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Nabbout M, Langham MC, Cottrell C, Wehrli FW. Quantification of neurovascular compliance with retrospectively gated phase-contrast MRI. MAGMA (NEW YORK, N.Y.) 2024; 37:307-314. [PMID: 38194215 DOI: 10.1007/s10334-023-01137-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Neurovascular compliance (NVC) is the change in the brain's arterial tree blood volume, ΔV, divided by the change in intra-vascular blood pressure, ΔP, during the cardiac cycle. The primary aim of this work was to evaluate the performance of MRI measurement of NVC obtained from time-resolved measurements of internal carotid artery (ICA) and vertebral artery (VA) flow rates. A secondary aim was to explore whether NVC could be estimated from common carotid (CCA) flow in conjunction with prior knowledge of mean ICA and VA fractional flow rates, given the small cross-section of ICA and VA in some populations, in particular small children. METHODS ΔV was quantified from the blood flow rate measured at the ICA and VA for actual NVC derivation. It was further estimated from individually measured CCA flow rate and mean flow fractions ICA/CCA and VA/CCA (which could alternatively be obtained from literature data), to yield estimated NVC. Time-resolved blood flow rate in CCA, ICA and VA was obtained via retrospectively-gated 2D PC-MRI at 1.5 T in healthy subjects (N = 16, 8 women, mean age 36 ± 13 years). ΔP was determined via a brachial pressure measurement. RESULTS Actual and estimated mean NVC were 27 ± 15 and 38 ± 15 μL/mmHg, respectively, and the two measurements were strongly correlated (r = 0.80; p = 0.0002) with test-retest intra-class correlation coefficients of 0.964 and 0.899. CONCLUSION Both methods yielded excellent retest precision. In spite of a large bias, actual and estimated NVC were strongly correlated.
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Affiliation(s)
- Marianne Nabbout
- Laboratory for Structural, Physiologic, and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael C Langham
- Laboratory for Structural, Physiologic, and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christiana Cottrell
- Laboratory for Structural, Physiologic, and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Felix W Wehrli
- Laboratory for Structural, Physiologic, and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
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Holmgren M, Henze A, Wåhlin A, Eklund A, Fox AJ, Johansson E. Phase-contrast magnetic resonance imaging of intracranial and extracranial blood flow in carotid near-occlusion. Neuroradiology 2024; 66:589-599. [PMID: 38400954 PMCID: PMC10937755 DOI: 10.1007/s00234-024-03309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/08/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Compare extracranial internal carotid artery flow rates and intracranial collateral use between conventional ≥ 50% carotid stenosis and carotid near-occlusion, and between symptomatic and asymptomatic carotid near-occlusion. METHODS We included patients with ≥ 50% carotid stenosis. Degree of stenosis was diagnosed on CTA. Mean blood flow rates were assessed with four-dimensional phase-contrast MRI. RESULTS We included 110 patients of which 83% were symptomatic, and 38% had near-occlusion. Near-occlusions had lower mean internal carotid artery flow (70 ml/min) than conventional ≥ 50% stenoses (203 ml/min, P < .001). Definite use of ≥ 1 collateral was found in 83% (35/42) of near-occlusions and 10% (7/68) of conventional stenoses (P < .001). However, there were no differences in total cerebral blood flow (514 ml/min vs. 519 ml/min, P = .78) or ipsilateral hemispheric blood flow (234 vs. 227 ml/min, P = .52), between near-occlusions and conventional ≥ 50% stenoses, based on phase-contrast MRI flow rates. There were no differences in total cerebral or hemispheric blood flow, or collateral use, between symptomatic and asymptomatic near-occlusions. CONCLUSION Near-occlusions have lower internal carotid artery flow rates and more collateral use, but similar total cerebral blood flow and hemispheric blood flow, compared to conventional ≥ 50% carotid stenosis.
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Affiliation(s)
- Madelene Holmgren
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Alexander Henze
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Anders Wåhlin
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
- Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
| | - Allan J Fox
- Sunnybrook Health Science Center, University of Toronto, Toronto, Canada
| | - Elias Johansson
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden.
- Wallenberg Center for Molecular Medicine, Umeå University, Umeå, Sweden.
- Neuroscience and Physiology, Gothenburg University, Göteborg, Sweden.
