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Rivera-Rivera LA, Roberts GS, Peret A, Langhough RE, Jonaitis EM, Du L, Field A, Eisenmenger L, Johnson SC, Johnson KM. Unraveling diurnal and technical variability in cerebral hemodynamics from neurovascular 4D-Flow MRI. J Cereb Blood Flow Metab 2024:271678X241232190. [PMID: 38340787 DOI: 10.1177/0271678x241232190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Neurovascular 4D-Flow MRI enables non-invasive evaluation of cerebral hemodynamics including measures of cerebral blood flow (CBF), vessel pulsatility index (PI), and cerebral pulse wave velocity (PWV). 4D-Flow measures have been linked to various neurovascular disorders including small vessel disease and Alzheimer's disease; however, physiological and technical sources of variability are not well established. Here, we characterized sources of diurnal physiological and technical variability in cerebral hemodynamics using 4D-Flow in a retrospective study of cognitively unimpaired older adults (N = 750) and a prospective study of younger adults (N = 10). Younger participants underwent repeated MRI sessions at 7am, 4 pm, and 10 pm. In the older cohort, having an MRI earlier on the day was significantly associated with higher CBF and lower PI. In prospective experiments, time of day significantly explained variability in CBF and PI; however, not in PWV. Test-retest experiments showed high CBF intra-session repeatability (repeatability coefficient (RPC) =7.2%), compared to lower diurnal repeatability (RPC = 40%). PI and PWV displayed similar intra-session and diurnal variability (PI intra-session RPC = 22%, RPC = 24% 7am vs 4 pm; PWV intra-session RPC = 17%, RPC = 21% 7am vs 4 pm). Overall, CBF measures showed low technical variability, supporting diurnal variability is from physiology. PI and PWV showed higher technical variability but less diurnal variability.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Anthony Peret
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rebecca E Langhough
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Erin M Jonaitis
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lianlian Du
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aaron Field
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kevin M Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Rivera-Rivera LA, Vikner T, Eisenmenger L, Johnson SC, Johnson KM. Four-dimensional flow MRI for quantitative assessment of cerebrospinal fluid dynamics: Status and opportunities. NMR Biomed 2023:e5082. [PMID: 38124351 DOI: 10.1002/nbm.5082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023]
Abstract
Neurological disorders can manifest with altered neurofluid dynamics in different compartments of the central nervous system. These include alterations in cerebral blood flow, cerebrospinal fluid (CSF) flow, and tissue biomechanics. Noninvasive quantitative assessment of neurofluid flow and tissue motion is feasible with phase contrast magnetic resonance imaging (PC MRI). While two-dimensional (2D) PC MRI is routinely utilized in research and clinical settings to assess flow dynamics through a single imaging slice, comprehensive neurofluid dynamic assessment can be limited or impractical. Recently, four-dimensional (4D) flow MRI (or time-resolved three-dimensional PC with three-directional velocity encoding) has emerged as a powerful extension of 2D PC, allowing for large volumetric coverage of fluid velocities at high spatiotemporal resolution within clinically reasonable scan times. Yet, most 4D flow studies have focused on blood flow imaging. Characterizing CSF flow dynamics with 4D flow (i.e., 4D CSF flow) is of high interest to understand normal brain and spine physiology, but also to study neurological disorders such as dysfunctional brain metabolite waste clearance, where CSF dynamics appear to play an important role. However, 4D CSF flow imaging is challenged by the long T1 time of CSF and slower velocities compared with blood flow, which can result in longer scan times from low flip angles and extended motion-sensitive gradients, hindering clinical adoption. In this work, we review the state of 4D CSF flow MRI including challenges, novel solutions from current research and ongoing needs, examples of clinical and research applications, and discuss an outlook on the future of 4D CSF flow.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tomas Vikner
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Radiation Sciences, Radiation Physics and Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sterling C Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Rivera-Rivera LA. Editorial for "Non-Contrast-Enhanced MR Arteriography of Potential Living-Related Liver Donor: Using Contrast Enhanced CT Arteriography as Standard Reference". J Magn Reson Imaging 2023; 58:905-906. [PMID: 36524449 DOI: 10.1002/jmri.28567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 08/08/2023] Open
Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Fico BG, Miller KB, Rivera-Rivera LA, Corkery AT, Pearson AG, Loggie NA, Howery AJ, Rowley HA, Johnson KM, Johnson SC, Wieben O, Barnes JN. Cerebral hemodynamics comparison using transcranial doppler ultrasound and 4D flow MRI. Front Physiol 2023; 14:1198615. [PMID: 37304825 PMCID: PMC10250020 DOI: 10.3389/fphys.2023.1198615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction: Age-related changes in cerebral hemodynamics are controversial and discrepancies may be due to experimental techniques. As such, the purpose of this study was to compare cerebral hemodynamics measurements of the middle cerebral artery (MCA) between transcranial Doppler ultrasound (TCD) and four-dimensional flow MRI (4D flow MRI). Methods: Twenty young (25 ± 3 years) and 19 older (62 ± 6 years) participants underwent two randomized study visits to evaluate hemodynamics at baseline (normocapnia) and in response to stepped hypercapnia (4% CO2, and 6% CO2) using TCD and 4D flow MRI. Cerebral hemodynamic measures included MCA velocity, MCA flow, cerebral pulsatility index (PI) and cerebrovascular reactivity to hypercapnia. MCA flow was only assessed using 4D flow MRI. Results: MCA velocity between the TCD and 4D flow MRI methods was positively correlated across the normocapnia and hypercapnia conditions (r = 0.262; p = 0.004). Additionally, cerebral PI was significantly correlated between TCD and 4D flow MRI across the conditions (r = 0.236; p = 0.010). However, there was no significant association between MCA velocity using TCD and MCA flow using 4D flow MRI across the conditions (r = 0.079; p = 0.397). When age-associated differences in cerebrovascular reactivity using conductance were compared using both methodologies, cerebrovascular reactivity was greater in young adults compared to older adults when using 4D flow MRI (2.11 ± 1.68 mL/min/mmHg/mmHg vs. 0.78 ± 1.68 mL/min/mmHg/mmHg; p = 0.019), but not with TCD (0.88 ± 1.01 cm/s/mmHg/mmHg vs. 0.68 ± 0.94 cm/s/mmHg/mmHg; p = 0.513). Conclusion: Our results demonstrated good agreement between the methods at measuring MCA velocity during normocapnia and in response to hypercapnia, but MCA velocity and MCA flow were not related. In addition, measurements using 4D flow MRI revealed effects of aging on cerebral hemodynamics that were not apparent using TCD.
