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Hellsten Y, Gliemann L. Peripheral limitations for performance: Muscle capillarization. Scand J Med Sci Sports 2024; 34:e14442. [PMID: 37770233 DOI: 10.1111/sms.14442] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 10/03/2023]
Abstract
Sufficient delivery of oxygen and metabolic substrates, together with removal of waste products, are key elements of muscle performance. Capillaries are the primary site for this exchange in skeletal muscle and the degree of muscle capillarization affects diffusion conditions by influencing mean transit time, capillary surface area and diffusion distance. Muscle capillarization may thus represent a limiting factor for performance. Exercise training increases the number of capillaries per muscle fiber by about 10%-20% within a few weeks in untrained subjects, whereas capillary growth progresses more slowly in well-trained endurance athletes. Studies show that capillaries are tortuous, situated along and across the length of the fibers with an arrangement related to muscle fascicles. Although direct data is lacking, it is possible that years of training not only enhances capillary density but also optimizes the positioning of capillaries, to further improve the diffusion conditions. Muscle capillarization has been shown to increase oxygen extraction during exercise in humans, but direct evidence for a causal link between increased muscle capillarization and performance is scarce. This review covers current knowledge on the implications of muscle capillarization for oxygen and glucose uptake as well as performance. A brief overview of the process of capillary growth and of physical factors, inherent to exercise, which promote angiogenesis, provides the foundation for a discussion on how different training modalities may influence muscle capillary growth. Finally, we identify three areas for future research on the role of capillarization for exercise performance.
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Affiliation(s)
- Ylva Hellsten
- The August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Lasse Gliemann
- The August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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2
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Agrawal I, Bano S, Chaudhary A, Ahuja A. Role of Permeability Surface Area Product in Grading of Brain Gliomas using CT Perfusion. Asian J Neurosurg 2023; 18:751-760. [PMID: 38161609 PMCID: PMC10756843 DOI: 10.1055/s-0043-1774820] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Purpose The aim of this study was to evaluate the role of permeability surface area product in grading brain gliomas using computed tomography (CT) perfusion Materials and Methods CT perfusion was performed on 33 patients with brain glioma diagnosed on magnetic resonance imaging. Of these, 19 had high-grade glioma and 14 had low-grade glioma on histopathological follow-up. CT perfusion values were obtained and first compared between the tumor region and normal brain parenchyma. Then the relative values of perfusion parameters were compared between high- and low-grade gliomas. Cut-off values, sensitivity, specificity, and strength of agreement for each parameter were calculated and compared subsequently. A conjoint factor (permeability surface area product + cerebral blood volume) was also evaluated since permeability surface area product and cerebral blood volume are considered complimentary factors for tumor vascularity. Results All five perfusion parameters namely permeability surface area product, cerebral blood volume, cerebral blood flow, mean transit time, and time to peak were found significantly higher in the tumor region than normal brain parenchyma. Among these perfusion parameters, only relative permeability surface area product and relative cerebral blood volume were found significant in differentiating high- and low-grade glioma. Moreover, relative permeability surface area product was significantly better than all other perfusion parameters with highest sensitivity and specificity (97.74 and 100%, respectively, at a cut-off of 9.0065). Relative permeability surface area product had a very good agreement with the histopathology grade. The conjoint factor did not yield any significant diagnostic advantage over permeability surface area product. Conclusion Relative permeability surface area product and relative cerebral blood volume were helpful in differentiating high- and low-grade glioma; however, relative permeability surface area product was significantly better than all other perfusion parameters. Grading brain gliomas using relative permeability surface area product can add crucial value in their management and prognostication; hence, it should be evaluated in the routine CT perfusion imaging protocol.
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Affiliation(s)
- Ira Agrawal
- Department of Radiodiagnosis, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Shahina Bano
- Department of Radiodiagnosis, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Ajay Chaudhary
- Department of Neurosurgery, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi, India
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Li JJ, Zhang XP, Xiao X, Zhang CC, Wang R, Dai JJ, Luo ZD, Liu N. [ Mean transit time of water bodies in a typical soil-plant-atmosphere continuum of the subtropical monsoon region]. Ying Yong Sheng Tai Xue Bao 2023; 34:3184-3194. [PMID: 38511356 DOI: 10.13287/j.1001-9332.202312.010] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
The mean transit time (MTT) is a good indicator of water cycle processes. We know little about the MTT of different water bodies within the soil-plant-atmosphere continuum (SPAC) in the subtropical monsoon region. We estimated the MTT of stratified soil water at different depths as well as the xylem water and leaf water in typical Cinnamomum camphora woodland located in Changsha City from March 2017 to October 2019. The main methods used in this study included the stable isotope technology, the linear mixed model and the sine wave fitting method. The results showed that the stable isotopes were more depleted in summer and enriched in winter for different water bodies within the SPAC. The δ2H values of soil water gradually decreased as depth increased. The δ2H values of xylem water closely resembled those of soil water, but the δ2H values of leaf water were more positive and exhibited larger variation. Results of the linear mixed model indicated that the lower MTT values of soil water and plant water occurred between June and September, while the higher values were often observed around January and from April to May. The precipitation replenishment exhibited a significant negative correlation with the MTT. The MTT of soil water generally increased with depth, although preferential flow could enhance the replenishment of deeper soil water and subsequently reduce the MTT. The mean MTT values of xylem water and leaf water were similar. Results of the sine wave fitting method showed that the young water fraction (Fyw) of soil water gradually decreased as depth increased, while the MTT of soil water gradually increased as depth increased. The Fyw and MTT of xylem water were lower and higher than those of leaf water, respectively. Both the mean MTT values of soil water based on the linear mixed model or the sine wave fitting method increased from the surface to the deeper soil layers. The former exhibited a smaller variation range and the latter showed a larger variation range. The mean MTT value of xylem water based on the linear mixed model was 2.4 days less than that of leaf water, while the MTT value of xylem water in the sine wave fitting method was 87.4 days higher than that of leaf water. These differences may be due to the parameterization of "new/young water", the uncertainty of results, and the effect of evaporative fractionation. This study contributes to a better understanding of water transport and consumption processes within the SPAC and provides valuable insights for agricultural production and water resources management in the subtropical monsoon region.
