Noninvasive Measurement of Cerebral Blood Flow Under Anesthesia Using Arterial Spin Labeling MRI: A Pilot Study

Venkatraghavan, Lashmi; Poublanc, Julien; Bharadwaj, Suparna; Sobczyk, Olivia; Crawley, Adrian; Mandell, Daniel M.; Mikulis, David J.; Fisher, Joseph A.

doi:10.1097/ana.0000000000000231

Cited by 14 publications

(12 citation statements)

References 22 publications

(22 reference statements)

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“…We hypothesised that the end-tidal gas profile resulting in the most stable rCVR might be considered for anaesthetic management and form the basis of further investigation to formulate a strategy to decrease neurological complications postoperatively. Supporting this contention is that the available BOLD MRI literature on anesthetised humans, 19–22 indicate similar rCVR–ETCO 2 interactions (but less comprehensively analysed) to those described here, indicating that this study in awake subjects has clinical crossover to the anesthetised state. Importantly, an extensive review of the impact of anaesthesia on CO 2 -CVR indicates that, in humans, cerebral reactivity to CO 2 is maintained with volatile and propofol anaesthesia at standard clinical doses 23 …”

Section: Introductionsupporting

confidence: 58%

Differential regional cerebrovascular reactivity to end-tidal gas combinations commonly seen during anaesthesia

Mutch

Duffin

2022

European Journal of Anaesthesiology

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BACKGROUND Regional cerebrovascular reactivity (rCVR) is highly variable in the human brain as measured by blood oxygenation level-dependent (BOLD) MRI to changes in both end-tidal CO 2 and O 2 .OBJECTIVES We examined awake participants under carefully controlled end-tidal gas concentrations to assess how regional CVR changes may present with end-tidal gas changes seen commonly with anaesthesia. DESIGN Observational study.SETTING Tertiary care centre, Winnipeg, Canada. The imaging for the study occurred in 2019. SUBJECTS Twelve healthy adult subjects.INTERVENTIONS Cerebral BOLD response was studied under two end-tidal gas paradigms. First end-tidal oxygen (ETO 2 ) maintained stable whereas ETCO 2 increased incrementally from hypocapnia to hypercapnia (CO 2 ramp); second ETCO 2 maintained stable whereas ETO 2 increased from normoxia to hyperoxia (O 2 ramp). BOLD images were modeled with end-tidal gas sequences split into two equal segments to examine regional CVR. MAIN OUTCOME MEASURESThe voxel distribution comparing hypocapnia to mild hypercapnia and mild hyperoxia (mean F I O 2 ¼ 0.3) to marked hyperoxia (mean F I O 2 ¼ 0.7) were compared in a paired fashion (P < 0.005 to reach threshold for voxel display). Additionally, type analysis was conducted on CO 2 ramp data. This stratifies the BOLD response to the CO 2 ramp into four categories of CVR slope based on segmentation (type A; R/Rslope: normal response, type B R/À, type C À/À: intracranial steal, type D À/R.) Types B to D represent altered responses to the CO 2 stimulus. RESULTS Differential regional responsiveness was seen for both end-tidal gases. Hypocapnic regional CVR was more marked than hypercapnic CVR in 0.3% of voxels examined (P < 0.005, paired comparison); the converse occurred in 2.3% of voxels. For O 2 , mild hyperoxia had more marked CVR in 0.2% of voxels compared with greater hyperoxia; the converse occurred in 0.5% of voxels. All subjects had altered regional CO 2 response based on Type Analysis ranging from 4 AE 2 to 7 AE 3% of voxels.CONCLUSION In awake subjects, regional differences and abnormalities in CVR were observed with changes in end-tidal gases common during the conduct of anaesthesia. On the basis of these findings, consideration could be given to minimising regional CVR fluctuations in patients-at-risk of neurological complications by tighter control of end-tidal gases near the individual's resting values.

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Section: Introductionsupporting

confidence: 58%

Differential regional cerebrovascular reactivity to end-tidal gas combinations commonly seen during anaesthesia

Mutch

Duffin

2022

European Journal of Anaesthesiology

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“…A recent study already evaluated ASL and anatomical imaging in direct comparison: here, ASL provided more accurate results than structural imaging only in a small patient cohort [ 19 ]. Another study evaluated the effects of anesthesia using ASL [ 20 ]. The latter could also become more interesting regarding changes of perfusion of tumors under anesthesia.…”

Section: Discussionmentioning

confidence: 99%

A comparison of arterial spin labeling and dynamic susceptibility perfusion imaging for resection control in glioblastoma surgery

Lindner¹,

Ahmeti

Juhász³

et al. 2018

Oncotarget

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Resection control using magnetic resonance imaging during neurosurgical interventions increases confidence regarding the extent of tumor removal already during the procedure. In addition to morphological imaging, functional information such as perfusion might become an important marker of the presence and extent of residual tumor mass. The aim of this study was to implement arterial spin labeling (ASL) perfusion imaging as a noninvasive alternative to dynamic susceptibility contrast (DSC) perfusion imaging in patients suffering from intra-axial tumors for resection control already during surgery. The study included 15 patients suffering from glioblastoma multiforme in whom perfusion imaging using DSC and ASL was performed before, during, and after surgery. The data obtained from intraoperative scanning were analyzed by two readers blinded to any clinical information, and the presence of residual tumor mass was evaluated using a ranking scale. Similarity of results was analyzed using the intraclass correlation coefficient and Pearson's correlation coefficient. The results show that intraoperative ASL is as reliable as DSC when performing intraoperative perfusion imaging. According to the results of this study, intraoperative imaging using ASL represents an attractive alternative to contrast agent-based perfusion imaging.

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“…For example, an ASL study in 4 patients with Moyamoya disease found that halogenated anesthesia (sevoflurane) was associated with consistently higher global gray matter CBF. 48 In our study, intravenous propofol sedation, with or without mask induction using a halogenated anesthetic, was performed for all children 3 months to 6 years of age. Between 6 and 9 years of age, there were variable rates of sedation.…”

Section: Discussionmentioning

confidence: 99%

Gray Matter Growth Is Accompanied by Increasing Blood Flow and Decreasing Apparent Diffusion Coefficient during Childhood

Forkert

Lober

et al. 2016

AJNR Am J Neuroradiol

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Noninvasive Measurement of Cerebral Blood Flow Under Anesthesia Using Arterial Spin Labeling MRI: A Pilot Study

Abstract: ASL-MRI is a feasible, noninvasive method of quantitative estimation of global and regional CBF in mechanically ventilated patients under anesthesia. In this pilot study CBF was consistently greater with sevoflurane than with propofol.

Cited by 14 publications

References 22 publications

Differential regional cerebrovascular reactivity to end-tidal gas combinations commonly seen during anaesthesia

Differential regional cerebrovascular reactivity to end-tidal gas combinations commonly seen during anaesthesia

A comparison of arterial spin labeling and dynamic susceptibility perfusion imaging for resection control in glioblastoma surgery

Gray Matter Growth Is Accompanied by Increasing Blood Flow and Decreasing Apparent Diffusion Coefficient during Childhood

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