1
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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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2
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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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3
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Hou X, Guo P, Wang P, Liu P, Lin DDM, Fan H, Li Y, Wei Z, Lin Z, Jiang D, Jin J, Kelly C, Pillai JJ, Huang J, Pinho MC, Thomas BP, Welch BG, Park DC, Patel VM, Hillis AE, Lu H. Deep-learning-enabled brain hemodynamic mapping using resting-state fMRI. NPJ Digit Med 2023; 6:116. [PMID: 37344684 PMCID: PMC10284915 DOI: 10.1038/s41746-023-00859-y] [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: 10/10/2022] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
Cerebrovascular disease is a leading cause of death globally. Prevention and early intervention are known to be the most effective forms of its management. Non-invasive imaging methods hold great promises for early stratification, but at present lack the sensitivity for personalized prognosis. Resting-state functional magnetic resonance imaging (rs-fMRI), a powerful tool previously used for mapping neural activity, is available in most hospitals. Here we show that rs-fMRI can be used to map cerebral hemodynamic function and delineate impairment. By exploiting time variations in breathing pattern during rs-fMRI, deep learning enables reproducible mapping of cerebrovascular reactivity (CVR) and bolus arrival time (BAT) of the human brain using resting-state CO2 fluctuations as a natural "contrast media". The deep-learning network is trained with CVR and BAT maps obtained with a reference method of CO2-inhalation MRI, which includes data from young and older healthy subjects and patients with Moyamoya disease and brain tumors. We demonstrate the performance of deep-learning cerebrovascular mapping in the detection of vascular abnormalities, evaluation of revascularization effects, and vascular alterations in normal aging. In addition, cerebrovascular maps obtained with the proposed method exhibit excellent reproducibility in both healthy volunteers and stroke patients. Deep-learning resting-state vascular imaging has the potential to become a useful tool in clinical cerebrovascular imaging.
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Affiliation(s)
- Xirui Hou
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pengfei Guo
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Puyang Wang
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Peiying Liu
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Doris D M Lin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hongli Fan
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yang Li
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhiliang Wei
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Zixuan Lin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dengrong Jiang
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jin Jin
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine Kelly
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jay J Pillai
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marco C Pinho
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Binu P Thomas
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Babu G Welch
- Department of Neurologic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Denise C Park
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Vishal M Patel
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA.
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4
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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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5
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Li M, Zhang Q, Yang K. Role of MRI-Based Functional Imaging in Improving the Therapeutic Index of Radiotherapy in Cancer Treatment. Front Oncol 2021; 11:645177. [PMID: 34513659 PMCID: PMC8429950 DOI: 10.3389/fonc.2021.645177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/30/2021] [Indexed: 02/05/2023] Open
Abstract
Advances in radiation technology, such as intensity-modulated radiation therapy (IMRT), have largely enabled a biological dose escalation of the target volume (TV) and reduce the dose to adjacent tissues or organs at risk (OARs). However, the risk of radiation-induced injury increases as more radiation dose utilized during radiation therapy (RT), which predominantly limits further increases in TV dose distribution and reduces the local control rate. Thus, the accurate target delineation is crucial. Recently, technological improvements for precise target delineation have obtained more attention in the field of RT. The addition of functional imaging to RT can provide a more accurate anatomy of the tumor and normal tissues (such as location and size), along with biological information that aids to optimize the therapeutic index (TI) of RT. In this review, we discuss the application of some common MRI-based functional imaging techniques in clinical practice. In addition, we summarize the main challenges and prospects of these imaging technologies, expecting more inspiring developments and more productive research paths in the near future.
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Affiliation(s)
- Mei Li
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Kaixuan Yang
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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6
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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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7
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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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8
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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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9
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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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10
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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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11
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Miao X, Wu Y, Liu D, Jiang H, Woods D, Stern MT, Blair NIS, Airan RD, Bettegowda C, Rosch KS, Qin Q, van Zijl PCM, Pillai JJ, Hua J. Whole-Brain Functional and Diffusion Tensor MRI in Human Participants with Metallic Orthodontic Braces. Radiology 2020; 294:149-157. [PMID: 31714192 PMCID: PMC6939835 DOI: 10.1148/radiol.2019190070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 09/12/2019] [Accepted: 09/26/2019] [Indexed: 11/11/2022]
Abstract
Background MRI performed with echo-planar imaging (EPI) sequences is sensitive to susceptibility artifacts in the presence of metallic objects, which presents a substantial barrier for performing functional MRI and diffusion tensor imaging (DTI) in patients with metallic orthodontic material and other head implants. Purpose To evaluate the ability to reduce susceptibility artifacts in healthy human participants wearing metallic orthodontic braces for two alternative approaches: T2-prepared functional MRI and diffusion-prepared DTI with three-dimensional fast gradient-echo readout. Materials and Methods In this prospective study conducted from February to September 2018, T2-prepared functional MRI and diffusion-prepared DTI were performed in healthy human participants. Removable dental braces with bonding trays were used so that MRI could be performed with braces and without braces in the same participants. Results were evaluated in regions with strong (EPI dropout regions for functional MRI and the inferior fronto-occipital fasciculus for DTI) and minimal (motor cortex for functional MRI and the posterior limb of internal capsule for DTI) susceptibility artifacts. Signal-to-noise ratio (SNR), contrast-to-noise ratio for functional MRI, apparent diffusion coefficient and fractional anisotropy for DTI, and degree of distortion (quantified with the Jaccard index, which measures the similarity of geometric shapes) were compared in regions with strong or minimal susceptibility effects between the current standard EPI sequences and the proposed alternatives by using paired t test. Results Six participants were evaluated (mean age ± standard deviation, 40 years ± 6; three women). In brain regions with strong susceptibility effects from the metallic braces, T2-prepared functional MRI showed significantly higher SNR (37.8 ± 2.4 vs 15.5 ± 5.3; P < .001) and contrast-to-noise ratio (0.83 ± 0.16 vs 0.29 ± 0.10; P < .001), whereas diffusion-prepared DTI showed higher SNR (5.8 ± 1.5 vs 3.8 ± 0.7; P = .03) than did conventional EPI methods. Apparent diffusion coefficient and fractional anisotropy were consistent with the literature. Geometric distortion was substantially reduced throughout the brain with the proposed methods (significantly higher Jaccard index, 0.95 ± 0.12 vs 0.81 ± 0.61; P < .001). Conclusion T2-prepared functional MRI and diffusion-prepared diffusion tensor imaging can acquire functional and diffusion MRI, respectively, in healthy human participants wearing metallic dental braces with less susceptibility artifacts and geometric distortion than with conventional echo-planar imaging. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Dietrich in this issue.
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Affiliation(s)
| | | | - Dapeng Liu
- From the Neurosection, Division of MRI Research, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, 707 N Broadway, Baltimore, Md 21205 (X.M., Y.W., D.L., H.J.,
Q.Q., P.C.M.v.Z., J.H.); F.M. Kirby Research Center for Functional Brain
Imaging, Kennedy Krieger Institute, Baltimore, Md (X.M., Y.W., D.L., Q.Q.,
P.C.M.v.Z., J.H.); Department of Medical Imaging, Nanfang Hospital, Southern
Medical University, Guangzhou, P.R. China (Y.W.); Department of Orthodontics and
Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
(D.W., M.T.S.); Department of Biomedical Engineering, Johns Hopkins University,
Baltimore, Md (N.I.S.B.); Division of Neuroradiology, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (R.D.A., J.J.P.); Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, Md (C.B., J.J.P.);
Center for Neurodevelopmental and Imaging Research and Department of
Neuropsychology, Kennedy Krieger Institute, Baltimore, Md (K.S.R.); and
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Md (K.S.R.)
| | - Hangyi Jiang
- From the Neurosection, Division of MRI Research, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, 707 N Broadway, Baltimore, Md 21205 (X.M., Y.W., D.L., H.J.,
Q.Q., P.C.M.v.Z., J.H.); F.M. Kirby Research Center for Functional Brain
Imaging, Kennedy Krieger Institute, Baltimore, Md (X.M., Y.W., D.L., Q.Q.,
P.C.M.v.Z., J.H.); Department of Medical Imaging, Nanfang Hospital, Southern
Medical University, Guangzhou, P.R. China (Y.W.); Department of Orthodontics and
Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
(D.W., M.T.S.); Department of Biomedical Engineering, Johns Hopkins University,
Baltimore, Md (N.I.S.B.); Division of Neuroradiology, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (R.D.A., J.J.P.); Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, Md (C.B., J.J.P.);
Center for Neurodevelopmental and Imaging Research and Department of
Neuropsychology, Kennedy Krieger Institute, Baltimore, Md (K.S.R.); and
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Md (K.S.R.)