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Affiliation(s)
- Jia-Jie Li
- School of Geographical Science, Hunan Normal University, Changsha 410081, China
| | - Xin-Ping Zhang
- School of Geographical Science, Hunan Normal University, Changsha 410081, China
| | - Xiong Xiao
- School of Geographical Science, Hunan Normal University, Changsha 410081, China
| | - Ci-Cheng Zhang
- School of Geographical Science, Hunan Normal University, Changsha 410081, China
| | - Rui Wang
- School of Geographical Science, Hunan Normal University, Changsha 410081, China
| | - Jun-Jie Dai
- School of Geographical Science, Hunan Normal University, Changsha 410081, China
| | - Zi-Dong Luo
- Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
| | - Na Liu
- College of Geography and Tourism, Hengyang Normal University, Hengyang 421002, Hunan, China
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Chandola S, Dhamija E, Paul SB, Hari S, Batra A, Mathur S, Deo SVS. Imaging features of breast cancer subtypes on contrast enhanced ultrasound: a feasibility study. Ecancermedicalscience 2023; 17:1619. [PMID: 38414960 PMCID: PMC10898897 DOI: 10.3332/ecancer.2023.1619] [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: 06/24/2023] [Indexed: 02/29/2024] Open
Abstract
The objective of this research was to study the contrast enhancement patterns of the different molecular subtypes of breast cancer on contrast-enhanced ultrasound (CEUS) using both qualitative and quantitative parameters. This prospective study included females with a single breast mass which was histopathologically proven carcinoma. B mode ultrasound (USG) and CEUS were performed in all patients during baseline assessment. Qualitative CEUS assessment encompassed enhancement pattern, presence of fill-in and washout. Quantitative assessment included measurement of peak enhancement, time to peak; area under the curve and mean transit time. A p-value < 0.05 was considered statistically significant for differentiating the subtypes. The included thirty masses were categorised into two subtypes-triple negative breast cancer (TNBC) (36.7%) and non-TNBC (63.3%) subtypes. With B-mode USG, a statistically significant difference was observed between the two groups with respect to their shape and margins. TNBC lesions showed an oval shape, circumscribed margins and peripheral nodular enhancement on CEUS with the absence of fill-in even in the delayed phase (p-value - 0.04). The two subtypes did not significantly differ in terms of quantitative perfusion parameters. The various subtypes of breast cancer therefore possess distinct contrast enhancement patterns. CEUS potentially allows differentiation amongst these molecular subtypes that may aid in radiology-pathology (rad-path) correlation and follow up of the patients.
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Affiliation(s)
- Stuti Chandola
- Department of Radiodiagnosis and Interventional Radiology, IRCH, AIIMS, New Delhi 110029, India
| | - Ekta Dhamija
- Department of Radiodiagnosis and Interventional Radiology, IRCH, AIIMS, New Delhi 110029, India
| | - Shashi B Paul
- Department of Radiodiagnosis and Interventional Radiology, IRCH, AIIMS, New Delhi 110029, India
| | - Smriti Hari
- Department of Radiodiagnosis and Interventional Radiology, IRCH, AIIMS, New Delhi 110029, India
| | - Atul Batra
- Department of Medical Oncology, IRCH, AIIMS, New Delhi 110029, India
| | - Sandeep Mathur
- Department of Pathology, IRCH, AIIMS, New Delhi 110029, India
| | - S V S Deo
- Department of Surgical Oncology, IRCH, AIIMS, New Delhi 110029, India
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Hofmann BB, Fischer I, Donaldson DM, Abusabha Y, Karadag C, Muhammad S, Beseoglu K, Hänggi D, Turowski B, Rubbert C, Cornelius JF, Kamp MA. Evaluation of MTT Heterogeneity of Perfusion CT Imaging in the Early Brain Injury Phase: An Insight into aSAH Pathopysiology. Brain Sci 2023; 13:brainsci13050824. [PMID: 37239296 DOI: 10.3390/brainsci13050824] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
The concept of early brain injury (EBI) is based on the assumption of a global reduction in brain perfusion following aneurysmal subarachnoid hemorrhage (aSAH). However, the heterogeneity of computed tomography perfusion (CTP) imaging in EBI has not yet been investigated. In contrast, increased mean transit time (MTT) heterogeneity, a possible marker of microvascular perfusion heterogeneity, in the delayed cerebral ischemia (DCI) phase has recently been associated with a poor neurological outcome after aSAH. Therefore, in this study, we investigated whether the heterogeneity of early CTP imaging in the EBI phase is an independent predictor of the neurological outcome after aSAH. We retrospectively analyzed the heterogeneity of the MTT using the coefficient of variation (cvMTT) in early CTP scans (within 24 h after ictus) of 124 aSAH patients. Both linear and logistic regression were used to model the mRS outcome, which were treated as numerical and dichotomized values, respectively. Linear regression was used to investigate the linear dependency between the variables. No significant difference in cvMTT between the patients with and those without EVD could be observed (p = 0.69). We found no correlation between cvMTT in early CTP imaging and initial modified Fisher (p = 0.07) and WFNS grades (p = 0.23). The cvMTT in early perfusion imaging did not correlate significantly with the 6-month mRS for the entire study population (p = 0.15) or for any of the subgroups (without EVD: p = 0.21; with EVD: p = 0.3). In conclusion, microvascular perfusion heterogeneity, assessed by the heterogeneity of MTT in early CTP imaging, does not appear to be an independent predictor of the neurological outcome 6 months after aSAH.