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Affiliation(s)
- Brandon G. Fico
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Kathleen B. Miller
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Leonardo A. Rivera-Rivera
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Adam T. Corkery
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Andrew G. Pearson
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Nicole A. Loggie
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Anna J. Howery
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Howard A. Rowley
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Kevin M. Johnson
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Sterling C. Johnson
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veteran’s Hospital, Madison, WI, United States
| | - Oliver Wieben
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Jill N. Barnes
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
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Roberts GS, Peret A, Jonaitis EM, Koscik RL, Hoffman CA, Rivera-Rivera LA, Cody KA, Rowley HA, Johnson SC, Wieben O, Johnson KM, Eisenmenger LB. Normative Cerebral Hemodynamics in Middle-aged and Older Adults Using 4D Flow MRI: Initial Analysis of Vascular Aging. Radiology 2023; 307:e222685. [PMID: 36943077 PMCID: PMC10140641 DOI: 10.1148/radiol.222685] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/06/2023] [Accepted: 02/06/2023] [Indexed: 03/23/2023]
Abstract
Background Characterizing cerebrovascular hemodynamics in older adults is important for identifying disease and understanding normal neurovascular aging. Four-dimensional (4D) flow MRI allows for a comprehensive assessment of cerebral hemodynamics in a single acquisition. Purpose To establish reference intracranial blood flow and pulsatility index values in a large cross-sectional sample of middle-aged (45-65 years) and older (>65 years) adults and characterize the effect of age and sex on blood flow and pulsatility. Materials and Methods In this retrospective study, patients aged 45-93 years (cognitively unimpaired) underwent cranial 4D flow MRI between March 2010 and March 2020. Blood flow rates and pulsatility indexes from 13 major arteries and four venous sinuses and total cerebral blood flow were collected. Intraobserver and interobserver reproducibility of flow and pulsatility measures was assessed in 30 patients. Descriptive statistics (mean ± SD) of blood flow and pulsatility were tabulated for the entire group and by age and sex. Multiple linear regression and linear mixed-effects models were used to assess the effect of age and sex on total cerebral blood flow and vessel-specific flow and pulsatility, respectively. Results There were 759 patients (mean age, 65 years ± 8 [SD]; 506 female patients) analyzed. For intra- and interobserver reproducibility, median intraclass correlation coefficients were greater than 0.90 for flow and pulsatility measures across all vessels. Regression coefficients β ± standard error from multiple linear regression showed a 4 mL/min decrease in total cerebral blood flow each year (age β = -3.94 mL/min per year ± 0.44; P < .001). Mixed effects showed a 1 mL/min average annual decrease in blood flow (age β = -0.95 mL/min per year ± 0.16; P < .001) and 0.01 arbitrary unit (au) average annual increase in pulsatility over all vessels (age β = 0.011 au per year ± 0.001; P < .001). No evidence of sex differences was observed for flow (β = -1.60 mL/min per male patient ± 1.77; P = .37), but pulsatility was higher in female patients (sex β = -0.018 au per male patient ± 0.008; P = .02). Conclusion Normal reference values for blood flow and pulsatility obtained using four-dimensional flow MRI showed correlations with age. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Steinman in this issue.
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Affiliation(s)
- Grant S. Roberts
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Anthony Peret
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Erin M. Jonaitis
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Rebecca L. Koscik
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Carson A. Hoffman
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Leonardo A. Rivera-Rivera
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Karly A. Cody
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Howard A. Rowley
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Sterling C. Johnson
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Oliver Wieben
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Kevin M. Johnson
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Laura B. Eisenmenger
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
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Roberts GS, Hoffman CA, Rivera-Rivera LA, Berman SE, Eisenmenger LB, Wieben O. Automated hemodynamic assessment for cranial 4D flow MRI. Magn Reson Imaging 2023; 97:46-55. [PMID: 36581214 PMCID: PMC9892280 DOI: 10.1016/j.mri.2022.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
Cranial 4D flow MRI post-processing typically involves manual user interaction which is time-consuming and associated with poor repeatability. The primary goal of this study is to develop a robust quantitative velocity tool (QVT) that utilizes threshold-based segmentation techniques to improve segmentation quality over prior approaches based on centerline processing schemes (CPS) that utilize k-means clustering segmentation. This tool also includes an interactive 3D display designed for simplified vessel selection and automated hemodynamic visualization and quantification. The performances of QVT and CPS were compared in vitro in a flow phantom and in vivo in 10 healthy participants. Vessel segmentations were compared with ground-truth computed tomography in vitro (29 locations) and manual segmentation in vivo (13 locations) using linear regression. Additionally, QVT and CPS MRI flow rates were compared to perivascular ultrasound flow in vitro using linear regression. To assess internal consistency of flow measures in vivo, conservation of flow was assessed at vessel junctions using linear regression and consistency of flow along vessel segments was analyzed by fitting a Gaussian distribution to a histogram of normalized flow values. Post-processing times were compared between the QVT and CPS using paired t-tests. Vessel areas segmented in vitro (CPS: slope = 0.71, r = 0.95 and QVT: slope = 1.03, r = 0.95) and in vivo (CPS: slope = 0.61, r = 0.96 and QVT: slope = 0.93, r = 0.96) were strongly correlated with ground-truth area measurements. However, CPS (using k-means segmentation) consistently underestimated vessel areas. Strong correlations were observed between QVT and ultrasound flow (slope = 0.98, r = 0.96) as well as flow at junctions (slope = 1.05, r = 0.98). Mean and standard deviation of flow along vessel segments was 9.33e-16 ± 3.05%. Additionally, the QVT demonstrated excellent interobserver agreement and significantly reduced post-processing by nearly 10 min (p < 0.001). By completely automating post-processing and providing an easy-to-use 3D visualization interface for interactive vessel selection and hemodynamic quantification, the QVT offers an efficient, robust, and repeatable means to analyze cranial 4D flow MRI. This software is freely available at: https://github.com/uwmri/QVT.
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Affiliation(s)
- Grant S Roberts
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue #1005, Madison, WI 53705, USA.
| | - Carson A Hoffman
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue #1005, Madison, WI 53705, USA
| | - Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue #1005, Madison, WI 53705, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, J5/1 Mezzanine, Madison, WI 53792, USA.
| | - Sara E Berman
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, J5/1 Mezzanine, Madison, WI 53792, USA.
| | - Laura B Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366 Clinical Science Center, Madison, WI 53792, USA.
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue #1005, Madison, WI 53705, USA; Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366 Clinical Science Center, Madison, WI 53792, USA.
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7
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Rivera-Rivera LA, Kecskemeti S, Jen ML, Miller Z, Johnson SC, Eisenmenger L, Johnson KM. Motion-corrected 4D-Flow MRI for neurovascular applications. Neuroimage 2022; 264:119711. [PMID: 36307060 PMCID: PMC9801539 DOI: 10.1016/j.neuroimage.2022.119711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Neurovascular 4D-Flow MRI has emerged as a powerful tool for comprehensive cerebrovascular hemodynamic characterization. Clinical studies in at risk populations such as aging adults indicate hemodynamic markers can be confounded by motion-induced bias. This study develops and characterizes a high fidelity 3D self-navigation approach for retrospective rigid motion correction of neurovascular 4D-Flow data. A 3D radial trajectory with pseudorandom ordering was combined with a multi-resolution low rank regularization approach to enable high spatiotemporal resolution self-navigators from extremely undersampled data. Phantom and volunteer experiments were performed at 3.0T to evaluate the ability to correct for different amounts of induced motions. In addition, the approach was applied to clinical-research exams from ongoing aging studies to characterize performance in the clinical setting. Simulations, phantom and volunteer experiments with motion correction produced images with increased vessel conspicuity, reduced image blurring, and decreased variability in quantitative measures. Clinical exams revealed significant changes in hemodynamic parameters including blood flow rates, flow pulsatility index, and lumen areas after motion correction in probed cerebral arteries (Flow: P<0.001 Lt ICA, P=0.002 Rt ICA, P=0.004 Lt MCA, P=0.004 Rt MCA; Area: P<0.001 Lt ICA, P<0.001 Rt ICA, P=0.004 Lt MCA, P=0.004 Rt MCA; flow pulsatility index: P=0.042 Rt ICA, P=0.002 Lt MCA). Motion induced bias can lead to significant overestimation of hemodynamic markers in cerebral arteries. The proposed method reduces measurement bias from rigid motion in neurovascular 4D-Flow MRI in challenging populations such as aging adults.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States
| | - Steve Kecskemeti
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States
| | - Mu-Lan Jen
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States
| | - Zachary Miller
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States
| | - Sterling C Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States; Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States.