| | - David Woods
- From the Neurosection, Division of MRI Research, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, 707 N Broadway, Baltimore, Md 21205 (X.M., Y.W., D.L., H.J.,
Q.Q., P.C.M.v.Z., J.H.); F.M. Kirby Research Center for Functional Brain
Imaging, Kennedy Krieger Institute, Baltimore, Md (X.M., Y.W., D.L., Q.Q.,
P.C.M.v.Z., J.H.); Department of Medical Imaging, Nanfang Hospital, Southern
Medical University, Guangzhou, P.R. China (Y.W.); Department of Orthodontics and
Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
(D.W., M.T.S.); Department of Biomedical Engineering, Johns Hopkins University,
Baltimore, Md (N.I.S.B.); Division of Neuroradiology, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (R.D.A., J.J.P.); Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, Md (C.B., J.J.P.);
Center for Neurodevelopmental and Imaging Research and Department of
Neuropsychology, Kennedy Krieger Institute, Baltimore, Md (K.S.R.); and
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Md (K.S.R.)
| | - Moshe T. Stern
- From the Neurosection, Division of MRI Research, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, 707 N Broadway, Baltimore, Md 21205 (X.M., Y.W., D.L., H.J.,
Q.Q., P.C.M.v.Z., J.H.); F.M. Kirby Research Center for Functional Brain
Imaging, Kennedy Krieger Institute, Baltimore, Md (X.M., Y.W., D.L., Q.Q.,
P.C.M.v.Z., J.H.); Department of Medical Imaging, Nanfang Hospital, Southern
Medical University, Guangzhou, P.R. China (Y.W.); Department of Orthodontics and
Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
(D.W., M.T.S.); Department of Biomedical Engineering, Johns Hopkins University,
Baltimore, Md (N.I.S.B.); Division of Neuroradiology, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (R.D.A., J.J.P.); Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, Md (C.B., J.J.P.);
Center for Neurodevelopmental and Imaging Research and Department of
Neuropsychology, Kennedy Krieger Institute, Baltimore, Md (K.S.R.); and
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Md (K.S.R.)
| | - Nicholas I. S. Blair
- From the Neurosection, Division of MRI Research, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, 707 N Broadway, Baltimore, Md 21205 (X.M., Y.W., D.L., H.J.,
Q.Q., P.C.M.v.Z., J.H.); F.M. Kirby Research Center for Functional Brain
Imaging, Kennedy Krieger Institute, Baltimore, Md (X.M., Y.W., D.L., Q.Q.,
P.C.M.v.Z., J.H.); Department of Medical Imaging, Nanfang Hospital, Southern
Medical University, Guangzhou, P.R. China (Y.W.); Department of Orthodontics and
Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
(D.W., M.T.S.); Department of Biomedical Engineering, Johns Hopkins University,
Baltimore, Md (N.I.S.B.); Division of Neuroradiology, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (R.D.A., J.J.P.); Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, Md (C.B., J.J.P.);
Center for Neurodevelopmental and Imaging Research and Department of
Neuropsychology, Kennedy Krieger Institute, Baltimore, Md (K.S.R.); and
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Md (K.S.R.)
| | - Raag D. Airan
- From the Neurosection, Division of MRI Research, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, 707 N Broadway, Baltimore, Md 21205 (X.M., Y.W., D.L., H.J.,
Q.Q., P.C.M.v.Z., J.H.); F.M. Kirby Research Center for Functional Brain
Imaging, Kennedy Krieger Institute, Baltimore, Md (X.M., Y.W., D.L., Q.Q.,
P.C.M.v.Z., J.H.); Department of Medical Imaging, Nanfang Hospital, Southern
Medical University, Guangzhou, P.R. China (Y.W.); Department of Orthodontics and
Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
(D.W., M.T.S.); Department of Biomedical Engineering, Johns Hopkins University,
Baltimore, Md (N.I.S.B.); Division of Neuroradiology, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (R.D.A., J.J.P.); Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, Md (C.B., J.J.P.);
Center for Neurodevelopmental and Imaging Research and Department of
Neuropsychology, Kennedy Krieger Institute, Baltimore, Md (K.S.R.); and
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Md (K.S.R.)
| | - Chetan Bettegowda
- From the Neurosection, Division of MRI Research, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, 707 N Broadway, Baltimore, Md 21205 (X.M., Y.W., D.L., H.J.,
Q.Q., P.C.M.v.Z., J.H.); F.M. Kirby Research Center for Functional Brain
Imaging, Kennedy Krieger Institute, Baltimore, Md (X.M., Y.W., D.L., Q.Q.,
P.C.M.v.Z., J.H.); Department of Medical Imaging, Nanfang Hospital, Southern
Medical University, Guangzhou, P.R. China (Y.W.); Department of Orthodontics and
Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
(D.W., M.T.S.); Department of Biomedical Engineering, Johns Hopkins University,
Baltimore, Md (N.I.S.B.); Division of Neuroradiology, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (R.D.A., J.J.P.); Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, Md (C.B., J.J.P.);
Center for Neurodevelopmental and Imaging Research and Department of
Neuropsychology, Kennedy Krieger Institute, Baltimore, Md (K.S.R.); and
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Md (K.S.R.)
| | - Keri S. Rosch
- From the Neurosection, Division of MRI Research, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, 707 N Broadway, Baltimore, Md 21205 (X.M., Y.W., D.L., H.J.,
Q.Q., P.C.M.v.Z., J.H.); F.M. Kirby Research Center for Functional Brain
Imaging, Kennedy Krieger Institute, Baltimore, Md (X.M., Y.W., D.L., Q.Q.,
P.C.M.v.Z., J.H.); Department of Medical Imaging, Nanfang Hospital, Southern
Medical University, Guangzhou, P.R. China (Y.W.); Department of Orthodontics and
Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
(D.W., M.T.S.); Department of Biomedical Engineering, Johns Hopkins University,
Baltimore, Md (N.I.S.B.); Division of Neuroradiology, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (R.D.A., J.J.P.); Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, Md (C.B., J.J.P.);
Center for Neurodevelopmental and Imaging Research and Department of
Neuropsychology, Kennedy Krieger Institute, Baltimore, Md (K.S.R.); and
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Md (K.S.R.)
| | - Qin Qin
- From the Neurosection, Division of MRI Research, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, 707 N Broadway, Baltimore, Md 21205 (X.M., Y.W., D.L., H.J.,
Q.Q., P.C.M.v.Z., J.H.); F.M. Kirby Research Center for Functional Brain
Imaging, Kennedy Krieger Institute, Baltimore, Md (X.M., Y.W., D.L., Q.Q.,
P.C.M.v.Z., J.H.); Department of Medical Imaging, Nanfang Hospital, Southern
Medical University, Guangzhou, P.R. China (Y.W.); Department of Orthodontics and
Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
(D.W., M.T.S.); Department of Biomedical Engineering, Johns Hopkins University,
Baltimore, Md (N.I.S.B.); Division of Neuroradiology, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (R.D.A., J.J.P.); Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, Md (C.B., J.J.P.);
Center for Neurodevelopmental and Imaging Research and Department of
Neuropsychology, Kennedy Krieger Institute, Baltimore, Md (K.S.R.); and
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Md (K.S.R.)
| | - Peter C. M. van Zijl
- From the Neurosection, Division of MRI Research, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, 707 N Broadway, Baltimore, Md 21205 (X.M., Y.W., D.L., H.J.,
Q.Q., P.C.M.v.Z., J.H.); F.M. Kirby Research Center for Functional Brain
Imaging, Kennedy Krieger Institute, Baltimore, Md (X.M., Y.W., D.L., Q.Q.,
P.C.M.v.Z., J.H.); Department of Medical Imaging, Nanfang Hospital, Southern
Medical University, Guangzhou, P.R. China (Y.W.); Department of Orthodontics and
Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
(D.W., M.T.S.); Department of Biomedical Engineering, Johns Hopkins University,
Baltimore, Md (N.I.S.B.); Division of Neuroradiology, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (R.D.A., J.J.P.); Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, Md (C.B., J.J.P.);
Center for Neurodevelopmental and Imaging Research and Department of
Neuropsychology, Kennedy Krieger Institute, Baltimore, Md (K.S.R.); and
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Md (K.S.R.)