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Affiliation(s)
- Björn B Hofmann
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Igor Fischer
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Daniel M Donaldson
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Yousef Abusabha
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Cihat Karadag
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Sajjad Muhammad
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Kerim Beseoglu
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
- Department of Neurosurgery, International Neuroscience Institute, 30625 Hannover, Germany
| | - Bernd Turowski
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Christian Rubbert
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Marcel A Kamp
- Centre for Palliative and Neuro-Palliative Care, Brandenburg Medical School Theodor Fontane, Campus Rüdersdorf, 15562 Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
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Sayin ES, Schulman J, Poublanc J, Levine HT, Raghavan LV, Uludag K, Duffin J, Fisher JA, Mikulis DJ, Sobczyk O. Investigations of hypoxia-induced deoxyhemoglobin as a contrast agent for cerebral perfusion imaging. Hum Brain Mapp 2022; 44:1019-1029. [PMID: 36308389 PMCID: PMC9875930 DOI: 10.1002/hbm.26131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/19/2022] [Revised: 08/01/2022] [Accepted: 10/09/2022] [Indexed: 01/28/2023] Open
Abstract
The assessment of resting perfusion measures (mean transit time, cerebral blood flow, and cerebral blood volume) with magnetic resonance imaging currently requires the presence of a susceptibility contrast agent such as gadolinium. Here, we present an initial comparison between perfusion measures obtained using hypoxia-induced deoxyhemoglobin and gadolinium in healthy study participants. We hypothesize that resting cerebral perfusion measures obtained using precise changes of deoxyhemoglobin concentration will generate images comparable to those obtained using a clinical standard, gadolinium. Eight healthy study participants were recruited (6F; age 23-60). The study was performed using a 3-Tesla scanner with an eight-channel head coil. The experimental protocol consisted of a high-resolution T1-weighted scan followed by two BOLD sequence scans in which each participant underwent a controlled bolus of transient pulmonary hypoxia, and subsequently received an intravenous bolus of gadolinium. The resting perfusion measures calculated using hypoxia-induced deoxyhemoglobin and gadolinium yielded maps that looked spatially comparable. There was no statistical difference between methods in the average voxel-wise measures of mean transit time, relative cerebral blood flow and relative cerebral blood volume, in the gray matter or white matter within each participant. We conclude that perfusion measures generated with hypoxia-induced deoxyhemoglobin are spatially and quantitatively comparable to those generated from a gadolinium injection in the same healthy participant.
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Affiliation(s)
- Ece Su Sayin
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada,Department of Anaesthesia and Pain ManagementUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Jacob Schulman
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada,Techna Institute, University Health NetworkTorontoCanada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging LabUniversity Health NetworkTorontoOntarioCanada
| | - Harrison T. Levine
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada,Department of Anaesthesia and Pain ManagementUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Lakshmikumar Venkat Raghavan
- Department of Anaesthesia and Pain ManagementUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Kamil Uludag
- Techna Institute, University Health NetworkTorontoCanada,Joint Department of Medical Imaging and the Functional Neuroimaging LabUniversity Health NetworkTorontoOntarioCanada,Center for Neuroscience Imaging Research, Institute for Basic Science and Department of Biomedical EngineeringSungkyunkwan UniversitySuwonRepublic of Korea
| | - James Duffin
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada,Department of Anaesthesia and Pain ManagementUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Joseph A. Fisher
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada,Department of Anaesthesia and Pain ManagementUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - David J. Mikulis
- Techna Institute, University Health NetworkTorontoCanada,Joint Department of Medical Imaging and the Functional Neuroimaging LabUniversity Health NetworkTorontoOntarioCanada
| | - Olivia Sobczyk
- Department of Anaesthesia and Pain ManagementUniversity Health Network, University of TorontoTorontoOntarioCanada,Joint Department of Medical Imaging and the Functional Neuroimaging LabUniversity Health NetworkTorontoOntarioCanada
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Stevenson JL, Geris J, Birkel C, Tetzlaff D, Soulsby C. Assessing land use influences on isotopic variability and stream water ages in urbanising rural catchments. Isotopes Environ Health Stud 2022; 58:277-300. [PMID: 35549960 DOI: 10.1080/10256016.2022.2070615] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/01/2022] [Indexed: 06/15/2023]
Abstract
Stable water isotopes are invaluable in helping understand catchment functioning and are widely used in experimental catchments, with higher frequency data becoming increasingly common. Such datasets incur substantial logistical costs, reducing their feasibility for use by decision makers needing to understand multi-catchment, landscape-scale functioning over a relatively short period to assess the impact of proposed land use change. Instead, reconnaissance style surveys (high spatial resolution across the landscape at a lower temporal frequency, over a relatively short period) offer an alternative, complementary approach. To test if such sampling could identify heterogeneities in hydrological functioning, and associated landscape controls, we sampled 27 stream sites fortnightly for one year within a peri-urban landscape undergoing land use change. Visual examination of raw data and application of mean transit time and young water fraction models indicated urbanisation, agriculture and responsive soils caused more rapid cycling of precipitation to stream water, whereas mature forestry provided attenuation. We were also able to identify contiguous catchments which functioned fundamentally differently, meaning their response to land use alteration would also be different. This study demonstrated how stable water isotopes can be a valuable, low-cost addition to tools available for environmental decision makers by providing local, process-based information.
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Affiliation(s)
- Jamie Lee Stevenson
- School of Geosciences, Northern Rivers Institute, University of Aberdeen, Aberdeen, UK
| | - Josie Geris
- School of Geosciences, Northern Rivers Institute, University of Aberdeen, Aberdeen, UK
| | - Christian Birkel
- Department of Geography and Water and Global Change Observatory, University of Costa Rica, San José, Costa Rica
| | - Doerthe Tetzlaff
- Geographisches Institut, Humboldt University Berlin, Berlin, Germany
- IGB Leibniz Institute of Freshwater Ecology and Inland Fisheries, Berlin, Germany
| | - Chris Soulsby
- School of Geosciences, Northern Rivers Institute, University of Aberdeen, Aberdeen, UK
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Xu X, Tan Z, Fan M, Ma M, Fang W, Liang J, Xiao Z, Shi C, Luo L. Comparative Study of Multi-Delay Pseudo-Continuous Arterial Spin Labeling Perfusion MRI and CT Perfusion in Ischemic Stroke Disease. Front Neuroinform 2021; 15:719719. [PMID: 34456703 PMCID: PMC8386683 DOI: 10.3389/fninf.2021.719719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/02/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
With the aging population, stroke has gradually become the leading cause of death and disability among adults. It is necessary to verify whether multi-delay pseudo-continuous arterial spin labeling (pCASL) MRI can be used as a standard neuroimaging protocol in the patients with ischemic stroke. We aimed to investigate the clinical utility of multi-delay pCASL for evaluating cerebral perfusion in ischemic stroke disease. Twenty-one ischemic stroke patients [18 men and 3 women; median age, 62 years (age range, 37-84 years)] were enrolled in this study. All patients underwent examinations, including the multi-delay pCASL protocol (using 6 PLDs between 1,000 and 3,500 ms) and computed tomography perfusion (CTP). The cerebral blood flow (CBF) and arterial transit time (ATT) maps were obtained by the multi-delay pCASL protocol, while CBF and mean transit time (MTT) maps were derived by CTP measurements. Based on the voxel level analysis, Pearson correlation coefficients were used to estimate the associations between the two modalities in the gray matter, white matter, and whole brain of each subject. Moderate to high positive associations between ASL-CBF and CTP-CBF were acquired by voxel-level-wise analysis in the gray matter, white matter, and whole brain of the enrolled patients (all P < 0.005), and the average Pearson correlation coefficients were 0.647, 0.585, and 0.646, respectively. Highly significant positive correlations between ASL-ATT and CTP-MTT were obtained by voxel-level-wise associations in the gray matter, white matter, and whole brain (all P < 0.005), and the average Pearson correlation coefficients were 0.787, 0.707, and 0.799, respectively. In addition, significant associations between ASL and CT perfusion were obtained in the gray, white matter and whole brain, according to the subgroup analyses of patient's age and disease stage. There is a correlation between perfusion parameters from multi-delay pCASL and CT perfusion imaging in patients with ischemic stroke. Multi-delay pCASL is radiation-free and non-invasive, and could be an alternative method to CT scans for assessing perfusion in ischemic stroke disease.