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Zavriyev AI, Kaya K, Wu KC, Pierce ET, Franceschini MA, Robinson MB. Measuring pulsatile cortical blood flow and volume during carotid endarterectomy. BIOMEDICAL OPTICS EXPRESS 2024; 15:1355-1369. [PMID: 38495722 PMCID: PMC10942688 DOI: 10.1364/boe.507730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 03/19/2024]
Abstract
Carotid endarterectomy (CEA) involves removal of plaque in the carotid artery to reduce the risk of stroke and improve cerebral perfusion. This study aimed to investigate the utility of assessing pulsatile blood volume and flow during CEA. Using a combined near-infrared spectroscopy/diffuse correlation spectroscopy instrument, pulsatile hemodynamics were assessed in 12 patients undergoing CEA. Alterations to pulsatile amplitude, pulse transit time, and beat morphology were observed in measurements ipsilateral to the surgical side. The additional information provided through analysis of pulsatile hemodynamic signals has the potential to enable the discovery of non-invasive biomarkers related to cortical perfusion.
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Affiliation(s)
- Alexander I Zavriyev
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kutlu Kaya
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kuan Cheng Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric T Pierce
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Angela Franceschini
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell B Robinson
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Xie L, Zhang Y, Hong H, Xu S, Cui L, Wang S, Li J, Liu L, Lin M, Luo X, Li K, Zeng Q, Zhang M, Zhang R, Huang P. Higher intracranial arterial pulsatility is associated with presumed imaging markers of the glymphatic system: An explorative study. Neuroimage 2024; 288:120524. [PMID: 38278428 DOI: 10.1016/j.neuroimage.2024.120524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Arterial pulsation has been suggested as a key driver of paravascular cerebrospinal fluid flow, which is the foundation of glymphatic clearance. However, whether intracranial arterial pulsatility is associated with glymphatic markers in humans has not yet been studied. METHODS Seventy-three community participants were enrolled in the study. 4D phase-contrast magnetic resonance imaging (MRI) was used to quantify the hemodynamic parameters including flow pulsatility index (PIflow) and area pulsatility index (PIarea) from 13 major intracerebral arterial segments. Three presumed neuroimaging markers of the glymphatic system were measured: including dilation of perivascular space (PVS), diffusivity along the perivascular space (ALPS), and volume fraction of free water (FW) in white matter. We explored the relationships between PIarea, PIflow, and the presumed glymphatic markers, controlling for related covariates. RESULTS PIflow in the internal carotid artery (ICA) C2 segment (OR, 1.05; 95 % CI, 1.01-1.10, per 0.01 increase in PI) and C4 segment (OR, 1.05; 95 % CI, 1.01-1.09) was positively associated with the dilation of basal ganglia PVS, and PIflow in the ICA C4 segment (OR, 1.06, 95 % CI, 1.02-1.10) was correlated with the dilation of PVS in the white matter. ALPS was associated with PIflow in the basilar artery (β, -0.273, p, 0.046) and PIarea in the ICA C2 (β, -0.239, p, 0.041) and C7 segments (β, -0.238, p, 0.037). CONCLUSIONS Intracranial arterial pulsatility was associated with presumed neuroimaging markers of the glymphatic system, but the results were not consistent across different markers. Further studies are warranted to confirm these findings.
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Affiliation(s)
- Linyun Xie
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Yao Zhang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Hui Hong
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Shan Xu
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Lei Cui
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Shuyue Wang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Jixuan Li
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Lingyun Liu
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Miao Lin
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Xiao Luo
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Kaicheng Li
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Qingze Zeng
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Minming Zhang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Ruiting Zhang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Peiyu Huang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China.