| | - Jay J. Pillai
- From the Neurosection, Division of MRI Research, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, 707 N Broadway, Baltimore, Md 21205 (X.M., Y.W., D.L., H.J.,
Q.Q., P.C.M.v.Z., J.H.); F.M. Kirby Research Center for Functional Brain
Imaging, Kennedy Krieger Institute, Baltimore, Md (X.M., Y.W., D.L., Q.Q.,
P.C.M.v.Z., J.H.); Department of Medical Imaging, Nanfang Hospital, Southern
Medical University, Guangzhou, P.R. China (Y.W.); Department of Orthodontics and
Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
(D.W., M.T.S.); Department of Biomedical Engineering, Johns Hopkins University,
Baltimore, Md (N.I.S.B.); Division of Neuroradiology, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (R.D.A., J.J.P.); Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, Md (C.B., J.J.P.);
Center for Neurodevelopmental and Imaging Research and Department of
Neuropsychology, Kennedy Krieger Institute, Baltimore, Md (K.S.R.); and
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Md (K.S.R.)
| | - Jun Hua
- From the Neurosection, Division of MRI Research, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, 707 N Broadway, Baltimore, Md 21205 (X.M., Y.W., D.L., H.J.,
Q.Q., P.C.M.v.Z., J.H.); F.M. Kirby Research Center for Functional Brain
Imaging, Kennedy Krieger Institute, Baltimore, Md (X.M., Y.W., D.L., Q.Q.,
P.C.M.v.Z., J.H.); Department of Medical Imaging, Nanfang Hospital, Southern
Medical University, Guangzhou, P.R. China (Y.W.); Department of Orthodontics and
Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
(D.W., M.T.S.); Department of Biomedical Engineering, Johns Hopkins University,
Baltimore, Md (N.I.S.B.); Division of Neuroradiology, Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (R.D.A., J.J.P.); Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, Md (C.B., J.J.P.);
Center for Neurodevelopmental and Imaging Research and Department of
Neuropsychology, Kennedy Krieger Institute, Baltimore, Md (K.S.R.); and
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Md (K.S.R.)
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12
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Orukari IE, Siegel JS, Warrington NM, Baxter GA, Bauer AQ, Shimony JS, Rubin JB, Culver JP. Altered hemodynamics contribute to local but not remote functional connectivity disruption due to glioma growth. J Cereb Blood Flow Metab 2020; 40:100-115. [PMID: 30334672 PMCID: PMC6928560 DOI: 10.1177/0271678x18803948] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Glioma growth can cause pervasive changes in the functional connectivity (FC) of brain networks, which has been associated with re-organization of brain functions and development of functional deficits in patients. Mechanisms underlying functional re-organization in brain networks are not understood and efforts to utilize functional imaging for surgical planning, or as a biomarker of functional outcomes are confounded by the heterogeneity in available human data. Here we apply multiple imaging modalities in a well-controlled murine model of glioma with extensive validation using human data to explore mechanisms of FC disruption due to glioma growth. We find gliomas cause both local and distal changes in FC. FC changes in networks proximal to the tumor occur secondary to hemodynamic alterations but surprisingly, remote FC changes are independent of hemodynamic mechanisms. Our data strongly implicate hemodynamic alterations as the main driver of local changes in measurements of FC in patients with glioma.
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Affiliation(s)
- Inema E Orukari
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Joshua S Siegel
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Nicole M Warrington
- Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA
| | - Grant A Baxter
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St Louis, MO, USA
| | - Adam Q Bauer
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St Louis, MO, USA
| | - Joshua B Rubin
- Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA.,Department of Neuroscience, Washington University in St. Louis, St Louis, MO, USA
| | - Joseph P Culver
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.,Mallinckrodt Institute of Radiology, Washington University in St. Louis, St Louis, MO, USA.,Department of Physics, Washington University in St. Louis, St. Louis, MO, USA
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13
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van Niftrik CHB, Piccirelli M, Muscas G, Sebök M, Fisher JA, Bozinov O, Stippich C, Valavanis A, Regli L, Fierstra J. The voxel-wise analysis of false negative fMRI activation in regions of provoked impaired cerebrovascular reactivity. PLoS One 2019; 14:e0215294. [PMID: 31059517 PMCID: PMC6502350 DOI: 10.1371/journal.pone.0215294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/30/2019] [Indexed: 12/30/2022] Open
Abstract
Task-evoked Blood-oxygenation-level-dependent (BOLD-fMRI) signal activation is widely used to interrogate eloquence of brain areas. However, data interpretation can be improved, especially in regions with absent BOLD-fMRI signal activation. Absent BOLD-fMRI signal activation may actually represent false-negative activation due to impaired cerebrovascular reactivity (BOLD-CVR) of the vascular bed. The relationship between impaired BOLD-CVR and BOLD-fMRI signal activation may be better studied in healthy subjects where neurovascular coupling is known to be intact. Using a model-based prospective end-tidal carbon dioxide (CO2) targeting algorithm, we performed two controlled 3 tesla BOLD-CVR studies on 17 healthy subjects: 1: at the subjects’ individual resting end-tidal CO2 baseline. 2: Around +6.0 mmHg CO2 above the subjects’ individual resting baseline. Two BOLD-fMRI finger-tapping experiments were performed at similar normo- and hypercapnic levels. Relative BOLD fMRI signal activation and t-values were calculated for BOLD-CVR and BOLD-fMRI data. For each component of the cerebral motor-network (precentral gyrus, postcentral gyrus, supplementary motor area, cerebellum und fronto-operculum), the correlation between BOLD-CVR and BOLD-fMRI signal changes and t-values was investigated. Finally, a voxel-wise quantitative analysis of the impact of BOLD-CVR on BOLD-fMRI was performed. For the motor-network, the linear correlation coefficient between BOLD-CVR and BOLD-fMRI t-values were significant (p<0.01) and in the range 0.33–0.55, similar to the correlations between the CVR and fMRI Δ%signal (p<0.05; range 0.34–0.60). The linear relationship between CVR and fMRI is challenged by our voxel-wise analysis of Δ%signal and t-value change between normo- and hypercapnia. Our main finding is that BOLD fMRI signal activation maps are markedly dampened in the presence of impaired BOLD-CVR and highlights the importance of a complementary BOLD-CVR assessment in addition to a task-evoked BOLD fMRI to identify brain areas at risk for false-negative BOLD-fMRI signal activation.
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Affiliation(s)
- Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- * E-mail:
| | - Marco Piccirelli
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giovanni Muscas
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Neurosurgery, Careggi University Hospital, Florence, University of Florence, Florence, Italy
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Joseph Arnold Fisher
- Department of Anesthesiology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christoph Stippich
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antonios Valavanis
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Neuroradiology, 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, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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14
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Reliability of Functional Magnetic Resonance Imaging in Patients with Brain Tumors: A Critical Review and Meta-Analysis. World Neurosurg 2019; 125:183-190. [DOI: 10.1016/j.wneu.2019.01.194] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 11/20/2022]
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15
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Agarwal S, Sair HI, Gujar S, Hua J, Lu H, Pillai JJ. Functional Magnetic Resonance Imaging Activation Optimization in the Setting of Brain Tumor-Induced Neurovascular Uncoupling Using Resting-State Blood Oxygen Level-Dependent Amplitude of Low Frequency Fluctuations. Brain Connect 2019; 9:241-250. [PMID: 30547681 DOI: 10.1089/brain.2017.0562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The goal of this study was to demonstrate that a novel resting state BOLD ALFF (amplitude of low frequency fluctuations)-based correction method can substantially enhance the detectability of motor task activation in the presence of tumor-induced neurovascular uncoupling (NVU). Twelve de novo brain tumor patients who underwent comprehensive clinical BOLD fMRI exams including task fMRI and resting state fMRI (rsfMRI) were evaluated. Each patient displayed decreased/absent task fMRI activation in the ipsilesional primary motor cortex in the absence of corresponding motor deficit or suboptimal task performance, consistent with NVU. Z-score maps for the motor tasks were obtained from general linear model (GLM) analysis (reflecting motor activation vs. rest). ALFF maps were calculated from rsfMRI data. Precentral and postcentral gyri in contralesional (CL) and ipsilesional (IL) hemispheres were parcellated using an Automated Anatomical Labeling (AAL) template for each patient. A novel ALFF-based correction method was used to identify the NVU affected voxels in the ipsilesional primary motor cortex (PMC), and a correction factor was applied to normalize the baseline Z-scores for these voxels. In all cases, substantially greater activation was seen on post-ALFF correction motor activation maps within the ipsilesional precentral gyri than in the pre-ALFF correction activation maps. We have demonstrated the feasibility of a new resting state ALFF-based technique for effective correction of brain tumor-related NVU in the primary motor cortex.