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8
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Fico BG, Miller KB, Rivera-Rivera LA, Corkery AT, Pearson AG, Eisenmann NA, Howery AJ, Rowley HA, Johnson KM, Johnson SC, Wieben O, Barnes JN. The Impact of Aging on the Association Between Aortic Stiffness and Cerebral Pulsatility Index. Front Cardiovasc Med 2022; 9:821151. [PMID: 35224051 PMCID: PMC8863930 DOI: 10.3389/fcvm.2022.821151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/14/2022] [Indexed: 01/25/2023] Open
Abstract
The central arteries dampen the pulsatile forces from myocardial contraction, limiting the pulsatility that reaches the cerebral vasculature, although there are limited data on this relationship with aging in humans. The purpose of this study was to determine the association between aortic stiffness and cerebral artery pulsatility index in young and older adults. We hypothesized that cerebral pulsatility index would be associated with aortic stiffness in older adults, but not in young adults. We also hypothesized that both age and aortic stiffness would be significant predictors for cerebral pulsatility index. This study included 23 healthy older adults (aged 62 ± 6 years) and 33 healthy young adults (aged 25 ± 4 years). Aortic stiffness was measured using carotid-femoral pulse wave velocity (cfPWV), while cerebral artery pulsatility index in the internal carotid arteries (ICAs), middle cerebral arteries (MCAs), and basilar artery were assessed using 4D Flow MRI. Cerebral pulsatility index was calculated as (maximum flow - minimum flow) / mean flow. In the combined age group, there was a positive association between cfPWV and cerebral pulsatility index in the ICAs (r = 0.487; p < 0.001), MCAs (r = 0.393; p = 0.003), and basilar artery (r = 0.576; p < 0.001). In young adults, there were no associations between cfPWV and cerebral pulsatility index in any of the arteries of interest (ICAs: r = 0.253; p = 0.156, MCAs: r = -0.059; p = 0.743, basilar artery r = 0.171; p = 0.344). In contrast, in older adults there was a positive association between cfPWV and cerebral pulsatility index in the MCAs (r = 0.437; p = 0.037) and basilar artery (r = 0.500; p = 0.015). However, the relationship between cfPWV and cerebral pulsatility index in the ICAs of the older adults did not reach the threshold for significance (r = 0.375; p = 0.078). In conclusion, age and aortic stiffness are significant predictors of cerebral artery pulsatility index in healthy adults. This study highlights the importance of targeting aortic stiffness in our increasingly aging population to reduce the burden of age-related changes in cerebral hemodynamics.
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Affiliation(s)
- Brandon G. Fico
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Kathleen B. Miller
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Leonardo A. Rivera-Rivera
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States,Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Adam T. Corkery
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Andrew G. Pearson
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Nicole A. Eisenmann
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Anna J. Howery
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Howard A. Rowley
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States,Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Kevin M. Johnson
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States,Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States,Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veteran's Hospital, Madison, WI, United States
| | - Oliver Wieben
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Jill N. Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States,*Correspondence: Jill N. Barnes
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9
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Rivera-Rivera LA. Editorial for "Does the Internal Carotid Artery Attenuate Blood-Flow Pulsatility in Small Vessel Disease? A 7T 4D-Flow MRI Study". J Magn Reson Imaging 2022; 56:536-537. [PMID: 34997661 DOI: 10.1002/jmri.28055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Leonardo A Rivera-Rivera
- Departments of Medicine and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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10
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Pravdivtseva MS, Gaidzik F, Berg P, Hoffman C, Rivera-Rivera LA, Medero R, Bodart L, Roldan-Alzate A, Speidel MA, Johnson KM, Wieben O, Jansen O, Hövener JB, Larsen N. Pseudo-Enhancement in Intracranial Aneurysms on Black-Blood MRI: Effects of Flow Rate, Spatial Resolution, and Additional Flow Suppression. J Magn Reson Imaging 2021; 54:888-901. [PMID: 33694334 PMCID: PMC8403769 DOI: 10.1002/jmri.27587] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Vessel-wall enhancement (VWE) on black-blood MRI (BB MRI) has been proposed as an imaging marker for a higher risk of rupture and associated with wall inflammation. Whether VWE is causally linked to inflammation or rather induced by flow phenomena has been a subject of debate. PURPOSE To study the effects of slow flow, spatial resolution, and motion-sensitized driven equilibrium (MSDE) preparation on signal intensities in BB MRI of patient-specific aneurysm flow models. STUDY TYPE Prospective. SUBJECTS/FLOW ANEURYSM MODEL/VIRTUAL VESSELS Aneurysm flow models based on 3D rotational angiography datasets of three patients with intracranial aneurysms were 3D printed and perfused at two different flow rates, with and without Gd-containing contrast agent. FIELD STRENGTH/SEQUENCE Variable refocusing flip angle 3D fast-spin echo sequence at 3 T with and without MSDE with three voxel sizes ((0.5 mm)3 , (0.7 mm)3 , and (0.9 mm)3 ); time-resolved with phase-contrast velocity-encoding 3D spoiled gradient echo sequence (4D flow MRI). ASSESSMENT Three independent observers performed a qualitative visual assessment of flow patterns and signal enhancement. Quantitative analysis included voxel-wise evaluation of signal intensities and magnitude velocity distributions in the aneurysm. STATISTICAL TESTS Kruskal-Wallis test, potential regressions. RESULTS A hyperintense signal in the lumen and adjacent to the aneurysm walls on BB MRI was colocalized with slow flow. Signal intensities increased by a factor of 2.56 ± 0.68 (P < 0.01) after administering Gd contrast. After Gd contrast administration, the signal was suppressed most in conjunction with high flows and with MSDE (2.41 ± 2.07 for slow flow without MSDE, and 0.87 ± 0.99 for high flow with MSDE). A clear result was not achieved by modifying the spatial resolution . DATA CONCLUSIONS Slow-flow phenomena contribute substantially to aneurysm enhancement and vary with MRI parameters. This should be considered in the clinical setting when assessing VWE in patients with an unruptured aneurysm. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Mariya S. Pravdivtseva
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University,Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Franziska Gaidzik
- Lab. of Fluid Dynamics and Technical Flows, Forschungscampus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Philipp Berg
- Lab. of Fluid Dynamics and Technical Flows, Forschungscampus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Carson Hoffman
- Department of Medical Physics and Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA, Madison, WI, United States
| | - Leonardo A. Rivera-Rivera
- Department of Medical Physics and Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA, Madison, WI, United States
| | - Rafael Medero
- Department of Mechanical Engineering and Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA, Madison, WI, United States
| | - Lindsay Bodart
- Department of Medical Physics and Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA, Madison, WI, United States
| | - Alejandro Roldan-Alzate
- Department of Mechanical Engineering and Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA, Madison, WI, United States
| | - Michael A. Speidel
- Department of Medical Physics and Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA, Madison, WI, United States
| | - Kevin M. Johnson
- Department of Medical Physics and Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA, Madison, WI, United States
| | - Oliver Wieben
- Department of Medical Physics and Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA, Madison, WI, United States
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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11
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Rivera-Rivera LA, Cody KA, Eisenmenger L, Cary P, Rowley HA, Carlsson CM, Johnson SC, Johnson KM. Assessment of vascular stiffness in the internal carotid artery proximal to the carotid canal in Alzheimer's disease using pulse wave velocity from low rank reconstructed 4D flow MRI. J Cereb Blood Flow Metab 2021; 41:298-311. [PMID: 32169012 PMCID: PMC8370001 DOI: 10.1177/0271678x20910302] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/27/2020] [Accepted: 02/07/2020] [Indexed: 12/19/2022]
Abstract
Clinical evidence shows vascular factors may co-occur and complicate the expression of Alzheimer's disease (AD); yet, the pathologic mechanisms and involvement of different compartments of the vascular network are not well understood. Diseases such as arteriosclerosis diminish vascular compliance and will lead to arterial stiffness, a well-established risk factor for cardiovascular morbidity. Arterial stiffness can be assessed using pulse wave velocity (PWV); however, this is usually done from carotid-to-femoral artery ratios. To probe the brain vasculature, intracranial PWV measures would be ideal. In this study, high temporal resolution 4D flow MRI was used to assess transcranial PWV in 160 subjects including AD, mild cognitive impairment (MCI), healthy controls, and healthy subjects with apolipoprotein ɛ4 positivity (APOE4+) and parental history of AD dementia (FH+). High temporal resolution imaging was achieved by high temporal binning of retrospectively gated data using a local-low rank approach. Significantly higher transcranial PWV in AD dementia and MCI subjects was found when compared to old-age-matched controls (AD vs. old-age-matched controls: P <0.001, AD vs. MCI: P = 0.029, MCI vs. old-age-matched controls P = 0.013). Furthermore, vascular changes were found in clinically healthy middle-age adults with APOE4+ and FH+ indicating significantly higher transcranial PWV compared to controls (P <0.001).
