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Catholic University of the Sacred Heart-A. Gemelli Hospital, Rome, Italy (M.E.L.); Department of Neuroscience, Weill Cornell Graduate School of the Medical Sciences, New York, NY (A.I.H.); and Department of Radiology, Weill Medical College of Cornell University, New York, NY (A.I.H.)
| | - Behroze Vachha
- From the Departments of Radiology (H.S., B.V., M.E.L., M.J., A.I.H., K.K.P.), Medical Physics (K.K.P.), and Epidemiology-Biostatistics (J.R.F., Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Catholic University of the Sacred Heart-A. Gemelli Hospital, Rome, Italy (M.E.L.); Department of Neuroscience, Weill Cornell Graduate School of the Medical Sciences, New York, NY (A.I.H.); and Department of Radiology, Weill Medical College of Cornell University, New York, NY (A.I.H.)
| | - Maria E Laino
- From the Departments of Radiology (H.S., B.V., M.E.L., M.J., A.I.H., K.K.P.), Medical Physics (K.K.P.), and Epidemiology-Biostatistics (J.R.F., Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Catholic University of the Sacred Heart-A. Gemelli Hospital, Rome, Italy (M.E.L.); Department of Neuroscience, Weill Cornell Graduate School of the Medical Sciences, New York, NY (A.I.H.); and Department of Radiology, Weill Medical College of Cornell University, New York, NY (A.I.H.)
| | - Mehrnaz Jenabi
- From the Departments of Radiology (H.S., B.V., M.E.L., M.J., A.I.H., K.K.P.), Medical Physics (K.K.P.), and Epidemiology-Biostatistics (J.R.F., Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Catholic University of the Sacred Heart-A. Gemelli Hospital, Rome, Italy (M.E.L.); Department of Neuroscience, Weill Cornell Graduate School of the Medical Sciences, New York, NY (A.I.H.); and Department of Radiology, Weill Medical College of Cornell University, New York, NY (A.I.H.)
| | - Jessica R Flynn
- From the Departments of Radiology (H.S., B.V., M.E.L., M.J., A.I.H., K.K.P.), Medical Physics (K.K.P.), and Epidemiology-Biostatistics (J.R.F., Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Catholic University of the Sacred Heart-A. Gemelli Hospital, Rome, Italy (M.E.L.); Department of Neuroscience, Weill Cornell Graduate School of the Medical Sciences, New York, NY (A.I.H.); and Department of Radiology, Weill Medical College of Cornell University, New York, NY (A.I.H.)
| | - Zhigang Zhang
- From the Departments of Radiology (H.S., B.V., M.E.L., M.J., A.I.H., K.K.P.), Medical Physics (K.K.P.), and Epidemiology-Biostatistics (J.R.F., Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Catholic University of the Sacred Heart-A. Gemelli Hospital, Rome, Italy (M.E.L.); Department of Neuroscience, Weill Cornell Graduate School of the Medical Sciences, New York, NY (A.I.H.); and Department of Radiology, Weill Medical College of Cornell University, New York, NY (A.I.H.)
| | - Andrei I Holodny
- From the Departments of Radiology (H.S., B.V., M.E.L., M.J., A.I.H., K.K.P.), Medical Physics (K.K.P.), and Epidemiology-Biostatistics (J.R.F., Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Catholic University of the Sacred Heart-A. Gemelli Hospital, Rome, Italy (M.E.L.); Department of Neuroscience, Weill Cornell Graduate School of the Medical Sciences, New York, NY (A.I.H.); and Department of Radiology, Weill Medical College of Cornell University, New York, NY (A.I.H.)
| | - Kyung K Peck
- From the Departments of Radiology (H.S., B.V., M.E.L., M.J., A.I.H., K.K.P.), Medical Physics (K.K.P.), and Epidemiology-Biostatistics (J.R.F., Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Catholic University of the Sacred Heart-A. Gemelli Hospital, Rome, Italy (M.E.L.); Department of Neuroscience, Weill Cornell Graduate School of the Medical Sciences, New York, NY (A.I.H.); and Department of Radiology, Weill Medical College of Cornell University, New York, NY (A.I.H.)