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Affiliation(s)
- Shruti Agarwal
- 1 Divisions of Neuroradiology and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Haris I Sair
- 1 Divisions of Neuroradiology and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sachin Gujar
- 1 Divisions of Neuroradiology and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jun Hua
- 2 Divisions of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,3 F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Hanzhang Lu
- 2 Divisions of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,3 F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Jay J Pillai
- 1 Divisions of Neuroradiology and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,4 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Agarwal S, Sair HI, Pillai JJ. Limitations of Resting-State Functional MR Imaging in the Setting of Focal Brain Lesions. Neuroimaging Clin N Am 2018; 27:645-661. [PMID: 28985935 DOI: 10.1016/j.nic.2017.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Methods of image acquisition and analysis for resting-state functional MR imaging (rsfMR imaging) are still evolving. Neurovascular uncoupling and susceptibility artifact are important confounds of rsfMR imaging in the setting of focal brain lesions such as brain tumors. This article reviews the detection of these confounds using rsfMR imaging metrics in the setting of focal brain lesions. In the near future, with the wide range of ongoing research in rsfMR imaging, these issues likely will be overcome and will open new windows into brain function and connectivity.
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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, Phipps B-100, 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, Phipps B-100, 1800 Orleans 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, Phipps B-100, 1800 Orleans Street, Baltimore, MD 21287, USA.
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Agarwal S, Lu H, Pillai JJ. Value of Frequency Domain Resting-State Functional Magnetic Resonance Imaging Metrics Amplitude of Low-Frequency Fluctuation and Fractional Amplitude of Low-Frequency Fluctuation in the Assessment of Brain Tumor-Induced Neurovascular Uncoupling. Brain Connect 2018; 7:382-389. [PMID: 28657344 DOI: 10.1089/brain.2016.0480] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to explore whether the phenomenon of brain tumor-related neurovascular uncoupling (NVU) in resting-state blood oxygen level-dependent functional magnetic resonance imaging (BOLD fMRI) (rsfMRI) may also affect the resting-state fMRI (rsfMRI) frequency domain metrics the amplitude of low-frequency fluctuation (ALFF) and fractional ALFF (fALFF). Twelve de novo brain tumor patients, who underwent clinical fMRI examinations, including task-based fMRI (tbfMRI) and rsfMRI, were included in this Institutional Review Board-approved study. Each patient displayed decreased/absent tbfMRI activation in the primary ipsilesional (IL) sensorimotor cortex in the absence of a corresponding motor deficit or suboptimal task performance, consistent with NVU. Z-score maps for the motor tasks were obtained from general linear model analysis (reflecting motor activation vs. rest). Seed-based correlation analysis (SCA) maps of sensorimotor network, ALFF, and fALFF were calculated from rsfMRI data. Precentral and postcentral gyri in contralesional (CL) and IL hemispheres were parcellated using an automated anatomical labeling template for each patient. Region of interest (ROI) analysis was performed on four maps: tbfMRI, SCA, ALFF, and fALFF. Voxel values in the CL and IL ROIs of each map were divided by the corresponding global mean of ALFF and fALFF in the cortical brain tissue. Group analysis revealed significantly decreased IL ALFF (p = 0.02) and fALFF (p = 0.03) metrics compared with CL ROIs, consistent with similar findings of significantly decreased IL BOLD signal for tbfMRI (p = 0.0005) and SCA maps (p = 0.0004). The frequency domain metrics ALFF and fALFF may be markers of lesion-induced NVU in rsfMRI similar to previously reported alterations in tbfMRI activation and SCA-derived resting-state functional connectivity maps.
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Affiliation(s)
- Shruti Agarwal
- 1 Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Hanzhang Lu
- 1 Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland.,2 Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Jay J Pillai
- 1 Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland.,3 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Agarwal S, Sair HI, Pillai JJ. The Resting-State Functional Magnetic Resonance Imaging Regional Homogeneity Metrics-Kendall's Coefficient of Concordance-Regional Homogeneity and Coherence-Regional Homogeneity-Are Valid Indicators of Tumor-Related Neurovascular Uncoupling. Brain Connect 2018; 7:228-235. [PMID: 28363248 DOI: 10.1089/brain.2016.0482] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study is to determine whether regional homogeneity (ReHo) of resting-state blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (rsfMRI) data based on Kendall's coefficient of concordance (KCC-ReHo) and coherence (Cohe-ReHo) metrics may allow detection of brain tumor-induced neurovascular uncoupling (NVU) in the sensorimotor network similar to findings in standard motor task-based BOLD fMRI (tbfMRI) activation. Twelve de novo brain tumor patients undergoing clinical fMRI exams (tbfMRI and rsfMRI) were included in this Institutional Review Board (IRB)-approved study. Each patient displayed decreased/absent tbfMRI activation in the primary ipsilesional sensorimotor cortex in the absence of corresponding motor deficit or suboptimal task performance, consistent with NVU. Z-score maps for motor tasks were obtained from the general linear model (GLM) analysis (reflecting motor activation vs. rest). KCC-ReHo and Cohe-ReHo maps were calculated from rsfMRI data. Precentral and postcentral gyri in contralesional (CL) and ipsilesional (IL) hemispheres were parcellated using an automated anatomical labeling (AAL) template for each patient. Similar region of interest (ROI) analysis was performed on tbfMRI, KCC-ReHo, and Cohe-ReHo maps to allow direct comparison of results. Voxel values in CL and IL ROIs of each map were divided by the corresponding global mean of KCC-ReHo and Cohe-ReHo in bihemispheric cortical brain tissue. Group analysis revealed significantly decreased IL mean KCC-ReHo (p = 0.02) and Cohe-ReHo (p = 0.04) metrics compared with respective values in the CL ROIs, consistent with similar findings of significantly decreased ipsilesional BOLD signal for tbfMRI (p = 0.0005). Ipsilesional abnormalities in ReHo derived from rsfMRI may serve as potential indicators of NVU in patients with brain tumors and other resectable brain lesions; as such, ReHo findings may complement findings on tbfMRI used for presurgical planning.
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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, Maryland
| | - Haris I Sair
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Jay J Pillai
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
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Fierstra J, van Niftrik C, Piccirelli M, Bozinov O, Pangalu A, Krayenbühl N, Valavanis A, Weller M, Regli L. Diffuse gliomas exhibit whole brain impaired cerebrovascular reactivity. Magn Reson Imaging 2017; 45:78-83. [PMID: 28986176 DOI: 10.1016/j.mri.2017.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Cerebral diffuse gliomas exhibit perilesional impaired cerebrovascular reactivity (CVR), yet the degree of impairment as well as its full spatial extent in the brain remains unknown. With quantitative fMRI, we studied twelve subjects with untreated brain diffuse glioma and twelve healthy controls to assess CVR impairment and determine its distribution throughout the brain. METHODS In a prospective case-control study, quantitative CVR measurements were derived from BOLD fMRI volumes during standardized iso-oxic changes in carbon dioxide. Whole brain CVR was assessed with additional detailed analyses using specific tumor and tissue masks and compared to datasets of healthy controls. RESULTS Whole brain CVR was significantly impaired compared to healthy controls (0.11±0.10 versus 0.28±0.8, p<0.01). All diffuse glioma patients exhibited even more severely impaired intralesional CVR (mean 0.01±0.06). Increasing tumor volume significantly correlated with severity of intralesional CVR impairment (p<0.05, R2=0.38), and whole brain CVR impairment (p<0.05, R2=0.55). CONCLUSION Patients with brain diffuse glioma exhibit intralesional and whole brain impaired CVR with severity correlating to tumor volume. Quantitative fMRI may be entertained to study antitumor therapy efficacy by tracking CVR changes and may have a complementary role to better interpret BOLD associated neurovascular uncoupling.