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of
Medicine and Public Health, Madison, WI, USA
| | - Karly A Cody
- Alzheimer’s Disease Research Center, University of Wisconsin School
of Medicine and Public Health, Madison, WI, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, WI, USA
| | - Paul Cary
- Alzheimer’s Disease Research Center, University of Wisconsin School
of Medicine and Public Health, Madison, WI, USA
| | - Howard A Rowley
- Alzheimer’s Disease Research Center, University of Wisconsin School
of Medicine and Public Health, Madison, WI, USA
- Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, WI, USA
| | - Cynthia M Carlsson
- Alzheimer’s Disease Research Center, University of Wisconsin School
of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S.
Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Sterling C Johnson
- Alzheimer’s Disease Research Center, University of Wisconsin School
of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S.
Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of
Medicine and Public Health, Madison, WI, USA
- Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, WI, USA
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12
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Miller KB, Gallo SJ, Rivera-Rivera LA, Corkery AT, Howery AJ, Johnson SC, Rowley HA, Wieben O, Barnes JN. Vertebral artery hypoplasia influences age-related differences in blood flow of the large intracranial arteries. Aging Brain 2021; 1:100019. [PMID: 36911510 PMCID: PMC9997135 DOI: 10.1016/j.nbas.2021.100019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
Our purpose was to compare cerebral blood flow in the large intracranial vessels between healthy adults with (VAH+) and without (No VAH) vertebral artery hypoplasia. We also evaluated age-related differences in regional blood flow through the large cerebral arteries. Healthy young (n = 20; age = 25 ± 3 years) and older adults (n = 19; age = 61 ± 5 years) underwent 4D flow MRI scans to evaluate blood flow in the internal carotid arteries (ICA) and basilar artery (BA). VAH was determined retrospectively from 4D flow MRI using both structural (vessel diameter ≤ 2 mm) and flow criteria (flow ≤ 50 mL/min). We identified 5 young and 5 older adults with unilateral VAH (prevalence = 26%). ICA flow was lower in the VAH+ group compared with the No VAH group (367 ± 75 mL/min vs. 432 ± 92 mL/min, respectively; p < 0.05). There was no difference in BA flow between VAH+ and No VAH (110 ± 20 mL/min vs. 126 ± 40 mL/min, respectively; p = 0.24). When comparing age-related differences in blood flow in the No VAH group, older adults demonstrated lower BA flow compared with young adults (111 ± 38 mL/min vs. 140 ± 38 mL/min, respectively; p < 0.05) but not ICA flow (428 ± 89 mL/min vs. 436 ± 98 mL/min, respectively; p = 0.82). In contrast, in the VAH+ group, older adults had lower ICA flow compared with young adults (312 ± 65 mL/min vs. 421 ± 35 mL/min, respectively; p < 0.01), but not BA flow (104 ± 16 mL/min vs. 117 ± 23 mL/min, respectively; p = 0.32). Our results suggest that the presence of VAH is associated with lower ICA blood flow. Furthermore, VAH may contribute to the variability in the age-related differences in cerebral blood flow in healthy adults.
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Affiliation(s)
- Kathleen B Miller
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Samuel J Gallo
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Adam T Corkery
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Anna J Howery
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William. S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Howard A Rowley
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jill N Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
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13
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Maxa KM, Hoffman C, Rivera-Rivera LA, Motovylyak A, Turski PA, Mitchell CKC, Ma Y, Berman SE, Gallagher CL, Bendlin BB, Asthana S, Sager MA, Hermann BP, Johnson SC, Cook DB, Wieben O, Okonkwo OC. Cardiorespiratory Fitness Associates with Cerebral Vessel Pulsatility in a Cohort Enriched with Risk for Alzheimer's Disease. Brain Plast 2020; 5:175-184. [PMID: 33282680 PMCID: PMC7685671 DOI: 10.3233/bpl-190096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is increasing evidence that vascular disease risk factors contribute to evolution of the dementia syndrome of Alzheimer's disease (AD). One important measure of cerebrovascular health is pulsatility index (PI) which is thought to represent distal vascular resistance, and has previously been reported to be elevated in AD clinical syndrome. Physical inactivity has emerged as an independent risk factor for cardiovascular disease. OBJECTIVE This study aims to examine the relationship between a measure of habitual physical activity, cardiorespiratory fitness (CRF), and PI in the large cerebral vessels. METHODS Ninety-two cognitively-healthy adults (age = 65.34±5.95, 72% female) enrolled in the Wisconsin Registry for Alzheimer's Prevention participated in this study. Participants underwent 4D flow brain MRI to measure PI in the internal carotid artery (ICA), basilar artery, middle cerebral artery (MCA), and superior sagittal sinus. Participants also completed a self-report physical activity questionnaire. CRF was calculated using a previously-validated equation that incorporates sex, age, body-mass index, resting heart rate, and self-reported physical activity. A series of linear regression models adjusted for age, sex, APOE4 status, and 10-year atherosclerotic cardiovascular disease risk were used to analyze the relationship between CRF and PI. RESULTS Inverse associations were found between CRF and mean PI in the inferior ICA (p = .001), superior ICA (p = .035), and basilar artery (p = .040). No other cerebral vessels revealed significant associations between CRF and PI (p≥.228). CONCLUSIONS Higher CRF was associated with lower PI in several large cerebral vessels. Since increased pulsatility has been associated with poor brain health and reported in persons with AD, this suggests that aerobic fitness might provide protection against cerebrovascular changes related to the progression of AD clinical syndrome.
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Affiliation(s)
- Kaitlin M. Maxa
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Carson Hoffman
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Leonardo A. Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alice Motovylyak
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Patrick A. Turski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Carol K. C. Mitchell
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Yue Ma
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sara E. Berman
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- UW-Madison Medical Scientist and Neuroscience Training Programs, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Catherine L. Gallagher
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison, WI, USA
| | - Barbara B. Bendlin
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mark A. Sager
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C. Johnson
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Dane B. Cook
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, USA
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ozioma C. Okonkwo
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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14
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Eisenmenger LB, Rivera-Rivera LA, Johnson KM, Drolet BA. Utilisation of advanced MRI techniques to understand neurovascular complications of PHACE syndrome: a case of arterial stenosis and dissection. BMJ Case Rep 2020; 13:13/9/e235992. [PMID: 32928832 PMCID: PMC7490943 DOI: 10.1136/bcr-2020-235992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PHACE syndrome is a rare disorder with posterior fossa brain malformations, segmental infantile haemangiomas, arterial anomalies, cardiac defects and eye anomalies. Cerebral and cervical arterial abnormalities occur commonly in these patients, predisposing subjects with PHACE syndrome to neurovascular complications including migraine-like headaches, moyamoya vasculopathy, arterial dissection and arterial ischaemia stroke. We leveraged institutional MRI protocols developed for adult neurovascular disease to better elucidate the pathogenesis of the arterial alternations observed in PHACE. Using high-resolution vessel wall and 4D flow MRI, we demonstrated enhancement, focal dissection and altered blood flow in a 7-year-old girl with PHACE syndrome. This is the first-time vessel wall imaging has been used to detail the known arterial changes in PHACE, and these findings may indicate that progressive vascular narrowing and vessel wall changes/inflammation are a factor in chronic headaches and other arterial complications seen in subjects with PHACE syndrome.
