Age‐Related Changes of Normal Cerebral and Cardiac Blood Flow in Children and Adults Aged 7 Months to 61 Years

Abstract

BackgroundCerebral and cardiac blood flow are important to the pathophysiology and development of cerebro‐ and cardiovascular diseases. The purpose of this study was to investigate the age dependence of normal cerebral and cardiac hemodynamics in children and adults over a broad range of ages.Methods and ResultsOverall, 52 children (aged 0.6–17.2 years) and 30 adults (aged 19.2–60.7 years) without cerebro‐ and cardiovascular diseases were included in this study. Intracranial 4‐dimensional flow and cardiac 2‐dimensional phase‐contrast magnetic resonance imaging were performed for all participants to measure flow parameters in the major intracranial vessels and aorta. Total cerebral blood flow (TCBF), cardiac and cerebral indexes, brain volume, and global cerebral perfusion (TCBF/brain volume) were evaluated. Flow analysis revealed that TCBF increased significantly from age 7 months to 6 years (P<0.001) and declined thereafter (P<0.001). Both cardiac and cerebral indices declined with age (P<0.001). The ratio of TCBF to ascending aortic flow declined rapidly until age 18 years (P<0.001) and remained relatively stable thereafter. Age‐related changes of cerebral vascular peak velocities exhibited a trend similar to TCBF. By comparison, aortic peak velocities maintained relatively high levels in children and declined with age in adults (P<0.001). TCBF significantly correlated with brain volume in adults (P=0.005) and in 2 pediatric subgroups, aged <7 years (P<0.001) and 7 to 18 years (P=0.039).ConclusionsCerebral and cardiac flow parameters are highly associated with age. The findings collectively highlight the importance of age‐matched control data for the characterization of intracranial and cardiac hemodynamics.

Four-dimensional MRI flow examinations in cerebral and extracerebral vessels – ready for clinical routine?

“…Others reported similar findings (19, 33) studying the venous system (29, 34, 35), ultra-high field strengths (36, 37), comparative studies with 2D PC-MRI (38) and Doppler ultrasound (24), or carotid hemodynamics (13) using reduced TE and spiral 4D flow MRI (39). …”

“…Several groups reported comparable 3D blood flow patterns in IA phantoms using 4D flow MRI compared to particle image velocimetry measurements and computational fluid dynamics (CFD) (16–18). Multiple studies (19–29) have applied 4D flow MRI for the in vivo evaluation of normal intracranial vasculature, cerebral arteriovenous malformations, vein of Galen aneurysmal malformations, intra-aneurysmal flow and flow modification post- flow diverter stent placement. Some IA studies also evaluated wall shear stress (WSS) (23, 30, 31).…”

“…Normal or baseline cerebral flow values are important to understand the pathophysiology and/or progression of cerebrovascular diseases (29, 32). Cerebral arteriovenous malformations (AVMs) and intracranial atherosclerotic stenoses predictably result in abnormal hemodynamics, often affecting the systemic intracranial circulation (40, 41).…”

“…Using intracranial 4D flow MRI, Wu et al (29) reported reference values of age-related normal cerebral hemodynamic parameters in a cohort of 52 healthy subjects with ages ranging from 7 months to 61 years. Figure 2 illustrates the differences of cerebral 3D blood flow patterns and regional flow characteristics in a pediatric (age 6 years) and an adult (age 55 years) volunteer, respectively.…”

Pharmacotherapy in pediatric epilepsy: from trial and error to rational drug and dose selection – a long way to go

“…Although it is known that organ perfusion varies with age [34], specific quantitative information regarding hepatic and renal changes is still sparse in some groups of the pediatric population. Consequently, it is unclear to what degree variability in organ perfusion determines the changes in clearance between adults and children.…”