Change in Cerebral Perfusion after Carotid Angioplasty with Stenting Is Related to Cerebral Vasoreactivity: A Study Using Dynamic Susceptibility-Weighted Contrast-Enhanced MR Imaging and Functional MR Imaging with a Breath-Holding Paradigm

Chang, Tsin‐Yuan; Liu, Ho-Ling Anthony; Lee, T. H.; Kuan, Wei‐Fan; Chang, Chien Hung; Wu, Huey-Dong; Wu, Tzu Ching; Chang, Yen Jung

doi:10.3174/ajnr.a1589

Cited by 37 publications

(33 citation statements)

References 41 publications

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“…Breath-hold fMRI could supplement diffusion tensor imaging (DTI) of white matter deficits in future research. Similar to previous successful CVR studies of vasculopathies [10–14] and low to intermediate grade gliomas [15, 16], we selected Blood Oxygenation Level Dependent (BOLD) MRI signals instead of MR perfusion parameters derived from dynamic susceptibility contrast (DSC) Gadolinium perfusion and arterial spin labeling (ASL) data. Intravenous injection of gadolinium is not a usual practice for the diagnosis and follow-ups of patients with mTBI in clinical settings although a recent DSC study showed meningeal leakage in acute stage of mTBI [17].…”

Section: Discussionmentioning

confidence: 99%

“…Although the CVR map from breath-hold challenge replicates the primary features of abnormal CVR reported under CO 2 challenge, changes in respiration (i.e., apnea during breath-hold and ventilatory increases during CO 2 -inhalation) are known to serve as sources of variance in the BOLD signal [24]. Future research of breath-hold effects would be needed to establish a balance between high SNR provided by CO 2 inhalation and the convenience of the breath-hold protocol which is widely practiced in clinics [14, 15]. …”

Section: Discussionmentioning

confidence: 99%

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A case study of magnetic resonance imaging of cerebrovascular reactivity: A powerful imaging marker for mild traumatic brain injury

et al. 2014

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Primary objective To use breath-hold functional magnetic resonance imaging (fMRI) to localize the brain regions with impaired cerebrovascular reactivity (CVR) in a female patient diagnosed with mild traumatic brain injury (mTBI). The extent of impaired CVR was evaluated two months after concussion. Follow-up scan was performed one year post mTBI using the same breath-hold fMRI technique. Research design Case report. Methods and procedures fMRI blood oxygenation dependent level (BOLD) signals were measured under breath-hold challenge in a female mTBI patient two months after concussion followed by a second fMRI with breath-hold challenge one year later. CVR was expressed as the percent change of BOLD signals per unit time of breath-hold. Main outcomes In comparison with CVR measurement of normal control subjects, statistical maps of CVR revealed substantial neurovascular deficits and hemispheric asymmetry within gray and white matter in the initial breath-hold fMRI scan. Follow-up breath-hold fMRI performed one year post mTBI demonstrated normalization of CVR accompanied with symptomatic recovery. Conclusions CVR may serve as an imaging biomarker to detect subtle deficits in both gray and white matter for individual diagnosis of mTBI. The findings encourage further investigation of hypercapnic fMRI as a diagnostic tool for mTBI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A case study of magnetic resonance imaging of cerebrovascular reactivity: A powerful imaging marker for mild traumatic brain injury

et al. 2014

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“…Differences in measurement technique, stimulus magnitude (i.e., PaCO 2 change) and subject age make between study comparisons difficult (13). In contrast to healthy aging, impaired cerebrovascular reactivity has been shown to be associated with different pathological conditions, such as hypertension (209,256,463), arterial stenosis (80,340), and proximal arterial occlusion (21,171). Additionally, a recent study (355) has found that lower cerebral vasomotor reactivity was associated with an increased risk of death for both all cause and cardiovascular mortality in 1695 patients who had performed cerebral reactivity testing as part of the Rotterdam study.…”

