Cerebral arterial pulsatility is associated with features of small vessel disease in patients with acute stroke and TIA: a 4D flow MRI study

Abstract

Cerebral small vessel disease (SVD) is a major cause of stroke and cognitive impairment. However, the underlying mechanisms behind SVD are still poorly understood. High cerebral arterial pulsatility has been suggested as a possible cause of SVD. In population studies, arterial pulsatility has been linked to white matter hyperintensities (WMH), cerebral atrophy, and cognitive impairment, all features of SVD. In stroke, pulsatility data are scarce and contradictory. The aim of this study was to investigate the relationship between arterial pulsatility and SVD in stroke patients. With a cross-sectional design, 89 patients with acute ischemic stroke or TIA were examined with MRI. A neuropsychological assessment was performed 1 year later. Using 4D flow MRI, pulsatile indices (PI) were calculated for the internal carotid artery (ICA) and middle cerebral artery (M1, M3). Flow volume pulsatility (FVP), a measure corresponding to the cyclic expansion of the arterial tree, was calculated for the same locations. These parameters were assessed for associations with WMH volume, brain volume and cognitive function. ICA-FVP was associated with WMH volume (β = 1.67, 95% CI: [0.1, 3.24], p = 0.037). M1-PI and M1-FVP were associated with decreasing cognitive function (β = − 4.4, 95% CI: [− 7.7, − 1.1], p = 0.009 and β = − 13.15, 95% CI: [− 24.26, − 2.04], p = 0.02 respectively). In summary, this supports an association between arterial pulsatility and SVD in stroke patients, and provides a potential target for further research and preventative treatment. FVP may become a useful biomarker for assessing pulsatile stress with PCMRI and 4D flow MRI.

Arterial elasticity, endothelial function and intracranial vascular health: A multimodal MRI study

“…The pathogenesis role of increased pulsatility in intracranial small vessels disease has also been revealed by studies measuring cerebrovascular pulsatility directly. 28,29 Of note, although endothelial dysfunction has been suggested as a key early step in the pathophysiology of atherosclerosis, 30 we did not find an association with intracranial atherosclerosis in our study. The reason for this might be that the small numbers of subjects having plaque in a relatively healthy study population limit the power to detect a significant association.…”

4D flow MRI for non-invasive measurement of blood flow in the brain: A systematic review

“…Birnefeld et al. 16 examined the ICAs and MCAs (M1, M3) of 89 patients with acute ischaemic stroke or transient ischaemic attack (divided into two groups based on clinical assessment: those with associated cerebral small vessel disease (SVD) and those without). They found ICA pulsatility to be associated with increased white matter lesion volume and M1 pulsatility with decreased cognitive function.…”

“…Holmgren et al 34 demonstrated the technique's ability to measure arterial pulsatility and compliance, and cerebrovascular resistance, across a range of cerebral arteries in a population of elderly subjects (mean 79 AE 5 years). Birnefeld et al 16 examined the ICAs and MCAs (M1, M3) of 89 patients with acute ischaemic stroke or transient ischaemic attack (divided into two groups based on clinical assessment: those with associated cerebral small vessel disease (SVD) and those without). They found ICA pulsatility to be associated with increased white matter lesion volume and M1 pulsatility with decreased cognitive function.…”

Indexing Cerebrovascular Health Using Near-infrared Spectroscopy

“…MRI phase contrast images were processed using the scanner software (Siemens Syngo) by manually placing a region of interest around the middle cerebral artery and quantifying the flow. The MRI pulsatility index, PI MRI , was then obtained by subtracting the minimum flow from the maximum flow and dividing it by the mean flow over the cardiac cycle [14]; i.e.,…”