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Affiliation(s)
- Jorn Fierstra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland.
| | - Christiaan van Niftrik
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Marco Piccirelli
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Athina Pangalu
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Antonios Valavanis
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
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20
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Black DF, Vachha B, Mian A, Faro SH, Maheshwari M, Sair HI, Petrella JR, Pillai JJ, Welker K. American Society of Functional Neuroradiology-Recommended fMRI Paradigm Algorithms for Presurgical Language Assessment. AJNR Am J Neuroradiol 2017; 38:E65-E73. [PMID: 28860215 DOI: 10.3174/ajnr.a5345] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Functional MR imaging is increasingly being used for presurgical language assessment in the treatment of patients with brain tumors, epilepsy, vascular malformations, and other conditions. The inherent complexity of fMRI, which includes numerous processing steps and selective analyses, is compounded by institution-unique approaches to patient training, paradigm choice, and an eclectic array of postprocessing options from various vendors. Consequently, institutions perform fMRI in such markedly different manners that data sharing, comparison, and generalization of results are difficult. The American Society of Functional Neuroradiology proposes widespread adoption of common fMRI language paradigms as the first step in countering this lost opportunity to advance our knowledge and improve patient care. LANGUAGE PARADIGM REVIEW PROCESS A taskforce of American Society of Functional Neuroradiology members from multiple institutions used a broad literature review, member polls, and expert opinion to converge on 2 sets of standard language paradigms that strike a balance between ease of application and clinical usefulness. ASFNR RECOMMENDATIONS The taskforce generated an adult language paradigm algorithm for presurgical language assessment including the following tasks: Sentence Completion, Silent Word Generation, Rhyming, Object Naming, and/or Passive Story Listening. The pediatric algorithm includes the following tasks: Sentence Completion, Rhyming, Antonym Generation, or Passive Story Listening. DISCUSSION Convergence of fMRI language paradigms across institutions offers the first step in providing a "Rosetta Stone" that provides a common reference point with which to compare and contrast the usefulness and reliability of fMRI data. From this common language task battery, future refinements and improvements are anticipated, particularly as objective measures of reliability become available. Some commonality of practice is a necessary first step to develop a foundation on which to improve the clinical utility of this field.
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Affiliation(s)
- D F Black
- From the Mayo Clinic (D.F.B., K.W.), Rochester Minnesota
| | - B Vachha
- Memorial Sloan Kettering Cancer Center (B.V.), New York, New York
| | - A Mian
- Boston University School of Medicine (A.M.), Boston, Massachusetts
| | - S H Faro
- Johns Hopkins University School of Medicine and the Johns Hopkins Hospital (S.H.F., H.I.S., J.J.P.), Baltimore, Maryland
| | - M Maheshwari
- Children's Hospital of Wisconsin (M.M.), Milwaukee, Wisconsin
| | - H I Sair
- Johns Hopkins University School of Medicine and the Johns Hopkins Hospital (S.H.F., H.I.S., J.J.P.), Baltimore, Maryland
| | - J R Petrella
- Duke University School of Medicine, (J.R.P.) Durham, North Carolina
| | - J J Pillai
- Johns Hopkins University School of Medicine and the Johns Hopkins Hospital (S.H.F., H.I.S., J.J.P.), Baltimore, Maryland
| | - K Welker
- From the Mayo Clinic (D.F.B., K.W.), Rochester Minnesota
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21
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Hua J, Miao X, Agarwal S, Bettegowda C, Quiñones-Hinojosa A, Laterra J, Van Zijl PCM, Pekar JJ, Pillai JJ. Language Mapping Using T2-Prepared BOLD Functional MRI in the Presence of Large Susceptibility Artifacts-Initial Results in Patients With Brain Tumor and Epilepsy. ACTA ACUST UNITED AC 2017; 3:105-113. [PMID: 28804779 PMCID: PMC5552052 DOI: 10.18383/j.tom.2017.00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
At present, presurgical functional mapping is the most prevalent clinical application of functional magnetic resonance imaging (fMRI). Signal dropouts and distortions caused by susceptibility effects in the current standard echo planar imaging (EPI)-based fMRI images are well-known problems and pose a major hurdle for the application of fMRI in several brain regions, many of which are related to language mapping in presurgical planning. Such artifacts are particularly problematic in patients with previous surgical resection cavities, craniotomy hardware, hemorrhage, and vascular malformation. A recently developed T2-prepared (T2prep) fMRI approach showed negligible distortion and dropouts in the entire brain even in the presence of large susceptibility effects. Here, we present initial results comparing T2prep- and multiband EPI-fMRI scans for presurgical language mapping using a sentence completion task in patients with brain tumor and epilepsy. In all patients scanned, T2prep-fMRI showed minimal image artifacts (distortion and dropout) and greater functional sensitivity than EPI-fMRI around the lesions containing blood products and in air-filled cavities. This enhanced sensitivity in T2prep-fMRI was also evidenced by the fact that functional activation during the sentence completion task was detected with T2prep-fMRI but not with EPI-fMRI in the affected areas with the same statistical threshold, whereas cerebrovascular reactivity during a breath-hold task was preserved in these same regions, implying intact neurovascular coupling in these patients. Although further investigations are required to validate these findings with invasive methods such as direct cortical stimulation mapping as the gold standard, this approach provides an alternative method for performing fMRI in brain regions with large susceptibility effects.
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Affiliation(s)
- Jun Hua
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland.,Neurosection, Division of MRI Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xinyuan Miao
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland.,Neurosection, Division of MRI Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shruti Agarwal
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chetan Bettegowda
- Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - John Laterra
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter C M Van Zijl
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland.,Neurosection, Division of MRI Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James J Pekar
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland.,Neurosection, Division of MRI Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jay J Pillai
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Assignment Confidence in Localization of the Hand Motor Cortex: Comparison of Structural Imaging With Functional MRI. AJR Am J Roentgenol 2016; 207:1263-1270. [DOI: 10.2214/ajr.15.15119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Ravi H, Liu P, Peng SL, Liu H, Lu H. Simultaneous multi-slice (SMS) acquisition enhances the sensitivity of hemodynamic mapping using gas challenges. NMR IN BIOMEDICINE 2016; 29:1511-1518. [PMID: 27598821 PMCID: PMC5123823 DOI: 10.1002/nbm.3600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/29/2016] [Accepted: 07/18/2016] [Indexed: 06/06/2023]
Abstract
Hemodynamic mapping using gas inhalation has received increasing interest in recent years. Cerebrovascular reactivity (CVR), which reflects the ability of the brain vasculature to dilate in response to a vasoactive stimulus, can be measured by CO2 inhalation with continuous acquisition of blood oxygen level-dependent (BOLD) magnetic resonance images. Cerebral blood volume (CBV) can be measured by O2 inhalation. These hemodynamic mapping methods are appealing because of their absence of gadolinium contrast agent, their ability to assess both baseline perfusion and vascular reserve, and their utility in calibrating the functional magnetic resonance imaging (fMRI) signal. However, like other functional and physiological indices, a major drawback of these measurements is their poor sensitivity and reliability. Simultaneous multi-slice echo planar imaging (SMS EPI) is a fast imaging technology that allows the excitation and acquisition of multiple two-dimensional slices simultaneously, and has been shown to enhance the sensitivity of several MRI applications. To our knowledge, the benefit of SMS in gas inhalation imaging has not been investigated. In this work, we compared the sensitivity of CO2 and O2 inhalation data collected using SMS factor 2 (SMS2) and SMS factor 3 (SMS3) with those collected using conventional EPI (SMS1). We showed that the sensitivity of SMS scans was significantly (p = 0.01) higher than that of conventional EPI, although no difference was found between SMS2 and SMS3 (p = 0.3). On a voxel-wise level, approximately 20-30% of voxels in the brain showed a significant enhancement in sensitivity when using SMS compared with conventional EPI, with other voxels showing an increase, but not reaching statistical significance. When using SMS, the scan duration can be reduced by half, whilst maintaining the sensitivity of conventional EPI. The availability of a sensitive acquisition technique can further enhance the potential of gas inhalation MRI in clinical applications.
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Affiliation(s)
- Harshan Ravi
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Peiying Liu
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shin-Lei Peng
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA.
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Abstract
Cortical reorganization of function due to the growth of an adjacent brain tumor has clearly been demonstrated in a number of surgically proven cases. Such cases demonstrate the unmistakable implications for the neurosurgical treatment of brain tumors, as the cortical function may not reside where one may initially suspect based solely on the anatomical magnetic resonance imaging (MRI). Consequently, preoperative localization of eloquent areas adjacent to a brain tumor is necessary, as this may demonstrate unexpected organization, which may affect the neurosurgical approach to the lesion. However, in interpreting functional MRI studies, the interpreting physician must be cognizant of artifacts, which may limit the accuracy of functional MRI in the setting of brain tumors.