Section: Healthy Agingmentioning

confidence: 99%

Cerebral Vascular Control and Metabolism in Heat Stress

Bain

Nybo

Ainslie

2015

Comprehensive Physiology

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This review provides an in-depth update on the impact of heat stress on cerebrovascular functioning. The regulation of cerebral temperature, blood flow, and metabolism are discussed. We further provide an overview of vascular permeability, the neurocognitive changes, and the key clinical implications and pathologies known to confound cerebral functioning during hyperthermia. A reduction in cerebral blood flow (CBF), derived primarily from a respiratory-induced alkalosis, underscores the cerebrovascular changes to hyperthermia. Arterial pressures may also become compromised because of reduced peripheral resistance secondary to skin vasodilatation. Therefore, when hyperthermia is combined with conditions that increase cardiovascular strain, for example, orthostasis or dehydration, the inability to preserve cerebral perfusion pressure further reduces CBF. A reduced cerebral perfusion pressure is in turn the primary mechanism for impaired tolerance to orthostatic challenges. Any reduction in CBF attenuates the brain's convective heat loss, while the hyperthermic-induced increase in metabolic rate increases the cerebral heat gain. This paradoxical uncoupling of CBF to metabolism increases brain temperature, and potentiates a condition whereby cerebral oxygenation may be compromised. With levels of experimentally viable passive hyperthermia (up to 39.5-40.0 °C core temperature), the associated reduction in CBF (∼ 30%) and increase in cerebral metabolic demand (∼ 10%) is likely compensated by increases in cerebral oxygen extraction. However, severe increases in whole-body and brain temperature may increase blood-brain barrier permeability, potentially leading to cerebral vasogenic edema. The cerebrovascular challenges associated with hyperthermia are of paramount importance for populations with compromised thermoregulatory control--for example, spinal cord injury, elderly, and those with preexisting cardiovascular diseases.

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“…number of slices, slice thickness, and locations. For the dynamic BOLD study, the breath-holding paradigm was applied according to the conditions specified in our previous studies [24]. Briefly: 1) patients were made to breathe naturally for at least 6 minutes before breath-holding task; 2) during fMRI scanning, patients were asked to hold their breaths for 15 seconds after last expiration and then to breathe naturally for the next 45 seconds.…”

Section: Methodsmentioning

confidence: 99%

Heterogeneous Cerebral Vasoreactivity Dynamics in Patients with Carotid Stenosis

et al. 2013

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Cerebral vasoreactivity (CVR) can be assessed by functional MRI (fMRI) using hypercapnia challenges. In normal subjects, studies have shown temporal variability of CVR blood oxygenation level-dependent responses among different brain regions. In the current study, we analyzed the variability of BOLD CVR dynamics by fMRI with a breath-holding task in 17 subjects with unilateral carotid stenosis before they received carotid stenting. Great heterogeneity of CVR dynamics was observed when comparing BOLD responses between ipsilateral and contralateral hemispheres in each patient, especially in middle cerebral artery (MCA) territories. While some subjects (n=12) had similar CVR responses between either hemisphere, the others (n=5) had a poorly correlated pattern of BOLD changes between ipsilateral and contralateral hemispheres. In the latter group, defined as impaired CVR, post-stenting perfusion tended to be more significantly increased. Our data provides the first observation of divergent temporal BOLD responses during breath holding in patients with carotid stenosis. The development of collateral circulation and the derangement of cerebral hemodynamics can be detected through this novel analysis of the different patterns of BOLD changes. The results also help in prediction of robust increase of perfusion or hyperperfusion after carotid stenting.

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Change in Cerebral Perfusion after Carotid Angioplasty with Stenting Is Related to Cerebral Vasoreactivity: A Study Using Dynamic Susceptibility-Weighted Contrast-Enhanced MR Imaging and Functional MR Imaging with a Breath-Holding Paradigm

Cited by 37 publications

References 41 publications

A case study of magnetic resonance imaging of cerebrovascular reactivity: A powerful imaging marker for mild traumatic brain injury

A case study of magnetic resonance imaging of cerebrovascular reactivity: A powerful imaging marker for mild traumatic brain injury

Cerebral Vascular Control and Metabolism in Heat Stress

Heterogeneous Cerebral Vasoreactivity Dynamics in Patients with Carotid Stenosis

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