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Affiliation(s)
- Xi Xu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zefeng Tan
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Neurology, Shun De Hospital of Jinan University, Foshan, China
| | - Meng Fan
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Mengjie Ma
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Weimin Fang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jianye Liang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zeyu Xiao
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Changzheng Shi
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Engineering Research Center of Medical Imaging Artificial Intelligence for Precision Diagnosis and Treatment, Guangzhou, China
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Engineering Research Center of Medical Imaging Artificial Intelligence for Precision Diagnosis and Treatment, Guangzhou, China
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Ostman C, Garcia-Esperon C, Lillicrap T, Tomari S, Holliday E, Levi C, Bivard A, Parsons MW, Spratt NJ. Multimodal Computed Tomography Increases the Detection of Posterior Fossa Strokes Compared to Brain Non-contrast Computed Tomography. Front Neurol 2020; 11:588064. [PMID: 33329332 PMCID: PMC7714905 DOI: 10.3389/fneur.2020.588064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/28/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Aims: Multimodal computed tomography (mCT) (non-contrast CT, CT angiography, and CT perfusion) is not routinely used to assess posterior fossa strokes. We described the area under the curve (AUC) of brain NCCT, WB-CTP automated core-penumbra maps and comprehensive CTP analysis (automated core-penumbra maps and all perfusion maps) for posterior fossa strokes. Methods: We included consecutive patients with signs and symptoms of posterior fossa stroke who underwent acute mCT and follow up magnetic resonance diffusion weighted imaging (DWI). Multimodal CT images were reviewed blindly and independently by two stroke neurologists and area under the receiver operating characteristic curve (AUC) was used to compare imaging modalities. Results: From January 2014 to December 2019, 83 patients presented with symptoms suggestive of posterior fossa strokes and had complete imaging suitable for inclusion (49 posterior fossa strokes and 34 DWI negative patients). For posterior fossa strokes, comprehensive CTP analysis had an AUC of 0.68 vs. 0.62 for automated core-penumbra maps and 0.55 for NCCT. For cerebellar lesions >5 mL, the AUC was 0.87, 0.81, and 0.66, respectively. Conclusion: Comprehensive CTP analysis increases the detection of posterior fossa lesions compared to NCCT and should be implemented as part of the routine imaging assessment in posterior fossa strokes.
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Affiliation(s)
- Cecilia Ostman
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Carlos Garcia-Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia.,Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, Australia
| | - Thomas Lillicrap
- Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Shinya Tomari
- Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, Australia
| | - Elizabeth Holliday
- Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Christopher Levi
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.,Maridulu Budyari Gumal, The Sydney Partnership for Health Education Research & Enterprise (SPHERE), University of New South Wales, Sydney, NSW, Australia
| | - Andrew Bivard
- Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, NSW, Australia
| | - Mark W Parsons
- Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, Australia.,Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, NSW, Australia.,UNSW South Western Sydney Clinical School, University of New South Wales and Department of Neurology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Neil J Spratt
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia.,Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, Australia
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10
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Kuribara T, Mikami T, Iihoshi S, Miyata K, Kim S, Kawata Y, Komatsu K, Kimura Y, Enatsu R, Akiyama Y, Hirano T, Mikuni N. Ischemic Tolerance Evaluated by Computed Tomography Perfusion during Balloon Test Occlusion. J Stroke Cerebrovasc Dis 2020; 29:104807. [PMID: 32295733 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104807] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/21/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Balloon test occlusion (BTO) is performed to evaluate ischemic tolerance for large and giant cerebral aneurysms and head and neck tumors that may require parent artery occlusion. However, ischemic tolerance for the temporary test occlusion does not always guarantee a tolerance for permanent occlusion. In this study, we evaluated the utility of computed tomography (CT) perfusion during BTO to quantify ischemic tolerance for detecting delayed ischemic stroke. MATERIALS AND METHODS Forty-one patients who underwent BTO for the internal carotid artery were included. The correlations between the parameters of CT perfusion and collateral angiographic appearance or stump pressure during BTO were evaluated. The cerebral blood flow (CBF), cerebral blood volume, mean transit time (MTT), and time to peak (TTP) were obtained through CT perfusion, and the asymmetry ratios were determined. Collateral angiographic appearances were categorized into 5 grades (0-4). RESULTS The collateral angiographic appearance showed moderate correlations with CBF, MTT, and TTP that was significant. Of these, the absolute value of the correlation coefficient was the highest for MTT. MTT also showed a moderate correlation with stump pressure. CBF and MTT were significantly different between the poor collateral group (grades 2 and 3) and the good collateral group (grade 4). Based on the MTT, the good collateral group was identified with high sensitivity (75.0%) and specificity (81.2%). CONCLUSIONS In BTO, the MTT obtained through CT perfusion showed a correlation with collateral angiographic appearance and stump pressure. Thus, the MTT might be useful to quantify ischemic tolerance for detecting delayed ischemic stroke.