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Affiliation(s)
| | | | - Kevin M Johnson
- Radiology, University of Wisconsin, Madison, Wisconsin, USA.,Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Beth A Drolet
- Dermatology, University of Wisconsin, Madison, Wisconsin, USA
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Rivera-Rivera LA, Cody KA, Rutkowski D, Cary P, Eisenmenger L, Rowley HA, Carlsson CM, Johnson SC, Johnson KM. Intracranial vascular flow oscillations in Alzheimer's disease from 4D flow MRI. Neuroimage Clin 2020; 28:102379. [PMID: 32871386 PMCID: PMC7476069 DOI: 10.1016/j.nicl.2020.102379] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/10/2020] [Accepted: 08/07/2020] [Indexed: 11/26/2022]
Abstract
Recent modeling and experimental evidence suggests clearance of soluble metabolites from the brain can be driven by low frequency flow oscillations (LFOs) through the intramural periarterial drainage (IPAD) pathway. This study investigates the use of 4D flow MRI to derive LFOs from arterial and venous measures of blood flow. 3D radial 4D flow MRI data were acquired on a 3.0 T scanner and reconstructed using a low-rank constraint to produce time resolved measurements of blood flow. Physical phantom experiments were performed to validate the time resolved 4D flow against a standard 2D phase contrast (PC) approach. To evaluate the ability of 4D flow to distinguish physiologic flow changes from noise, healthy volunteers were scanned during a breath-hold (BH) maneuver and compared against 2D PC measures. Finally, flow measures were performed in intracranial arteries and veins of 112 participants including subjects diagnosed with Alzheimer's disease (AD) clinical syndrome (n = 23), and healthy controls (n = 89) on whom apolipoprotein ɛ4 positivity (APOE4+) and parental history of AD dementia (FH+) was known. To assess LFOs, flow range, standard deviation, demeaned temporal flow changes, and power spectral density were quantified from the time series. Group differences were assessed using ANOVA followed by Tukey-Kramer method for pairwise comparison for adjusted means (P < 0.05). Significantly lower LFOs as measured from flow variation range and standard deviations were observed in the arteries of AD subjects when compared to age-matched controls (P = 0.005, P = 0.011). Results suggest altered vascular function in AD subjects. 4D flow based spontaneous LFO measures might hold potential for longitudinal studies aimed at predicting cognitive trajectories in AD and study disease mechanisms.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Karly A Cody
- Alzheimer's Disease Research Center, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - David Rutkowski
- Department of Radiology, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Paul Cary
- Alzheimer's Disease Research Center, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Howard A Rowley
- Alzheimer's Disease Research Center, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; Department of Radiology, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Cynthia M Carlsson
- Alzheimer's Disease Research Center, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Sterling C Johnson
- Alzheimer's Disease Research Center, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; Department of Radiology, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.
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16
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17
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Rivera-Rivera LA, Schubert T, Johnson KM. Measurements of cerebral blood volume using quantitative susceptibility mapping, R 2 * relaxometry, and ferumoxytol-enhanced MRI. NMR Biomed 2019; 32:e4175. [PMID: 31482602 PMCID: PMC6868300 DOI: 10.1002/nbm.4175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/30/2019] [Accepted: 08/13/2019] [Indexed: 05/08/2023]
Abstract
Ferumoxytol-enhanced MRI holds potential for the non-invasive assessment of vascular architecture using estimates of cerebral blood volume (CBV). Ferumoxytol specifically enables steady-state imaging with extended acquisition times, for substantial improvements in resolution and contrast-to-noise ratio. With such data, quantitative susceptibility mapping (QSM) can be used to obtain images of local tissue magnetic susceptibility and hence estimate the increase in blood susceptibility after administration of a contrast agent, which in turn can be correlated to tissue CBV. Here, we explore the use of QSM for CBV estimation and compare it with R2 * (1/T2 *)-based results. Institutional review board approval was obtained, and all subjects provided written informed consent. For this prospective study, MR images were acquired on a 3.0 T scanner in 19 healthy subjects using a multiple-echo T2 *-weighted sequence. Scanning was performed before and after the administration of two doses of ferumoxytol (1 mg FE/kg and 4 mg FE/kg). Different QSM approaches were tested on numerical phantom simulations. Results showed that the accuracy of magnetic susceptibility measurements improved with increasing image resolution and decreasing vascular density. In vivo changes in magnetic susceptibility were measured after the administration of ferumoxytol utilizing QSM, and significantly higher QSM-based CBV was measured in gray matter compared with white matter. QSM- and R2 *-based CBV estimates correlated well, with similar average values, but a larger variance was found in QSM-based estimates.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705-2275, USA
| | - Tilman Schubert
- Department of Radiology and Nuclear Medicine, Basel University Hospital, Petersgraben 4, 4031 Basel, Switzerland
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705-2275, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53705-2275, USA
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18
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Miller KB, Howery AJ, Rivera-Rivera LA, Johnson SC, Rowley HA, Wieben O, Barnes JN. Age-Related Reductions in Cerebrovascular Reactivity Using 4D Flow MRI. Front Aging Neurosci 2019; 11:281. [PMID: 31680935 PMCID: PMC6811507 DOI: 10.3389/fnagi.2019.00281] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022] Open
Abstract
Cerebrovascular reactivity (CVR), is important for determining future risk of cerebrovascular disease. It is unclear if primary aging is associated with reductions in CVR because previous studies often include participants with vascular risk factors. Additionally, the inconsistency in the literature may be due to the inherent difficulty in quantifying intracranial cerebral blood flow and CVR. To address these limitations, we determined the effect of age on CVR in the large intracranial vessels in adults with low vascular risk using state-of-the-art MRI techniques. We also determined if the effect of age on CVR was sex-specific. Young (n = 20; 25 ± 3 years) and older (n = 19; 61 ± 5 years) healthy, physically active adults participated in the study. CVR was measured in response to hypercapnia using 4D flow MRI, which allows for simultaneous angiographic and quantitative blood flow measurements in the intracranial arteries. Older adults had lower global CVR and CVR in multiple intracranial arteries [right and left internal carotid arteries (ICA), right and left middle cerebral arteries (MCA), and basilar artery (BA)] compared with young adults (p < 0.05 for all). In addition, the MCA dilated significantly in response to hypercapnia in young (p < 0.05), but not older adults. Young men demonstrated higher global CVR and CVR in multiple intracranial arteries (ICAs, MCAs, and BA) compared with young women and older men (p < 0.05 for both); however, CVR did not differ between young women and older women. Our results demonstrate that, using 4D flow MRI, primary aging is associated with lower CVR in adults with low vascular risk. In addition, the effect of age on CVR may be driven by men. The 4D flow MRI technique may provide a promising new alternative to measure cerebrovascular physiology without the limitations of commonly used techniques. Future studies could utilize this MRI technique to examine interventions to maintain CVR with advancing age. This study was registered under clinicaltrials.gov # NCT02840851.