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Dlamini N, Slim M, Kirkham F, Shroff M, Dirks P, Moharir M, MacGregor D, Robertson A, deVeber G, Logan W. Predicting Ischemic Risk Using Blood Oxygen Level-Dependent MRI in Children with Moyamoya. AJNR Am J Neuroradiol 2019; 41:160-166. [PMID: 31806596 DOI: 10.3174/ajnr.a6324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/02/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Moyamoya is a progressive steno-occlusive arteriopathy. MR imaging assessment of cerebrovascular reactivity can be performed by measuring the blood oxygen level-dependent cerebrovascular reactivity response to vasoactive stimuli. Our objective was to determine whether negative blood oxygen level-dependent cerebrovascular reactivity status is predictive of ischemic events in childhood moyamoya. MATERIALS AND METHODS We conducted a retrospective study of a consecutive cohort of children with moyamoya who underwent assessment of blood oxygen level-dependent cerebrovascular reactivity. The charts of patients with written informed consent were reviewed for the occurrence of arterial ischemic stroke, transient ischemic attack, or silent infarcts. We used logistic regression to calculate the OR and 95% CI for ischemic events based on steal status. Hazard ratios for ischemic events based on age at blood oxygen level-dependent cerebrovascular reactivity imaging, sex, and moyamoya etiology were calculated using Cox hazards models. RESULTS Thirty-seven children (21 female; median age, 10.7 years; interquartile range, 7.5-14.7 years) were followed for a median of 28.8 months (interquartile range, 13.7-84.1 months). Eleven (30%) had ischemic events, 82% of which were TIA without infarcts. Steal was present in 15 of 16 (93.8%) hemispheres in which ischemic events occurred versus 25 of 58 (43.1%) ischemic-free hemispheres (OR = 19.8; 95% CI, 2.5-160; P = .005). Children with idiopathic moyamoya were at significantly greater risk of ischemic events (hazard ratio, 3.71; 95% CI, 1.1-12.8; P = .037). CONCLUSIONS Our study demonstrates that idiopathic moyamoya and the presence of steal are independently associated with ischemic events. The use of blood oxygen level-dependent cerebrovascular reactivity could potentially assist in the selection of patients for revascularization surgery and the direction of therapy in children with moyamoya.
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Affiliation(s)
- N Dlamini
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
| | - M Slim
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
| | - F Kirkham
- Developmental Neurosciences Unit and Biomedical Research Centre (F.K.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - M Shroff
- Department of Pediatrics, and Departments of Diagnostic Imaging (M. Shroff)
| | - P Dirks
- Surgery (P.D.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - M Moharir
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
| | - D MacGregor
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
| | - A Robertson
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
| | - G deVeber
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
| | - W Logan
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
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Vakamudi K, Posse S, Jung R, Cushnyr B, Chohan MO. Real-time presurgical resting-state fMRI in patients with brain tumors: Quality control and comparison with task-fMRI and intraoperative mapping. Hum Brain Mapp 2019; 41:797-814. [PMID: 31692177 PMCID: PMC7268088 DOI: 10.1002/hbm.24840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/11/2022] Open
Abstract
Resting-state functional magnetic resonance imaging (rsfMRI) is a promising task-free functional imaging approach, which may complement or replace task-based fMRI (tfMRI) in patients who have difficulties performing required tasks. However, rsfMRI is highly sensitive to head movement and physiological noise, and validation relative to tfMRI and intraoperative electrocortical mapping is still necessary. In this study, we investigate (a) the feasibility of real-time rsfMRI for presurgical mapping of eloquent networks with monitoring of data quality in patients with brain tumors and (b) rsfMRI localization of eloquent cortex compared with tfMRI and intraoperative electrocortical stimulation (ECS) in retrospective analysis. Five brain tumor patients were studied with rsfMRI and tfMRI on a clinical 3T scanner using MultiBand(8)-echo planar imaging (EPI) with repetition time: 400 ms. Moving-averaged sliding-window correlation analysis with regression of motion parameters and signals from white matter and cerebrospinal fluid was used to map sensorimotor and language resting-state networks. Data quality monitoring enabled rapid optimization of scan protocols, early identification of task noncompliance, and head movement-related false-positive connectivity to determine scan continuation or repetition. Sensorimotor and language resting-state networks were identifiable within 1 min of scan time. The Euclidean distance between ECS and rsfMRI connectivity and task-activation in motor cortex, Broca's, and Wernicke's areas was 5-10 mm, with the exception of discordant rsfMRI and ECS localization of Wernicke's area in one patient due to possible cortical reorganization and/or altered neurovascular coupling. This study demonstrates the potential of real-time high-speed rsfMRI for presurgical mapping of eloquent cortex with real-time data quality control, and clinically acceptable concordance of rsfMRI with tfMRI and ECS localization.
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Affiliation(s)
- Kishore Vakamudi
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Stefan Posse
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico.,Department of Physics and Astronomy, University of New Mexico, Albuquerque, New Mexico
| | - Rex Jung
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico
| | - Brad Cushnyr
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Muhammad O Chohan
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico
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