Resting quantitative cerebral blood flow in schizophrenia measured by pulsed arterial spin labeling perfusion MRI

Abstract

Arterial spin labeling imaging (ASL) perfusion MRI is a relatively novel technique that can allow for quantitative measurement of cerebral blood flow (CBF) by using magnetically labeled arterial blood water as an endogenous tracer. Available data on resting CBF in schizophrenia primarily comes from invasive and expensive nuclear medicine techniques that are often limited to small samples and yield mixed results. The noninvasive nature of ASL offers promise for larger-scale studies. The utility of this approach was examined in 24 healthy controls and 30 patients with schizophrenia. Differences between groups in quantitative CBF were assessed, as were relationships between CBF and psychiatric symptoms. Group comparisons demonstrated greater CBF for controls in several regions including bilateral precuneus and middle frontal gyrus. Patients showed increased CBF in left putamen/superior corona radiata and right middle temporal gyrus. For patients, greater severity of negative symptoms was associated with reduced CBF in bilateral superior temporal gyrus, cingulate gyrus, and left middle frontal gyrus. Increased severity of positive symptoms was related to both higher CBF in cingulate gyrus and superior frontal gyrus and decreased CBF in precentral gyrus/middle frontal gyrus. These findings support the feasibility and utility of implementing ASL in schizophrenia research and expand upon previous results.

Arterial spin labeling in patients with schizophrenia: a systematic review

“…These regions are closely related to the regulation of complex behaviors that are impaired in schizophrenia 16 . Pinkham et al 17 found a frontal region with increased rCBF, the right precentral gyrus, but no explanation was given for this finding and no other study in our review found similar results in this region or in any other frontal region. The anterior cingulate (ACC) is responsible for the integration of cognitive and emotional processes in goal-directed activities.…”

Increased resting perfusion of the hippocampus in high positive schizotypy: A pseudocontinuous arterial spin labeling study

“…To our knowledge, this is the first application of the ASL method to investigate differences in resting perfusion in a schizotypy group. Given that the study groups only differed on the presence of schizotypal traits, and that hippocampal hyperperfusion has been reported in patients with psychosis (Friston et al, 1992; Liddle et al, 1992; Malaspina et al, 2004; Pinkham et al, 2011; Schobel et al, 2013, 2009; Talati et al, 2014, 2015; although see Andreasen et al, 1997; Catafau et al, 1994; Early et al, 1987; Parellada et al, 1994), and in people at CHR of sychosis (Allen et al, 2017, 2016; Schobel et al, 2013), our study findings suggest that increased hippocampal activity (reflected in an elevation of regional perfusion) is also involved in the expression of subclinical psychotic‐like experiences.…”

“…Overall, these studies reported seemingly mixed results, including increases (Friston, Liddle, Frith, Hirsch, & Frackowiak, 1992; Liddle et al, 1992; Malaspina et al, 2004; Pinkham et al, 2011; Schobel et al, 2013, 2009; Talati et al, 2014; Talati, Rane, Skinner, Gore, & Heckers, 2015), decreases (Kindler et al, 2015; Nordahl et al, 1996; Scheef et al, 2010; Tamminga et al, 1992), or no differences (Horn et al, 2009; Ota et al, 2014; Vita et al, 1995). Beyond the hippocampus, other brain regions of significantly elevated resting perfusion in schizophrenia patients compared with healthy controls have involved the basal ganglia and middle temporal lobes (Pinkham et al, 2011), cerebellum, brainstem, and thalamus (Scheef et al, 2010). Noteworthy, while not directly focusing on the hippocampus as a specific region, initial PET and SPECT studies did not find increased perfusion in medial temporal regions (Andreasen et al, 1997; Catafau et al, 1994; Early, Reiman, Raichle, & Spitznagel, 1987; Parellada et al, 1994).…”

Impact of puberty on the evolution of cerebral perfusion during adolescence

“…Along with gray matter loss and white matter expansion (5), CBF thus represents one of the most important properties of brain physiology that changes during youth and may be critical for establishing normative growth charts of brain development. CBF is coupled to regional metabolism (6,7), changes under cognitive demands (8), responds specifically to psychoactive drugs (9), and is abnormal in a variety of psychiatric conditions including schizophrenia (10) and addiction (11). Thus, characterization of normative trajectories of CBF during adolescent development is highly relevant for understanding both normal brain function and its aberrations in psychopathology.…”