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Affiliation(s)
- Kathleen B Miller
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Anna J Howery
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Leonardo A Rivera-Rivera
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.,William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, WI, United States
| | - Howard A Rowley
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.,Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Oliver Wieben
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Jill N Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
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Li Y, Ahmed R, Rivera-Rivera LA, Stadler JA, Turski P, Aagaard-Kienitz B. Serial Quantitative and Qualitative Measurements of Flow in Vein of Galen Malformations Using 4-Dimensional Flow Magnetic Resonance Imaging (Phase Contrast Vastly undersampled Isotropic PRojection). World Neurosurg 2019; 126:405-412. [PMID: 30849554 PMCID: PMC6924166 DOI: 10.1016/j.wneu.2019.02.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vein of Galen malformations (VoGMs) induce cerebrovascular dysfunction through arterial steal and venous hypertension resulting, if untreated, in severe neurologic morbidity and mortality. Noninvasive techniques for quantitative, serial evaluation of cerebrovascular hemodynamics in VoGMs are lacking. This proof of concept study using quantitative blood flow measurements from 4-dimensional flow magnetic resonance imaging may be useful as a noninvasive biomarker to guide timing of intervention and assess disease progression and treatment outcomes. CASE DESCRIPTION Between July 2016 and July 2018, 4 patients harboring VoGMs underwent Phase Contrast Vastly undersampled Isotropic PRojection (PCVIPR) imaging at the University of Wisconsin Hospitals and Clinics. We applied PCVIPR imaging to assess its potential for obtaining anatomic and physiologic flow data before and after surgical embolization of VoGMs. Hemodynamic pressure parameters obtained from PCVIPR imaging were compared with stump pressures recorded in vivo. We found a decrease in mean arterial pressure from 97 mm Hg pretreatment to 65 mm Hg post treatment. These findings corroborate the decrement in venous pressure gradients documented on PCVIPR imaging. For all patients, pressure gradient changes on PCVIPR imaging correlated with in vivo arterial pressures and aided in clinical decision related to cerebrovascular evaluation, treatment planning, and clinical course. CONCLUSIONS Four-dimensional flow magnetic resonance imaging/PCVIPR imaging has a potential role in determining endovascular embolization and therapeutic outcomes on the basis of objective and reproducible hemodynamic characteristics of the vascular lesion. It represents a novel, noninvasive approach that may guide the extent and timing of therapeutic intervention and treatment of cerebrovascular diseases in pediatric patients.
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Affiliation(s)
- Yiping Li
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Raheel Ahmed
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - James A Stadler
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Patrick Turski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Beverly Aagaard-Kienitz
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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20
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Rivera-Rivera LA, Johnson KM, Turski PA, Wieben O, Schubert T. Measurement of microvascular cerebral blood volume changes over the cardiac cycle with ferumoxytol-enhanced T 2 * MRI. Magn Reson Med 2019; 81:3588-3598. [PMID: 30756424 DOI: 10.1002/mrm.27670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/28/2018] [Accepted: 01/04/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE This feasibility study investigates the non-invasive measurement of microvascular cerebral blood volume (BV) changes over the cardiac cycle using cardiac-gated, ferumoxytol-enhanced T 2 ∗ MRI. METHODS Institutional review board approval was obtained and all subjects provided written informed consent. Cardiac gated MR scans were prospectively acquired on a 3.0T scanner in 22 healthy subjects using T 2 ∗ -weighted sequences with 2D-EPI and 3D spiral trajectories. Images were collected before and after the intravenous administration of 2 doses of ferumoxytol (1 mg FE/kg and 4 mg FE/kg). Cardiac cycle-induced R 2 ∗ (1/ T 2 ∗ ) changes (Δ R 2 ∗ ) and BV changes (ΔBV) throughout the cardiac cycle in gray matter (GM) and white matter (WM) were quantified and differences assessed using ANOVA followed by post hoc analysis. RESULTS Δ R 2 ∗ was found to increase in a dose-dependent fashion. A significantly larger increase was observed in GM compared to WM in both 2D and 3D acquisitions (P < 0.050). In addition, Δ R 2 ∗ increased significantly (P < 0.001) post versus pre-contrast injection in GM in both T 2 ∗ MRI acquisitions. Mean GM Δ R 2 ∗ derived from 2D-EPI images was 0.14 ± 0.06 s-1 pre-contrast and 0.33 ± 0.13 s-1 after 5 mg FE/kg. In WM, Δ R 2 ∗ was 0.19 ± 0.06 s-1 pre-contrast, and 0.23 ± 0.06 s-1 after 5 mg FE/kg. The fractional changes in BV throughout the cardiac cycle were 0.031 ± 0.019% in GM and 0.011 ± 0.008% in WM (P < 0.001) after 5 mg FE/kg. CONCLUSION Cardiac-gated, ferumoxytol-enhanced T 2 ∗ MRI enables characterization of microvascular BV changes throughout the cardiac cycle in GM and WM tissue of healthy subjects.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Patrick A Turski
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tilman Schubert
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Department of Radiology and Nuclear Medicine, Basel University Hospital, Petersgraben 4, 4031, Basel, Switzerland
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21
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Moon C, Melah KE, Rivera-Rivera LA, Bratzke LC. Multimodal brain imaging investigation of self-reported sleep quality and daytime sleepiness in older adults with heart failure. Int J Neurosci 2018; 128:1044-1051. [PMID: 29745279 DOI: 10.1080/00207454.2018.1475374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE OF THE STUDY Individuals with heart failure (HF) have a high frequency of sleep problems. Patients with HF present with structural brain changes different from normal aging including reductions in brain volume, increases in white matter hyperintensity (WMH) and reduced cerebral blood flow. These structural changes in the brain may explain the pathophysiology of sleep and daytime problems. The objective of this study was to determine whether multimodal imaging data are related to self-reported sleep problems and daytime sleepiness in older adults with HF. METHODS Participants in this study underwent magnetic resonance imaging scans on the General Electric 3.0 T Discovery MR750 to acquire WMH, cerebral blood flow and brain volume. Data on 37 stable HF patients (mean age = 68; SD = 5.75) were included. RESULTS In this sample, WMH was associated with daytime sleepiness (p = 0.025). However, gray and white matter volume and cerebral blood flow were not associated with daytime sleepiness, sleep quality or insomnia. CONCLUSION Although further studies are needed to determine the relationship between WMH and sleep and daytime problems, the findings preliminarily support that increases in WMH from ischemic changes could explain increases in daytime sleepiness among people with HF.
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Affiliation(s)
- Chooza Moon
- a College of Nursing, University of Iowa , Iowa City , IA , USA
| | - Kelsey E Melah
- b School of Nursing, University of Wisconsin-Madison , Madison , WI , USA
| | | | - Lisa C Bratzke
- b School of Nursing, University of Wisconsin-Madison , Madison , WI , USA
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22
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Berman SE, Clark LR, Rivera-Rivera LA, Norton D, Racine AM, Rowley HA, Bendlin BB, Blennow K, Zetterberg H, Carlsson CM, Asthana S, Turski P, Wieben O, Johnson SC. Intracranial Arterial 4D Flow in Individuals with Mild Cognitive Impairment is Associated with Cognitive Performance and Amyloid Positivity. J Alzheimers Dis 2018; 60:243-252. [PMID: 28826187 DOI: 10.3233/jad-170402] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
It is becoming increasingly recognized that cerebrovascular disease is a contributing factor in the pathogenesis of Alzheimer's disease (AD). A unique 4D-Flow magnetic resonance imaging (MRI) technique, phase contrast vastly undersampled isotropic projection imaging (PC VIPR), enables examination of angiographic and quantitative metrics of blood flow in the arteries of the Circle of Willis within a single MRI acquisition. Thirty-eight participants with mild cognitive impairment (MCI) underwent a comprehensive neuroimaging protocol (including 4D-Flow imaging) and a standard neuropsychological battery. A subset of participants (n = 22) also underwent lumbar puncture and had cerebrospinal fluid (CSF) assayed for AD biomarkers. Cut-offs for biomarker positivity in CSF resulting from a receiver operating characteristic curve analysis of AD cases and controls from the larger Wisconsin Alzheimer's Disease Research Center cohort were used to classify MCI participants as biomarker positive or negative on amyloid-β (Aβ42), total-tau and total-tau/Aβ42 ratio. Internal carotid artery (ICA) and middle cerebral artery (MCA) mean flow were associated with executive functioning performance, with lower mean flow corresponding to worse performance. MCI participants who were biomarker positive for Aβ42 had lower ICA mean flow than did those who were Aβ42 negative. In sum, mean ICA and MCA arterial flow was associated with cognitive performance in participants with MCI and lower flow in the ICA was associated with amyloid positivity. This provides further evidence for vascular health as a contributing factor in the etiopathogenesis of AD, and could represent a point to intervene in the disease process.