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Liu P, Welch BG, Li Y, Gu H, King D, Yang Y, Pinho M, Lu H. Multiparametric imaging of brain hemodynamics and function using gas-inhalation MRI. Neuroimage 2016; 146:715-723. [PMID: 27693197 DOI: 10.1016/j.neuroimage.2016.09.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 12/30/2022] Open
Abstract
Diagnosis and treatment monitoring of cerebrovascular diseases routinely require hemodynamic imaging of the brain. Current methods either only provide part of the desired information or require the injection of multiple exogenous agents. In this study, we developed a multiparametric imaging scheme for the imaging of brain hemodynamics and function using gas-inhalation MRI. The proposed technique uses a single MRI scan to provide simultaneous measurements of baseline venous cerebral blood volume (vCBV), cerebrovascular reactivity (CVR), bolus arrival time (BAT), and resting-state functional connectivity (fcMRI). This was achieved with a novel, concomitant O2 and CO2 gas inhalation paradigm, rapid MRI image acquisition with a 9.3min BOLD sequence, and an advanced algorithm to extract multiple hemodynamic information from the same dataset. In healthy subjects, CVR and vCBV values were 0.23±0.03%/mmHg and 0.0056±0.0006%/mmHg, respectively, with a strong correlation (r=0.96 for CVR and r=0.91 for vCBV) with more conventional, separate acquisitions that take twice the scan time. In patients with Moyamoya syndrome, CVR in the stenosis-affected flow territories (typically anterior-cerebral-artery, ACA, and middle-cerebral-artery, MCA, territories) was significantly lower than that in posterior-cerebral-artery (PCA), which typically has minimal stenosis, flow territories (0.12±0.06%/mmHg vs. 0.21±0.05%/mmHg, p<0.001). BAT of the gas bolus was significantly longer (p=0.008) in ACA/MCA territories, compared to PCA, and the maps were consistent with the conventional contrast-enhanced CT perfusion method. FcMRI networks were robustly identified from the gas-inhalation MRI data after factoring out the influence of CO2 and O2 on the signal time course. The spatial correspondence between the gas-data-derived fcMRI maps and those using a separate, conventional fcMRI scan was excellent, showing a spatial correlation of 0.58±0.17 and 0.64±0.20 for default mode network and primary visual network, respectively. These findings suggest that advanced gas-inhalation MRI provides reliable measurements of multiple hemodynamic parameters within a clinically acceptable imaging time and is suitable for patient examinations.
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Affiliation(s)
- Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Babu G Welch
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX 75390, United States; Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Yang Li
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States; Biomedical Engineering Graduate Program, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Hong Gu
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, United States
| | - Darlene King
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Yihong Yang
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, United States
| | - Marco Pinho
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
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Glioblastoma Induces Vascular Dysregulation in Nonenhancing Peritumoral Regions in Humans. AJR Am J Roentgenol 2016; 206:1073-81. [PMID: 27007449 DOI: 10.2214/ajr.15.14529] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Glioblastoma is an invasive primary brain malignancy that typically infiltrates the surrounding tissue with malignant cells. It disrupts cerebral blood flow through a variety of biomechanical and biochemical mechanisms. Thus, neuroimaging focused on identifying regions of vascular dysregulation may reveal a marker of tumor spread. The purpose of this study was to use blood oxygenation level-dependent (BOLD) functional MRI (fMRI) to compare the temporal dynamics of the enhancing portion of a tumor with those of brain regions without apparent tumors. MATERIALS AND METHODS Patients with pathologically proven glioblastoma underwent preoperative resting-state BOLD fMRI, T1-weighted contrast-enhanced MRI, and FLAIR MRI. The contralesional control hemisphere, contrast-enhancing tumor, and peritu-moral edema were segmented by use of structural images and were used to extract the time series of these respective regions. The parameter estimates (beta values) for the two regressors and resulting z-statistic images were used as a metric to compare the similarity of the tumor dynamics to those of other brain regions. RESULTS The time course of the contrast-enhancing tumor was significantly different from that of the rest of the brain (p < 0.05). Similarly, the control signal intensity was significantly different from the tumor signal intensity (p < 0.05). Notably, the temporal dynamics in the peritumoral edema, which did not contain enhancing tumor, were most similar to the those of enhancing tumor than to those of control regions. CONCLUSION The findings show that the disruption in vascular regulation induced by a glioblastoma can be detected with BOLD fMRI and that the spatial distribution of these disruptions is localized to the immediate vicinity of the tumor and peritumoral edema.
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Leung J, Kosinski PD, Croal PL, Kassner A. Developmental trajectories of cerebrovascular reactivity in healthy children and young adults assessed with magnetic resonance imaging. J Physiol 2016; 594:2681-9. [PMID: 26847953 DOI: 10.1113/jp271056] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/28/2016] [Indexed: 01/13/2023] Open
Abstract
KEY POINTS Cerebrovascular reactivity (CVR) reflects the vasodilatory reserve of cerebral resistance vessels. Normal development in children is associated with significant changes in blood pressure, cerebral blood flow (CBF) and cerebral oxygen metabolism. Therefore, it stands to reason that CVR will also undergo changes during this period. The study acquired magnetic resonance imaging measures of CVR and CBF in healthy children and young adults to trace their changes with age. We found that CVR changes in two phases, increasing with age until the mid-teens, followed by a decrease. Baseline CBF declined steadily with age. We conclude that CVR varies with age during childhood, which prompts future CVR studies involving children to take into account the effect of development. ABSTRACT Cerebrovascular reactivity (CVR) reflects the vasculature's ability to accommodate changes in blood flow demand thereby serving as a critical imaging tool for mapping vascular reserve. Normal development is associated with extensive physiological changes in blood pressure, cerebral blood flow and cerebral metabolic rate of oxygen, all of which can affect CVR. Moreover, the evolution of these physiological parameters is most prominent during childhood. Therefore, the aim of this study was to use non-invasive magnetic resonance imaging (MRI) to characterize the developmental trajectories of CVR in healthy children and young adults, and relate them to changes in cerebral blood flow (CBF). Thirty-four healthy subjects (17 males, 17 females; age 9-30 years) underwent CVR assessment using blood oxygen level-dependent MRI in combination with a computer controlled CO2 stimulus. In addition, baseline CBF was measured with a pulsed arterial spin labelling sequence. CVR exhibited a gradual increase with age in both grey and white matter up to 14.7 years. After this break point, a negative correlation with age was detected. Baseline CBF maintained a consistent negative linear correlation across the entire age range. The significant age-dependent changes in CVR and CBF demonstrate the evolution of cerebral haemodynamics in children and should be taken into consideration. The shift in developmental trajectory of CVR from increasing to decreasing suggests that physiological factors beyond baseline CBF also influence CVR.
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Affiliation(s)
- Jackie Leung
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8
| | - Przemyslaw D Kosinski
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada, M5S 3E2
| | - Paula L Croal
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8
| | - Andrea Kassner
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada, M5S 3E2
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Ravi H, Thomas BP, Peng SL, Liu H, Lu H. On the optimization of imaging protocol for the mapping of cerebrovascular reactivity. J Magn Reson Imaging 2015; 43:661-8. [PMID: 26268541 DOI: 10.1002/jmri.25028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To devise an improved blood-oxygen-level-dependent (BOLD) imaging protocol for cerebrovascular reactivity (CVR) measurement that can remove a known artifact of negative values. METHODS Theoretical and simulation studies were first performed to understand the biophysical mechanism of the negative CVR signals, through which improved BOLD sequence parameters were proposed. This was achieved by equating signal intensities between cerebrospinal fluid and blood, by means of shortening the echo time (TE) of the BOLD sequence. Then, 10 healthy volunteers were recruited to participate in an experimental study, in which we compared the CVR results of two versions of the optimized ("Opt1" and "Opt2") protocols with that of the standard protocol at 3 Tesla. Two sessions were performed for each subject to test the reproducibility of all three protocols. RESULTS Experimental results demonstrated that the optimized protocols resulted in elimination of negative-CVR voxels. Quantitative CVR results were compared across protocols, which show that the optimized protocols yielded smaller CVR values (Opt1: 0.16 ± 0.01 %BOLD/mmHg CO2 ; Opt2: 0.15 ± 0.01 %BOLD/mmHg CO2 ) than (P < 0.001) the standard protocol (0.21 ± 0.01 %BOLD/mmHg CO2 ), but the CNR was comparable (P = 0.1) to the standard protocol. The coefficient-of-variation between repetitions was found to be 5.6 ± 1.4%, 6.3 ± 1.6%, and 6.9 ± 0.9% for the three protocols, but there were no significant differences (P = 0.65). CONCLUSION Based on the theoretical and experimental results obtained from this study, we suggest that the use of a TE shorter than those used in fMRI is necessary to minimize negative artifact in CVR results.