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Affiliation(s)
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
| | - Satoshi Iihoshi
- Department of Endovascular Neurosurgery and Stroke Center, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Kei Miyata
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Sangnyon Kim
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Yuka Kawata
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Katsuya Komatsu
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Yusuke Kimura
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Toru Hirano
- Division of Radiology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Nobuhiro Mikuni
- Division of Radiology, Sapporo Medical University Hospital, Sapporo, Japan
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11
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Ravindra VM, Kralik SF, Griauzde J, Gadgil N, LoPresti MA, Lam S. Preoperative computed tomography perfusion in pediatric moyamoya disease: a single-institution experience. J Neurosurg Pediatr 2020; 25:1-8. [PMID: 31978885 DOI: 10.3171/2019.10.peds19450] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Moyamoya disease is a progressive occlusive arteriopathy for which surgical revascularization is indicated. In this retrospective study, the authors investigated the use of preoperative CT perfusion with the aim of establishing pathological data references. METHODS The authors reviewed the medical records of children with moyamoya disease treated surgically at one institution between 2016 and 2019. Preoperative CT perfusion studies were used to quantify mean transit time (MTT), cerebral blood volume (CBV), cerebral blood flow (CBF), and time to peak (TTP) for the anterior, middle, and posterior cerebral artery vascular territories for each patient. CT perfusion parameter ratios (diseased/healthy hemispheres) and absolute differences were compared between diseased and normal vascular territories (defined by catheter angiography studies). Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values for CT perfusion parameters for severe angiographic moyamoya were calculated. RESULTS Nine children (89% female) had preoperative CT perfusion data; 5 of them had evidence of unilateral hemispheric disease and 4 had bilateral disease. The mean age at revascularization was 77 months (range 40-144 months). The etiology of disease was neurofibromatosis type 1 (3 patients), Down syndrome (2), primary moyamoya disease (2), cerebral proliferative angiopathy (1), and sickle cell disease (1). Five patients had undergone unilateral revascularization. Among these patients, pathological vascular territories demonstrated increased MTT in 66% of samples, increased TTP in 66%, decreased CBF in 47%, and increased CBV in 87%. Severe moyamoya (Suzuki stage ≥ 4) had diseased/healthy ratios ≥ 1 for MTT in 78% of cases, for TTP in 89%, for CBF in 67%, and for CBV in 89%. The MTT and TTP region of interest ratio ≥ 1 demonstrated 89% sensitivity, 67% specificity, 80% PPV, and 80% NPV for the prediction of severe angiographic moyamoya disease. CONCLUSIONS Pathological hemispheres in these children with moyamoya disease demonstrated increased MTT, TTP, and CBV and decreased CBF. The authors' results suggest that preoperative CT perfusion may, with high sensitivity, be useful in deciphering perfusion mismatch in brain tissue in children with moyamoya disease. More severe angiographic disease displays a more distinct correlation, allowing surgeons to recognize when to intervene in these patients.
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Affiliation(s)
| | - Stephen F Kralik
- 2Department of Pediatric Radiology, Baylor College of Medicine, Houston, Texas
| | - Julius Griauzde
- 3Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Sandi Lam
- 4Department of Neurosurgery, Northwestern University Feinberg School of Medicine; and
- 5Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois
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12
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Li L, Poloyac SM, Watkins SC, St Croix CM, Alexander H, Gibson GA, Loughran PA, Kirisci L, Clark RS, Kochanek PM, Vazquez AL, Manole MD. Cerebral microcirculatory alterations and the no-reflow phenomenon in vivo after experimental pediatric cardiac arrest. J Cereb Blood Flow Metab 2019; 39:913-925. [PMID: 29192562 PMCID: PMC6501505 DOI: 10.1177/0271678x17744717] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 01/02/2023]
Abstract
Decreased cerebral blood flow (CBF) after cardiac arrest (CA) contributes to secondary ischemic injury in infants and children. We previously reported cortical hypoperfusion with tissue hypoxia early in a pediatric rat model of asphyxial CA. In order to identify specific alterations as potential therapeutic targets to improve cortical hypoperfusion post-CA, we characterize the CBF alterations at the cortical microvascular level in vivo using multiphoton microscopy. We hypothesize that microvascular constriction and disturbances of capillary red blood cell (RBC) flow contribute to cortical hypoperfusion post-CA. After resuscitation from 9 min asphyxial CA, transient dilation of capillaries and venules at 5 min was followed by pial arteriolar constriction at 30 and 60 min (19.6 ± 1.3, 19.3 ± 1.2 µm at 30, 60 min vs. 22.0 ± 1.2 µm at baseline, p < 0.05). At the capillary level, microcirculatory disturbances were highly heterogeneous, with RBC stasis observed in 25.4% of capillaries at 30 min post-CA. Overall, the capillary plasma mean transit time was increased post-CA by 139.7 ± 51.5%, p < 0.05. In conclusion, pial arteriolar constriction, the no-reflow phenomenon and increased plasma transit time were observed post-CA. Our results detail the microvascular disturbances in a pediatric asphyxial CA model and provide a powerful platform for assessing specific vascular-targeted therapies.
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Affiliation(s)
- Lingjue Li
- 1 Center of Clinical Pharmaceutical Sciences, University of Pittsburgh, PA, USA.,2 School of Pharmacy, University of Pittsburgh, PA, USA
| | - Samuel M Poloyac
- 1 Center of Clinical Pharmaceutical Sciences, University of Pittsburgh, PA, USA.,2 School of Pharmacy, University of Pittsburgh, PA, USA
| | - Simon C Watkins
- 3 Center for Biologic Imaging, University of Pittsburgh, PA, USA
| | | | - Henry Alexander
- 4 Safar Center for Resuscitation Research, University of Pittsburgh, PA, USA
| | - Gregory A Gibson
- 3 Center for Biologic Imaging, University of Pittsburgh, PA, USA
| | | | | | - Robert Sb Clark
- 4 Safar Center for Resuscitation Research, University of Pittsburgh, PA, USA.,5 Department of Critical Care Medicine, University of Pittsburgh, PA, USA
| | - Patrick M Kochanek
- 4 Safar Center for Resuscitation Research, University of Pittsburgh, PA, USA.,5 Department of Critical Care Medicine, University of Pittsburgh, PA, USA.,6 Department of Pediatrics, University of Pittsburgh, PA, USA
| | | | - Mioara D Manole
- 4 Safar Center for Resuscitation Research, University of Pittsburgh, PA, USA.,5 Department of Critical Care Medicine, University of Pittsburgh, PA, USA.,6 Department of Pediatrics, University of Pittsburgh, PA, USA
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13
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Everaars H, de Waard GA, Driessen RS, Danad I, van de Ven PM, Raijmakers PG, Lammertsma AA, van Rossum AC, Knaapen P, van Royen N. Doppler Flow Velocity and Thermodilution to Assess Coronary Flow Reserve: A Head-to-Head Comparison With [ 15O]H 2O PET. JACC Cardiovasc Interv 2018; 11:2044-2054. [PMID: 30268877 DOI: 10.1016/j.jcin.2018.07.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [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] [Received: 04/12/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study sought to compare Doppler flow velocity reserve (CFRDoppl) and thermodilution-derived coronary flow reserve (CFRthermo) head-to-head with the gold standard for quantification of myocardial perfusion, [15O]H2O positron emission tomography (PET). BACKGROUND Coronary flow reserve (CFR) is an important parameter for assessing coronary vascular function. To date, 2 techniques are available for invasive assessment of CFR: Doppler flow velocity and thermodilution. Although these techniques have been compared with each other, neither has been compared with [15O]H2O PET perfusion imaging. METHODS CFR was assessed in 98 vessels of 40 consecutive stable patients with suspected coronary artery disease. Patients underwent [15O]H2O PET, followed by invasive angiography in conjunction with simultaneous measurements of fractional flow reserve, CFRDoppl, and CFRthermo. Both normal and obstructed arteries were included. RESULTS The quality of Doppler flow velocity traces was significantly lower than that of thermodilution curves (p < 0.001). A moderate correlation was observed between CFRDoppl and CFRthermo (r = 0.59; p < 0.001). CFRDoppl correlated well with PET-derived CFR (CFRPET) (r = 0.82; p < 0.001). In contrast, the correlation between CFRthermo and CFRPET was only modest (r = 0.55; p < 0.001). This difference in correlation with CFRPET was significant (t = 4.9; df = 95; p < 0.001). Bland-Altman analysis revealed a tendency of CFRthermo to overestimate flow reserve at higher values. CONCLUSIONS Coronary flow reserve, determined using Doppler flow velocity, has superior agreement with [15O]H2O PET in comparison with CFRthermo.