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Affiliation(s)
- Sara E Berman
- Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Medical Scientist Training Program, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Neuroscience Training Program, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Lindsay R Clark
- Geriatric Research Education and Clinical Center, William. S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | | | - Derek Norton
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison WI, USA
| | - Annie M Racine
- Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Howard A Rowley
- Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Barbara B Bendlin
- Geriatric Research Education and Clinical Center, William. S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Lab, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Lab, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Molecular Neuroscience, University College London, Institute of Neurology, London, UK.,UK Dementia Research Institute, London, UK
| | - Cynthia M Carlsson
- Geriatric Research Education and Clinical Center, William. S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sanjay Asthana
- Geriatric Research Education and Clinical Center, William. S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Patrick Turski
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.,Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.,Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C Johnson
- Geriatric Research Education and Clinical Center, William. S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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Rivera-Rivera LA, Johnson KM, Turski PA, Wieben O. Pressure Mapping and Hemodynamic Assessment of Intracranial Dural Sinuses and Dural Arteriovenous Fistulas with 4D Flow MRI. AJNR Am J Neuroradiol 2017; 39:485-487. [PMID: 29269408 DOI: 10.3174/ajnr.a5494] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 10/26/2017] [Indexed: 11/07/2022]
Abstract
The feasibility of 4D flow MR imaging to visualize flow patterns and generate relative pressure maps in the dural venous sinus in healthy subjects (n = 60) and patients with dural arteriovenous fistulas (n = 7) was investigated. Dural venous drainage was classified based on torcular Herophili anatomy by using 4D flow MR imaging-derived angiograms and magnitude images. Subjects were scanned in a 3T clinical MR imaging system. 4D flow MR imaging enabled noninvasive characterization of dural sinus anatomy and mapping of relative pressure differences.
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Affiliation(s)
- L A Rivera-Rivera
- From the Departments of Medical Physics (L.A.R.-R., K.M.J., P.A.T., O.W.)
| | - K M Johnson
- From the Departments of Medical Physics (L.A.R.-R., K.M.J., P.A.T., O.W.).,Radiology (K.M.J., P.A.T., O.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - P A Turski
- From the Departments of Medical Physics (L.A.R.-R., K.M.J., P.A.T., O.W.).,Radiology (K.M.J., P.A.T., O.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - O Wieben
- From the Departments of Medical Physics (L.A.R.-R., K.M.J., P.A.T., O.W.) .,Radiology (K.M.J., P.A.T., O.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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24
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Rivera-Rivera LA, Schubert T, Knobloch G, Turski PA, Wieben O, Reeder SB, Johnson KM. Comparison of ferumoxytol-based cerebral blood volume estimates using quantitative R 1 and R2* relaxometry. Magn Reson Med 2017; 79:3072-3081. [PMID: 29096054 DOI: 10.1002/mrm.26975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/24/2017] [Accepted: 09/28/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Cerebral perfusion is commonly assessed clinically with dynamic susceptibility contrast MRI using a bolus injection of gadolinium-based contrast agents, resulting in semi-quantitative values of cerebral blood volume (CBV). Steady-state imaging with ferumoxytol allows estimation of CBV with the potential for higher precision and accuracy. Prior CBV studies have focused on the signal disrupting T2* effects, but ferumoxytol also has high signal-enhancing T1 relaxivity. The purpose of this study was to investigate and compare CBV estimation using T1 and T2*, with the goal of understanding the contrast mechanisms and quantitative differences. METHODS Changes in R1 (1/T1 ) and R2* (1/ T2*) were measured after the administration of ferumoxytol using high-resolution quantitative approaches. Images were acquired at 3.0T and R1 was estimated from an ultrashort echo time variable flip angle approach, while R2* was estimated from a multiple gradient echo sequence. Twenty healthy volunteers were imaged at two doses. CBV was derived and compared from relaxometry in gray and white matter using different approaches. RESULTS R1 measurements showed a linear dependence of blood R1 with respect to dose in large vessels, in contrast to the nonlinear dose-dependence of blood R2* estimates. In the brain parenchyma, R2* showed linear dose-dependency whereas R1 showed nonlinearity. CBV calculations based on R2* changes in tissue and ferumoxytol blood concentration estimates based on R1 relaxivity showed the lowest variability in our cohort. CONCLUSIONS CBV measurements were successfully derived using a combined approach of R1 and R2* relaxometry. Magn Reson Med 79:3072-3081, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tilman Schubert
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland
| | - Gesine Knobloch
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Departments of Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Patrick A Turski
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Scott B Reeder
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Departments of Biomedical Engineering, Medicine and Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Hoscheidt SM, Kellawan JM, Berman SE, Rivera-Rivera LA, Krause RA, Oh JM, Beeri MS, Rowley HA, Wieben O, Carlsson CM, Asthana S, Johnson SC, Schrage WG, Bendlin BB. Insulin resistance is associated with lower arterial blood flow and reduced cortical perfusion in cognitively asymptomatic middle-aged adults. J Cereb Blood Flow Metab 2017; 37:2249-2261. [PMID: 27488909 PMCID: PMC5464714 DOI: 10.1177/0271678x16663214] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Insulin resistance (IR) is associated with poor cerebrovascular health and increased risk for dementia. Little is known about the unique effect of IR on both micro- and macrovascular flow particularly in midlife when interventions against dementia may be most effective. We examined the effect of IR as indexed by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) on cerebral blood flow in macro- and microvessels utilizing magnetic resonance imaging (MRI) among cognitively asymptomatic middle-aged individuals. We hypothesized that higher HOMA-IR would be associated with reduced flow in macrovessels and lower cortical perfusion. One hundred and twenty cognitively asymptomatic middle-aged adults (57 ± 5 yrs) underwent fasting blood draw, phase contrast-vastly undersampled isotropic projection reconstruction (PC VIPR) MRI, and arterial spin labeling (ASL) perfusion. Higher HOMA-IR was associated with lower arterial blood flow, particularly within the internal carotid arteries (ICAs), and lower cerebral perfusion in several brain regions including frontal and temporal lobe regions. Higher blood flow in bilateral ICAs predicted greater cortical perfusion in individuals with lower HOMA-IR, a relationship not observed among those with higher HOMA-IR. Findings provide novel evidence for an uncoupling of macrovascular blood flow and microvascular perfusion among individuals with higher IR in midlife.