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Affiliation(s)
- Harshan Ravi
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
| | - Binu P Thomas
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
| | - Shin-Lei Peng
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
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Agarwal S, Sair HI, Yahyavi-Firouz-Abadi N, Airan R, Pillai JJ. Neurovascular uncoupling in resting state fMRI demonstrated in patients with primary brain gliomas. J Magn Reson Imaging 2015. [PMID: 26201672 DOI: 10.1002/jmri.25012] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To demonstrate that the problem of brain tumor-related neurovascular uncoupling (NVU) is a significant issue with respect to resting state blood oxygen level dependent (BOLD) functional MRI (rsfMRI) similar to task-based BOLD fMRI, in which signal detectability can be compromised by breakdown of normal neurovascular coupling. METHODS We evaluated seven de novo brain tumor patients who underwent resting state fMRI as part of comprehensive clinical fMRI exams at 3 Tesla. For each of the seven patients who demonstrated evidence of NVU on task-based motor fMRI, we performed both an independent component analysis (ICA) and an atlas-based parcellation-based seed correlation analysis (SCA) of the resting state fMRI data. For each patient, ipsilesional (IL) and contralesional (CL) regions of interest (ROIs) comprising primary motor and somatosensory cortices were used to evaluate BOLD signal changes on Z score maps derived from both ICA and SCA analysis for evidence of NVU. A subsequent two-tailed t-test was performed to determine whether statistically significant differences between the two sides were present that were consistent with NVU. RESULTS In seven patients, overall decreased BOLD signal (based on suprathreshold voxels in ICA and SCA-derived Z-score maps) was noted in IL compared with CL ROIs (P < 0.01), consistent with NVU. CONCLUSION We have demonstrated that NVU can result in false negative BOLD signal changes on rsfMRI comparable to previously published findings on standard motor task-based fMRI.
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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, Maryland, USA
| | - Haris I Sair
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Noushin Yahyavi-Firouz-Abadi
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raag Airan
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jay J Pillai
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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DeYoe EA, Ulmer JL, Mueller WM, Sabsevitz DS, Reitsma DC, Pillai JJ. Imaging of the Functional and Dysfunctional Visual System. Semin Ultrasound CT MR 2015; 36:234-48. [PMID: 26233858 DOI: 10.1053/j.sult.2015.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Functional magnetic resonance imaging (fMRI) is used clinically to map the visual cortex before brain surgery or other invasive treatments to achieve an optimal balance between therapeutic effect and the avoidance of postoperative vision deficits. Clinically optimized stimuli, analyses, and displays permit identification of cortical subregions supporting high-acuity central vision that is critical for reading and other essential visual functions. A novel data display permits instant appreciation of the functional relationship between the pattern of fMRI brain activation and the pattern of vision loss and preservation within the patient׳s field of view. Neurovascular uncoupling and its detection in the visual cortex are key issues for the interpretation of fMRI results in patients with existing brain pathology.
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Affiliation(s)
- Edgar A DeYoe
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI.
| | - John L Ulmer
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Wade M Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - David S Sabsevitz
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Jay J Pillai
- Department of Radiology, Johns Hopkins University, Baltimore, MD
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31
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DeYoe EA, Raut RV. Visual mapping using blood oxygen level dependent functional magnetic resonance imaging. Neuroimaging Clin N Am 2014; 24:573-84. [PMID: 25441501 DOI: 10.1016/j.nic.2014.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Functional magnetic resonance imaging (fMRI) is used clinically to map the visual cortex before brain surgery or other invasive treatments to achieve an optimal balance between therapeutic effect and the avoidance of postoperative vision deficits. Clinically optimized stimuli, behavioral task, analysis, and displays permit identification of cortical subregions supporting high-acuity central vision that is critical for reading and other essential visual functions. Emerging techniques such as resting-state fMRI may facilitate the use of fMRI-based vision mapping in a broader range of patients.
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Affiliation(s)
- Edgar A DeYoe
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Ryan V Raut
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, USA
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Bhogal AA, Siero JC, Fisher JA, Froeling M, Luijten P, Philippens M, Hoogduin H. Investigating the non-linearity of the BOLD cerebrovascular reactivity response to targeted hypo/hypercapnia at 7T. Neuroimage 2014; 98:296-305. [DOI: 10.1016/j.neuroimage.2014.05.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/30/2014] [Accepted: 05/04/2014] [Indexed: 11/26/2022] Open
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The vascular steal phenomenon is an incomplete contributor to negative cerebrovascular reactivity in patients with symptomatic intracranial stenosis. J Cereb Blood Flow Metab 2014; 34:1453-62. [PMID: 24917040 PMCID: PMC4158662 DOI: 10.1038/jcbfm.2014.106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 05/01/2014] [Accepted: 05/22/2014] [Indexed: 11/08/2022]
Abstract
'Vascular steal' has been proposed as a compensatory mechanism in hemodynamically compromised ischemic parenchyma. Here, independent measures of cerebral blood flow (CBF) and blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) responses to a vascular stimulus in patients with ischemic cerebrovascular disease are recorded. Symptomatic intracranial stenosis patients (n=40) underwent a multimodal 3.0T MRI protocol including structural (T1-weighted and T2-weighted fluid-attenuated inversion recovery) and hemodynamic (BOLD and CBF-weighted arterial spin labeling) functional MRI during room air and hypercarbic gas administration. CBF changes in regions demonstrating negative BOLD reactivity were recorded, as well as clinical correlates including symptomatic hemisphere by infarct and lateralizing symptoms. Fifteen out of forty participants exhibited negative BOLD reactivity. Of these, a positive relationship was found between BOLD and CBF reactivity in unaffected (stenosis degree<50%) cortex. In negative BOLD cerebrovascular reactivity regions, three patients exhibited significant (P<0.01) reductions in CBF consistent with vascular steal; six exhibited increases in CBF; and the remaining exhibited no statistical change in CBF. Secondary findings were that negative BOLD reactivity correlated with symptomatic hemisphere by lateralizing clinical symptoms and prior infarcts(s). These data support the conclusion that negative hypercarbia-induced BOLD responses, frequently assigned to vascular steal, are heterogeneous in origin with possible contributions from autoregulation and/or metabolism.
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Rosazza C, Aquino D, D’Incerti L, Cordella R, Andronache A, Zacà D, Bruzzone MG, Tringali G, Minati L. Preoperative mapping of the sensorimotor cortex: comparative assessment of task-based and resting-state FMRI. PLoS One 2014; 9:e98860. [PMID: 24914775 PMCID: PMC4051640 DOI: 10.1371/journal.pone.0098860] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/08/2014] [Indexed: 11/18/2022] Open
Abstract
Resting state fMRI (rs-fMRI) has recently been considered as a possible complement or alternative to task-based fMRI (tb-fMRI) for presurgical mapping. However, evidence of its usefulness remains scant, because existing studies have investigated relatively small samples and focused primarily on qualitative evaluation. The aim of this study is to investigate the clinical usefulness of rs-fMRI in the context of presurgical mapping of motor functions, and in particular to determine the degree of correspondence with tb-fMRI which, while not a gold-standard, is commonly used in preoperative setting. A group of 13 patients with lesions close to the sensorimotor cortex underwent rs-fMRI and tb-fMRI to localize the hand, foot and mouth motor areas. We assessed quantitatively the degree of correspondence between multiple rs-fMRI analyses (independent-component and seed-based analyses) and tb-fMRI, with reference to sensitivity and specificity of rs-fMRI with respect to tb-fMRI, and centre-of-mass distances. Agreement with electro-cortical stimulation (ECS) was also investigated, and a traditional map thresholding approach based on agreement between two experienced operators was compared to an automatic threshold determination method. Rs-fMRI can localize the sensorimotor cortex successfully, providing anatomical specificity for hand, foot and mouth motor subregions, in particular with seed-based analyses. Agreement with tb-fMRI was only partial and rs-fMRI tended to provide larger patterns of correlated activity. With respect to the ECS data available, rs-fMRI and tb-fMRI performed comparably, even though the shortest distance to stimulation points was observed for the latter. Notably, the results of both were on the whole robust to thresholding procedure. Localization performed by rs-fMRI is not equivalent to tb-fMRI, hence rs-fMRI cannot be considered as an outright replacement for tb-fMRI. Nevertheless, since there is significant agreement between the two techniques, rs-fMRI can be considered with caution as a potential alternative to tb-fMRI when patients are unable to perform the task.