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Affiliation(s)
- Henk Everaars
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Guus A de Waard
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Roel S Driessen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Pieter G Raijmakers
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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14
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Jorgenson CC, Chase SC, Olson LJ, Johnson BD. Assessment of Thoracic Blood Volume by Computerized Tomography in Patients With Heart Failure and Periodic Breathing. J Card Fail 2018; 24:479-483. [PMID: 29678727 DOI: 10.1016/j.cardfail.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/09/2017] [Revised: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Periodic breathing (PB) is often observed in patients with HF at rest, with sleep and during exercise. However, mechanisms underlying abnormal ventilatory control are not entirely established. METHODS Eleven subjects with HF (10 males, age = 69 ± 12 y) and 12 age-matched control subjects (8 males, age = 65 ± 9 y) participated in the study. PB was defined as a peak in the 0.003-0.04 Hz frequency range of the flow signal during 6 minutes of awake resting breathing. Thoracic blood volumes (Vt, thorax; Vh, heart; Vp, pulmonary), mean transit times (MTTs), and extravascular lung water (EVLW) were quantified using computerized tomography. RESULTS PB was observed in 7 subjects with HF and was associated with worse functional status. The HF PB-present group had thoracic blood volumes nearly double those of control and HF PB-absent subjects (volumes reported as mL/m2 body surface area, P values vs control: control = 813 ± 246, HF PB-absent = 822 ± 161 P = .981, HF PB-present = 1579 ± 548 P = .002). PB was associated with longer pulmonary MTT (control = 6.7 ± 1.2 s, HF PB-absent = 6.0 ± 0.8 s, HF PB-present = 8.4 ± 1.6 s; P = .033, HF PB-present vs HF PB-absent). EVLW was not elevated in the PB group. CONCLUSIONS Subjects with HF and PB at rest have greater centralization of blood volume.
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Affiliation(s)
| | - Steven C Chase
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Lyle J Olson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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15
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Szarmach A, Kaszubowski M, Sabisz A, Frydrychowski AF, Halena G, Piskunowicz M, Dzierzanowski J, Studniarek M, Szurowska E, Winklewski PJ. Regional resting state perfusion variability and delayed cerebrovascular uniform reactivity in subjects with chronic carotid artery stenosis. Acta Biochim Pol 2018. [PMID: 29529102 DOI: 10.18388/abp.2018_2581] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study was to assess regional perfusion at baseline and regional cerebrovascular resistance (CVR) to delayed acetazolamide challenge in subjects with chronic carotid artery stenosis. Sixteen patients (ten males) aged 70.94±7.71 with carotid artery stenosis ≥ 90% on the ipsilateral side and ≤ 50% on the contralateral side were enrolled into the study. In all patients, two computed tomography perfusion examinations were carried out; the first was performed before acetazolamide administration and the second 60 minutes after injection. The differences between mean values were examined by paired two-sample t-test and alternative nonparametric Wilcoxon's test. Normality assumption was examined using W Shapiro-Wilk test. The lowest resting-state cerebral blood flow (CBF) was observed in white matter (ipsilateral side: 18.4±6.2; contralateral side: 19.3±6.6) and brainstem (ipsilateral side: 27.8±8.5; contralateral side: 29.1±10.8). Grey matter (cerebral cortex) resting state CBF was below the normal value for subjects of this age: frontal lobe - ipsilateral side: 30.4±7.0, contralateral side: 33.7±7.1; parietal lobe - ipsilateral side: 36.4±11.3, contralateral side: 42.7±9.9; temporal lobe - ipsilateral side: 32.5±8.6, contralateral side: 39.4±10.8; occipital lobe - ipsilateral side: 24.0±6.0, contralateral side: 26.4±6.6). The highest resting state CBF was observed in the insula (ipsilateral side: 49.2±17.4; contralateral side: 55.3±18.4). A relatively high resting state CBF was also recorded in the thalamus (ipsilateral side: 39.7±16.9; contralateral side: 41.7±14.1) and cerebellum (ipsilateral side: 41.4±12.2; contralateral side: 38.1±11.3). The highest CVR was observed in temporal lobe cortex (ipsilateral side: +27.1%; contralateral side: +26.1%) and cerebellum (ipsilateral side: +27.0%; contralateral side: +34.6%). The lowest CVR was recorded in brain stem (ipsilateral side: +20.2%; contralateral side: +22.2%) and white matter (ipsilateral side: +18.1%; contralateral side: +18.3%). All CBF values were provided in milliliters of blood per minute per 100 g of brain tissue (ml/100g/min). Resting state circulation in subjects with carotid artery stenosis is low in all analysed structures with the exception of insula and cerebellum. Acetazolamide challenge yields relatively uniform response in both hemispheres in the investigated population. Grey matter is more reactive to acetazolamide challenge than white matter or brainstem.