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Affiliation(s)
- Siobhan M Hoscheidt
- 1 Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Sara E Berman
- 1 Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Leonardo A Rivera-Rivera
- 3 Department of Medical Physics, University of Wisconsin, Madison, WI, USA.,4 Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Rachel A Krause
- 1 Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jennifer M Oh
- 1 Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michal S Beeri
- 5 The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel.,6 The Icahn School of Medicine, Mount Sinai, NY, USA
| | - Howard A Rowley
- 1 Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,4 Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Oliver Wieben
- 3 Department of Medical Physics, University of Wisconsin, Madison, WI, USA.,4 Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Cynthia M Carlsson
- 1 Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,7 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA.,8 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sanjay Asthana
- 1 Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,7 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA.,8 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C Johnson
- 1 Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,7 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA.,8 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - William G Schrage
- 2 Department of Kinesiology, University of Wisconsin, Madison, WI, USA
| | - Barbara B Bendlin
- 1 Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,8 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Rivera-Rivera LA, Schubert T, Turski P, Johnson KM, Berman SE, Rowley HA, Carlsson CM, Johnson SC, Wieben O. Changes in intracranial venous blood flow and pulsatility in Alzheimer's disease: A 4D flow MRI study. J Cereb Blood Flow Metab 2017; 37:2149-2158. [PMID: 27492950 PMCID: PMC5464708 DOI: 10.1177/0271678x16661340] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/16/2016] [Accepted: 06/23/2016] [Indexed: 01/09/2023]
Abstract
Cerebral blood flow, arterial pulsation, and vasomotion may be important indicators of cerebrovascular health in aging and diseases of aging such as Alzheimer's disease. Noninvasive markers that assess these characteristics may be helpful in the study of co-occurrence of these diseases and potential additive and interacting effects. In this study, 4D flow MRI was used to measure intra-cranial flow features with cardiac-gated phase contrast MRI in cranial arteries and veins. Mean blood flow and pulsatility index as well as the transit time of the peak flow from the middle cerebral artery to the superior sagittal sinus were measured in a total of 104 subjects comprising of four groups: (a) subjects with Alzheimer's disease, (b) age-matched controls, (c) subjects with mild cognitive impairment, and (d) a group of late middle-aged with parental history of sporadic Alzheimer's disease. The Alzheimer's disease group exhibited: a significant decrease in mean blood flow in the superior sagittal sinus, transverse sinus, middle cerebral artery, and internal carotid arteries; a significant decrease of the peak and end diastolic blood flow in the middle cerebral artery and superior sagittal sinus; a faster transmission of peak flow from the middle cerebral artery to the superior sagittal sinus and increased pulsatility index along the carotid siphon.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Tilman Schubert
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
- Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland
| | - Patrick Turski
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Sara E Berman
- Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Howard A Rowley
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Cynthia M Carlsson
- Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, USA
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Memorial VA Hospital, Madison, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Sterling C Johnson
- Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, USA
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Memorial VA Hospital, Madison, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
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Rivera-Rivera LA, Turski P, Johnson KM, Hoffman C, Berman SE, Kilgas P, Rowley HA, Carlsson CM, Johnson SC, Wieben O. 4D flow MRI for intracranial hemodynamics assessment in Alzheimer's disease. J Cereb Blood Flow Metab 2016; 36:1718-1730. [PMID: 26661239 PMCID: PMC5076787 DOI: 10.1177/0271678x15617171] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/30/2015] [Accepted: 10/14/2015] [Indexed: 01/14/2023]
Abstract
Cerebral blood flow, arterial pulsation, and vasomotion play important roles in the transport of waste metabolites out of the brain. Impaired vasomotion results in reduced driving force for the perivascular/glymphatic clearance of beta-amyloid. Noninvasive cerebrovascular characteristic features that potentially assess these transport mechanisms are mean blood flow (MBF) and pulsatility index (PI). In this study, 4D flow MRI was used to measure intra-cranial flow features, particularly MBF, PI, resistive index (RI) and cross-sectional area in patients with Alzheimer's disease (AD), mild cognitive impairment and in age matched and younger cognitively healthy controls. Three-hundred fourteen subjects participated in this study. Volumetric, time-resolved phase contrast (PC) MRI data were used to quantify hemodynamic parameters from 11 vessel segments. Anatomical variants of the Circle of Willis were also cataloged. The AD population reported a statistically significant decrease in MBF and cross-sectional area, and also an increase in PI and RI compared to age matched cognitively healthy control subjects. The 4D flow MRI technique used in this study provides quantitative measurements of intracranial vessel geometry and the velocity of flow. Cerebrovascular characteristics features of vascular health such as pulsatility index can be extracted from the 4D flow MRI data.
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Affiliation(s)
| | - Patrick Turski
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA Department of Radiology, University of Wisconsin - Madison, Madison, WI, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA
| | - Carson Hoffman
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA
| | - Sara E Berman
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Phillip Kilgas
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA
| | - Howard A Rowley
- Department of Radiology, University of Wisconsin - Madison, Madison, WI, USA
| | - Cynthia M Carlsson
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Memorial VA Hospital, Madison, WI, USA Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C Johnson
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Memorial VA Hospital, Madison, WI, USA Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA Department of Radiology, University of Wisconsin - Madison, Madison, WI, USA
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Berman SE, Rivera-Rivera LA, Clark LR, Racine AM, Keevil JG, Bratzke LC, Carlsson CM, Bendlin BB, Rowley HA, Blennow K, Zetterberg H, Asthana S, Turski P, Johnson SC, Wieben O. Intracranial Arterial 4D-Flow is Associated with Metrics of Brain Health and Alzheimer's Disease. Alzheimers Dement (Amst) 2015; 1:420-428. [PMID: 26693176 PMCID: PMC4674833 DOI: 10.1016/j.dadm.2015.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction Although cerebrovascular disease has long been known to co-occur with Alzheimer's disease (AD), recent studies suggest an etiologic contribution to AD pathogenesis. We used four dimensional (4D)-flow magnetic resonance imaging (MRI) to evaluate blood flow and pulsatility indices in the circle of Willis. We hypothesized decreased mean blood flow and increased pulsatility, metrics indicative of poor vascular health, would be associated with cerebral atrophy and an AD cerebrospinal fluid (CSF) profile. Methods A total of 312 patients along the AD continuum (172 middle aged, 60 cognitively healthy older, 44 mild cognitive impairment, and 36 AD) underwent MRI, CSF, and medical examinations. Regression was used to predict CSF biomarkers and atrophy from 4D-flow and analysis of covariance to compare vascular health between groups. Results Decreased mean flow in the middle cerebral artery (MCA) and superior portion of the internal carotid artery (sICA) and increased pulsatility in the MCA were associated with greater brain atrophy. Decreased mean flow in the sICA was associated with lower amyloid beta 1–42 (Aβ42) in the CSF, a pathologic biomarker profile associated with AD. Interestingly, although metrics of flow and pulsatility differed markedly across the AD spectrum, there were no significant differences in cardiovascular risk score, mean arterial pressure, and pulse pressure across the three age-matched older cohorts. Discussion By measuring intracranial arterial health directly with 4D-flow MRI, these data suggest that intracranial arterial health is compromised in symptomatic AD. Even after accounting for disease stage, cerebral artery health is associated with atrophy and an AD Aβ42 profile, suggesting neurovascular health may contribute to the etiopathogenesis of AD.
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Affiliation(s)
- Sara E Berman
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 ; Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53705 ; Medical Scientist Training Program, University of Wisconsin-Madison, Madison, WI 53705
| | - Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705
| | - Lindsay R Clark
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 ; Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53719
| | - Annie M Racine
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 ; Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53705
| | - Jon G Keevil
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison WI 53792
| | - Lisa C Bratzke
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 ; School of Nursing, University of Wisconsin-Madison, Madison, WI 53705
| | - Cynthia M Carlsson
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison WI 53705 ; Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792
| | - Barbara B Bendlin
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison WI 53705 ; Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 ; Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53719
| | - Howard A Rowley
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 ; Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792
| | - Kaj Blennow
- Clinical Neurochemistry Lab, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Lab, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden ; Department of Molecular Neuroscience, University College London, Institute of Neurology, London, UK
| | - Sanjay Asthana
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison WI 53705 ; Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 ; Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53719
| | - Patrick Turski
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 ; Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792
| | - Sterling C Johnson
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison WI 53705 ; Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 ; Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53719 ; Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, Madison, WI 53705
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 ; Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792
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