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Affiliation(s)
- Cristina Rosazza
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
- Scientific Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
- * E-mail:
| | - Domenico Aquino
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - Ludovico D’Incerti
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - Roberto Cordella
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - Adrian Andronache
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - Domenico Zacà
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - Giovanni Tringali
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - Ludovico Minati
- Scientific Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
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Pillai JJ, Mikulis DJ. Cerebrovascular reactivity mapping: an evolving standard for clinical functional imaging. AJNR Am J Neuroradiol 2014; 36:7-13. [PMID: 24788129 DOI: 10.3174/ajnr.a3941] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
SUMMARY This review article explains the methodology of breath-hold cerebrovascular reactivity mapping, both in terms of acquisition and analysis, and reviews applications of this method to presurgical mapping, particularly with respect to blood oxygen level-dependent fMRI. Its main application in clinical fMRI is for the assessment of neurovascular uncoupling potential. Neurovascular uncoupling is potentially a major limitation of clinical fMRI, particularly in the setting of mass lesions in the brain such as brain tumors and intracranial vascular malformations that are associated with alterations in regional hemodynamics on either an acquired or congenital basis. As such, breath-hold cerebrovascular reactivity mapping constitutes an essential component of quality control analysis in clinical fMRI, particularly when performed for presurgical mapping of eloquent cortex. Exogenous carbon dioxide challenges used for cerebrovascular reactivity mapping will also be discussed, and their applications to the evaluation of cerebrovascular reserve and cerebrovascular disease will be described.
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Affiliation(s)
- J J Pillai
- From the Division of Neuroradiology (J.J.P.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D J Mikulis
- Department of Medical Imaging (D.J.M.), The University of Toronto, The University Health Network, The Toronto Western Hospital, Toronto, Ontario, Canada
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Cerebrovascular reactivity in the brain white matter: magnitude, temporal characteristics, and age effects. J Cereb Blood Flow Metab 2014; 34:242-7. [PMID: 24192640 PMCID: PMC3915204 DOI: 10.1038/jcbfm.2013.194] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 09/27/2013] [Accepted: 10/08/2013] [Indexed: 11/08/2022]
Abstract
White matter (WM) comprises about half of the brain and its dysfunction is implicated in many brain disorders. While structural properties in healthy and diseased WM have been extensively studied, relatively little is known about the physiology underlying these structural characteristics. Recent advances in magnetic resonance (MR) technologies provided new opportunities to better understand perfusion and microvasculature in the WM. Here, we aim to evaluate vasodilatory capacity of the WM vasculature, which is thought to be important in tissue ischemia and autoregulation. Fifteen younger and fifteen older subjects performed a CO2 inhalation task while blood-oxygenation-level-dependent (BOLD) magnetic resonance imaging (MRI) images were continuously collected. The cerebrovascular reactivity (CVR) index showed that the value of CVR in the WM (0.03±0.002%/mm Hg) was positive, but was significantly lower than that in the gray matter (GM) (0.22±0.01%/mm Hg). More strikingly, the WM response showed a temporal delay of 19±3 seconds compared with GM, which was attributed to the longer time it takes for extravascular CO2 to change. With age, WM CVR response becomes greater and faster, which is opposite to the changes seen in the GM. These data suggest that characteristics of WM CVR are different from that of GM and caution should be used when interpreting pathologic WM CVR results.
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Krainik A, Villien M, Troprès I, Attyé A, Lamalle L, Bouvier J, Pietras J, Grand S, Le Bas JF, Warnking J. Functional imaging of cerebral perfusion. Diagn Interv Imaging 2013; 94:1259-78. [PMID: 24011870 DOI: 10.1016/j.diii.2013.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The functional imaging of perfusion enables the study of its properties such as the vasoreactivity to circulating gases, the autoregulation and the neurovascular coupling. Downstream from arterial stenosis, this imaging can estimate the vascular reserve and the risk of ischemia in order to adapt the therapeutic strategy. This method reveals the hemodynamic disorders in patients suffering from Alzheimer's disease or with arteriovenous malformations revealed by epilepsy. Functional MRI of the vasoreactivity also helps to better interpret the functional MRI activation in practice and in clinical research.
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Affiliation(s)
- A Krainik
- Clinique universitaire de neuroradiologie et IRM, CHU de Grenoble, CS 10217, 38043 Grenoble cedex, France; Inserm U836, université Joseph-Fourier, site santé, chemin Fortuné-Ferrini, 38706 La Tronche cedex, France; UMS IRMaGe, unité IRM 3T recherche, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 9, France.
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Siero JC, Bhogal A, Jansma JM. Blood Oxygenation Level–dependent/Functional Magnetic Resonance Imaging. PET Clin 2013; 8:329-44. [DOI: 10.1016/j.cpet.2013.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Assessing Cerebrovascular Reactivity in Carotid Steno-Occlusive Disease Using MRI BOLD and ASL Techniques. Radiol Res Pract 2012; 2012:268483. [PMID: 22919485 PMCID: PMC3388310 DOI: 10.1155/2012/268483] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 04/17/2012] [Accepted: 04/17/2012] [Indexed: 12/13/2022] Open
Abstract
Impaired cerebrovascular reactivity (CVR), a predictive factor of imminent stroke, has been shown to be associated with carotid steno-occlusive disease. Magnetic resonance imaging (MRI) techniques, such as blood oxygenation level-dependent (BOLD) and arterial spin labeling (ASL), have emerged as promising noninvasive tools to evaluate altered CVR with whole-brain coverage, when combined with a vasoactive stimulus, such as respiratory task or injection of acetazolamide. Under normal cerebrovascular conditions, CVR has been shown to be globally and homogenously distributed between hemispheres, but with differences among cerebral regions. Such differences can be explained by anatomical specificities and different biochemical mechanisms responsible for vascular regulation. In patients with carotid steno-occlusive disease, studies have shown that MRI techniques can detect impaired CVR in brain tissue supplied by the affected artery. Moreover, resulting CVR estimations have been well correlated to those obtained with more established techniques, indicating that BOLD and ASL are robust and reliable methods to assess CVR in patients with cerebrovascular diseases. Therefore, the present paper aims to review recent studies which use BOLD and ASL to evaluate CVR, in healthy individuals and in patients with carotid steno-occlusive disease, providing a source of information regarding the obtained results and the methodological difficulties.
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Pillai JJ, Zacá D. Clinical utility of cerebrovascular reactivity mapping in patients with low grade gliomas. World J Clin Oncol 2011; 2:397-403. [PMID: 22171282 PMCID: PMC3235658 DOI: 10.5306/wjco.v2.i12.397] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/24/2011] [Accepted: 12/01/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate neurovascular uncoupling (NVU) associated with low grade gliomas (LGG) using blood oxygen level dependent (BOLD) cerebrovascular reactivity mapping.
METHODS: Seven patients with low grade gliomas referred by neurosurgeons for presurgical mapping were included in this pilot study. Cerebrovascular reactivity (CVR) mapping was performed by acquiring BOLD images while patients performed a block-design breath-hold (BH) hypercapnia task. CVR mapping was expressed as BOLD percentage signal change (PSC) from baseline associated with performance of the BH hypercapnia task. Standard T2* Dynamic Susceptibility Contrast perfusion imaging was performed and relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) maps were generated. Structural T1 weighted MR images were also acquired. A correlation analysis between intratumoral normalized (via ratio with contralateral homologous regions) BOLD BH PSC [referred to as (nCVR)] and intratumoral normalized resting state rCBV (rCBF) values (i.e., nCBV and nCBF, respectively) was performed.
RESULTS: No significant correlation was seen between the normalized BOLD BH PSC (i.e., nCBV) and nCBV or nCBF. However, the average nCVR (median = 0.50, z = -2.28, P = 0.01) was significantly less than 1.0, indicating abnormally reduced vascular responses in the tumor regions relative to normal contralesional homologous regions, whereas the average nCBV (median = 0.94, z = -0.92, P = 0.375) and nCBF (median = 0.93, z = -1.16, P = 0.25) were not significantly higher or lower than 1.0, indicating iso-perfusion in the tumor regions relative to normal contralesional homologous regions. These findings suggest that in LGG, hyperperfusion that is seen in high grade gliomas is not present, but, nevertheless, abnormally decreased regional CVR is present within and adjacent to LGG. Since the patients all demonstrated at least some residual function attributable to the cortical regions of impaired CVR, but were incapable of producing a BOLD response in these regions regardless of the tasks performed, such regionally decreased CVR is indicative of NVU. The low nCVR ratios indicate high prevalence of NVU in this LGG cohort, which is an important consideration in the interpretation of clinical presurgical mapping with functional magnetic resonance (MR) imaging.
CONCLUSION: Our preliminary study shows that BH CVR mapping is clinically feasible and demonstrates an unexpectedly high prevalence of NVU in patients with LGG.
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Affiliation(s)
- Jay J Pillai
- Jay J Pillai, Domenico Zacá, Neuroradiology Division, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, School of Medicine and The Johns Hopkins Hospital, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD 21287, United States
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