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Affiliation(s)
- Arkadiusz Szarmach
- 2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
| | - Mariusz Kaszubowski
- Department of Economic Sciences, Faculty of Management and Economics, Gdansk University of Technology, Gdańsk, Poland
| | - Agnieszka Sabisz
- 2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Grzegorz Halena
- Department of Cardiovascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Maciej Piskunowicz
- 1-st Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Michał Studniarek
- 1-st Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
- Department of Diagnostic Imaging, Medical University of Warsaw, Warsaw, Poland
| | - Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
| | - Pawel J Winklewski
- 2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
- Department of Human Physiology, Medical University of Gdansk, Gdańsk, Poland
- Faculty of Health Sciences, Pomeranian University of Slupsk, Słupsk, Poland
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16
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Szarmach A, Halena G, Kaszubowski M, Piskunowicz M, Studniarek M, Lass P, Szurowska E, Winklewski PJ. Carotid Artery Stenting and Blood-Brain Barrier Permeability in Subjects with Chronic Carotid Artery Stenosis. Int J Mol Sci 2017; 18:ijms18051008. [PMID: 28481312 PMCID: PMC5454921 DOI: 10.3390/ijms18051008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/23/2017] [Accepted: 05/03/2017] [Indexed: 01/28/2023] Open
Abstract
Failure of the blood-brain barrier (BBB) is a critical event in the development and progression of diseases such as acute ischemic stroke, chronic ischemia or small vessels disease that affect the central nervous system. It is not known whether BBB breakdown in subjects with chronic carotid artery stenosis can be restrained with postoperative recovery of cerebral perfusion. The aim of the study was to assess the short-term effect of internal carotid artery stenting on basic perfusion parameters and permeability surface area-product (PS) in such a population. Forty subjects (23 males) with stenosis of >70% within a single internal carotid artery and neurological symptoms who underwent a carotid artery stenting procedure were investigated. Differences in the following computed tomography perfusion (CTP) parameters were compared before and after surgery: global cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and PS. PS acquired by CTP is used to measure the permeability of the BBB to contrast material. In all baseline cases, the CBF and CBV values were low, while MTT and TTP were high on both the ipsi- and contralateral sides compared to reference values. PS was approximately twice the normal value. CBF was higher (+6.14%), while MTT was lower (−9.34%) on the contralateral than on the ipsilateral side. All perfusion parameters improved after stenting on both the ipsilateral (CBF +22.66%; CBV +18.98%; MTT −16.09%, TTP −7.62%) and contralateral (CBF +22.27%, CBV +19.72%, MTT −14.65%, TTP −7.46%) sides. PS decreased by almost half: ipsilateral −48.11%, contralateral −45.19%. The decline in BBB permeability was symmetrical on the ipsi- and contralateral sides to the stenosis. Augmented BBB permeability can be controlled by surgical intervention in humans.
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Affiliation(s)
- Arkadiusz Szarmach
- 2nd Department of Radiology, Medical University of Gdansk, Gdansk 80-210, Poland.
| | - Grzegorz Halena
- Department of Cardiovascular Surgery, Medical University of Gdansk, Gdansk 80-210, Poland.
| | - Mariusz Kaszubowski
- Department of Economic Sciences, Faculty of Management and Economics, Gdansk University of Technology, Gdansk 80-210, Poland.
| | - Maciej Piskunowicz
- 1st Department of Radiology, Medical University of Gdansk, Gdansk 80-210, Poland.
| | - Michal Studniarek
- 1st Department of Radiology, Medical University of Gdansk, Gdansk 80-210, Poland.
- Department of Diagnostic Imaging, Medical University of Warsaw, Warsaw 03-242, Poland.
| | - Piotr Lass
- Department of Nuclear Medicine, Medical University of Gdansk, Gdansk 80-210, Poland.
| | - Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdansk, Gdansk 80-210, Poland.
| | - Pawel J Winklewski
- Institute of Human Physiology, Medical University of Gdansk, Gdansk 80-210, Poland.
- Department of Clinical Sciences, Institute of Health Sciences, Pomeranian University of Slupsk, Slupsk 76-200, Poland.
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17
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Hashimoto A, Mikami T, Komatsu K, Noshiro S, Hirano T, Wanibuchi M, Mikuni N. Assessment of Hemodynamic Compromise Using Computed Tomography Perfusion in Combination with 123I-IMP Single-Photon Emission Computed Tomography without Acetazolamide Challenge Test. J Stroke Cerebrovasc Dis 2016; 26:627-635. [PMID: 27939758 DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 07/04/2016] [Revised: 10/03/2016] [Accepted: 11/13/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The acetazolamide challenge test in conjunction with 123I-IMP single-photon emission computed tomography (SPECT) is a known method of assessing cerebrovascular reserve capacity. In this study, we investigated whether CT perfusion in combination with resting state 123I-IMP SPECT could be used instead of the acetazolamide challenge test to evaluate hemodynamic compromise in patients with atherosclerotic occlusive disease. METHODS Twenty consecutive patients with unilateral internal carotid artery or middle cerebral artery steno-occlusive disease were enrolled. 123I-IMP SPECT was performed with and without the acetazolamide challenge test, and with CT perfusion. Cerebral blood flow (CBF), cerebral blood volume, and mean transit time (MTT) obtained by CT perfusion were compared with CBF and cerebrovascular reactivity (CVR) obtained by 123I-IMP SPECT. RESULTS The asymmetry ratio of MTT as measured by CT perfusion showed a strong correlation with the CVR to acetazolamide as measured by 123I-IMP SPECT (ρ = -.780, P <.001). Based on the CBF obtained through 123I-IMP SPECT and the MTT obtained through CT perfusion, hemodynamic compromise was detected with high sensitivity (1.000) and specificity (.929), and a cutoff value of 30% was found to be suitable for the asymmetry ratio of MTT. MTT prolongation was significantly improved after revascularization surgery in hemodynamic compromise (P = .028). CONCLUSION MTT as measured by CT perfusion in combination with CBF as measured by resting state 123I-IMP SPECT may be useful for evaluating hemodynamic compromise as an alternative to the acetazolamide challenge test.
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Affiliation(s)
- Atsumu Hashimoto
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
| | - Katsuya Komatsu
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Shouhei Noshiro
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Tohru Hirano
- Division of Radiology, Sapporo Medical University Hospital, Sapporo, Japan
| | | | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
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18
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Jiang CJ, Wang ZJ, Zhao YJ, Zhang ZY, Tao JJ, Ma JY. Erythropoietin reduces apoptosis of brain tissue cells in rats after cerebral ischemia/reperfusion injury: a characteristic analysis using magnetic resonance imaging. Neural Regen Res 2016; 11:1450-1455. [PMID: 27857749 PMCID: PMC5090848 DOI: 10.4103/1673-5374.191219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Accepted: 07/03/2016] [Indexed: 11/23/2022] Open
Abstract
Some in vitro experiments have shown that erythropoietin (EPO) increases resistance to apoptosis and facilitates neuronal survival following cerebral ischemia. However, results from in vivo studies are rarely reported. Perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) have been applied successfully to distinguish acute cerebral ischemic necrosis and penumbra in living animals; therefore, we hypothesized that PWI and DWI could be used to provide imaging evidence in vivo for the conclusion that EPO could reduce apoptosis in brain areas injured by cerebral ischemia/reperfusion. To validate this hypothesis, we established a rat model of focal cerebral ischemia/reperfusion injury, and treated with intra-cerebroventricular injection of EPO (5,000 U/kg) 20 minutes before injury. Brain tissue in the ischemic injury zone was sampled using MRI-guided localization. The relative area of abnormal tissue, changes in PWI and DWI in the ischemic injury zone, and the number of apoptotic cells based on TdT-mediated dUTP-biotin nick end-labeling (TUNEL) were assessed. Our findings demonstrate that EPO reduces the relative area of abnormally high signal in PWI and DWI, increases cerebral blood volume, and decreases the number of apoptotic cells positive for TUNEL in the area injured by cerebral ischemia/reperfusion. The experiment provides imaging evidence in vivo for EPO treating cerebral ischemia/reperfusion injury.
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Affiliation(s)
- Chun-juan Jiang
- Department of Radiology, Wuxi Second People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Zhong-juan Wang
- Department of Radiology, Wuxi Second People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Yan-jun Zhao
- Department of Radiology, Wuxi Second People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Zhui-yang Zhang
- Department of Radiology, Wuxi Second People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Jing-jing Tao
- Department of Radiology, Wuxi Second People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Jian-yong Ma
- Department of Radiology, Wuxi Second People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province, China
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Kheradmand A, Fisher M, Paydarfar D. Ischemic stroke in evolution: predictive value of perfusion computed tomography. J Stroke Cerebrovasc Dis 2013; 23:836-43. [PMID: 23954606 DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 04/10/2013] [Accepted: 07/07/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Various perfusion computed tomography (PCT) parameters have been used to identify tissue at risk of infarction in the setting of acute stroke. The purpose of this study was to examine predictive value of the PCT parameters commonly used in clinical practice to define ischemic penumbra. The patient selection criterion aimed to exclude the effect of thrombolysis from the imaging data. METHODS Consecutive acute stroke patients were screened and a total of 18 patients who initially underwent PCT and CT angiogram (CTA) on presentation but did not qualify to receive thrombolytic therapy were selected. The PCT images were postprocessed using a delay-sensitive deconvolution algorithm. All the patients had follow-up noncontrast CT or magnetic resonance imaging to delineate the extent of their infarction. The extent of lesions on PCT maps calculated from mean transit time (MTT), time to peak (TTP), cerebral blood flow, and cerebral blood volume were compared and correlated with the final infarct size. A collateral grading score was used to measure collateral blood supply on the CTA studies. RESULTS The average size of MTT lesions was larger than infarct lesions (P < .05). The correlation coefficient of TTP/infarct lesions (r = .95) was better than MTT/infarct lesions (r = .66) (P = .004). CONCLUSIONS A widely accepted threshold to define MTT lesions overestimates the ischemic penumbra. In this setting, TTP with appropriate threshold is a better predictor of infarct in acute stroke patients. The MTT/TTP mismatch correlates with the status of collateral blood supply to the tissue at risk of infarction.
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Affiliation(s)
- Amir Kheradmand
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Marc Fisher
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David Paydarfar
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
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Vavilala MS, Marro KI, Richards TL, Roberts JS, Curry P, Pihoker C, Bradford H, Shaw D. Change in mean transit time, apparent diffusion coefficient, and cerebral blood volume during pediatric diabetic ketoacidosis treatment. Pediatr Crit Care Med 2011; 12:e344-9. [PMID: 21516055 PMCID: PMC3157541 DOI: 10.1097/pcc.0b013e3182196c9c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Cerebral edema is a devastating complication of pediatric diabetic ketoacidosis. We examined measures describing potential causes of whole brain and regional brain edema (mean transit time, apparent diffusion coefficient, and relative cerebral blood volume) during treatment of diabetic ketoacidosis in children. DESIGN Prospective observational study. SETTING Regional children's hospital. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS After Institutional Review Board approval, children admitted with diabetic ketoacidosis (pH <7.3, HCO3 <15 mEq/L, glucose >300 mg/dL, and ketosis) underwent two serial paired contrast-enhanced (gadolinium) and diffusion magnetic resonance imaging scans. Change in whole brain and regional (frontal lobe, occipital lobe, and basal ganglia) mean transit time, apparent diffusion coefficient, and relative cerebral blood volume between the two time periods (12-24 hrs) and (36-72 hrs) after start of insulin treatment (time 0) were determined. Thirteen children (median age, 10.3 ± 1.1 yrs; 7 female) with diabetic ketoacidosis were examined. Overall, whole brain and regional mean transit time decreased from time 1 (first magnetic resonance imaging after time 0) to time 2 (second magnetic resonance imaging after time 0) by 51% ± 59% (p = .01), without differences between the brain regions examined. Whole brain apparent diffusion coefficient increased by 4.7% ± 3.4% (p = .001), without differences between the brain regions examined. There was no change in relative cerebral blood volume for the whole brain and for the three brain regions examined. CONCLUSIONS In this study, whole brain mean transit time decreased and apparent diffusion coefficient increased, suggesting a vasogenic process between the two study periods during diabetic ketoacidosis treatment.
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Affiliation(s)
- Monica S Vavilala
- Department of Anesthesiology, University of Washington, Seattle, WA, USA.
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