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Holmgren M, Henze A, Wåhlin A, Eklund A, Fox AJ, Johansson E. Diagnostic separation of conventional ⩾50% carotid stenosis and near-occlusion with phase-contrast MRI. Eur Stroke J 2024; 9:135-143. [PMID: 38032058 PMCID: PMC10916822 DOI: 10.1177/23969873231215634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION The aim of this study was to assess sensitivity, specificity and interrater reliability of phase-contrast MRI (PC-MRI) for diagnosing carotid near-occlusion. PATIENTS AND METHODS Prospective cross-sectional study conducted between 2018 and 2021. We included participants with suspected 50%-100% carotid stenosis on at least one side, all were examined with CT angiography (CTA) and PC-MRI and both ICAs were analyzed. Degree of stenosis on CTA was the reference test. PC-MRI-based blood flow rates in extracranial ICA and intracranial cerebral arteries were assessed. ICA-cerebral blood flow (CBF) ratio was defined as ICA divided by sum of both ICAs and Basilar artery. RESULTS We included 136 participants. The ICAs were 102 < 50% stenosis, 88 conventional ⩾50% stenosis (31 with ⩾70%), 49 near-occlusion, 12 occlusions, 20 unclear cause of small distal ICA on CTA and one excluded. For separation of near-occlusion and conventional stenoses, ICA flow rate and ICA-CBF ratio had the highest area under the curve (AUC; 0.98-0.99) for near-occlusion. ICA-CBF ratio ⩽0.225 was 90% (45/49) sensitive and 99% (188/190) specific for near-occlusion. Inter-rater reliability for this threshold was excellent (kappa 0.98). Specificity was 94% (29/31) for cases with ⩾70% stenosis. PC-MRI had modest performance for separating <50% and conventional ⩾50% stenosis (highest AUC 0.74), and eight (16%) of near-occlusions were not distinguishable from occlusion (no visible flow). CONCLUSION ICA-CBF ratio ⩽0.225 on PC-MRI is an accurate and reliable method to separate conventional ⩾50% stenosis and near-occlusion that is feasible for routine use. PC-MRI should be considered further as a potential standard method for near-occlusion detection, to be used side-by-side with established modalities as PC-MRI cannot separate other degrees of stenosis.
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Affiliation(s)
- Madelene Holmgren
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Alexander Henze
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Anders Wåhlin
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
- Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
| | - Allan J Fox
- Sunnybrook Health Science Center, University of Toronto, Toronto, ON, Canada
| | - Elias Johansson
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden
- Wallenberg Center for Molecular Medicine, Umeå University, Umeå, Sweden
- Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
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6
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Semenov S. Electromagnetic tomographic cerebral angiography. Sci Rep 2024; 14:1792. [PMID: 38245538 PMCID: PMC10799899 DOI: 10.1038/s41598-024-51632-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
World Health Organization stated that "Cardiovascular diseases (CVDs) are the leading cause of death globally. Angiography is an important method in diagnostic of CVD. Standard-of-Care methods of angiography, such as X-Ray or CT- or MRI- angiography methods, being accurate and widely adopted in clinical practice, are bulky, expensive and energy in-efficient. X-ray and CT- angiography methods are also potentially hazardous as techniques require the use of ionizing contrast agents. Electromagnetic tomography (EMT) is an emerging medical imaging modality. EMT is applicable for safe functional imaging but suffers from a limited spatial resolution because of relatively large wavelength of electromagnetic radiation as compared to sizes of biological targets of particular interest, such as, for example blood vessels. Novel approach and method, presented in the study is capable to overcome such limitations and provide a mean for a dynamic, on-line EMT angiography. New method of EMT angiography was presented in application to cerebral angiography. Achieved imaging results clearly demonstrate applicability of the method for detecting small cerebral vessels of the diameter as small as 1.3 mm and to distinguish vessels with different dimensions. The technical challenges in the development of angiography capable EMT systems are assessed and discussed.
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Chen W, Song X, Wei H, Fu M, Chen S, Wei C, Zheng Z, Wu J, Li R. Variations of arterial compliance and vascular resistance due to plaque or infarct in a single vascular territory of the middle cerebral artery. Quant Imaging Med Surg 2023; 13:7802-7813. [PMID: 38106282 PMCID: PMC10722046 DOI: 10.21037/qims-23-222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/06/2023] [Indexed: 12/19/2023]
Abstract
Background Arterial compliance (AC) and vascular resistance (VR) are crucial for the regulation capacity of the vascular system. However, alterations of these features and hemodynamics due to atherosclerosis in a single intracranial artery territory have not been extensively investigated. Thus this study aimed to examine the AC, VR, and hemodynamic variations due to plaque and infarction in the middle cerebral artery (MCA). Methods Patients with symptomatic MCA atherosclerosis were recruited. Both sides of the MCA were assessed and then classified according to the following scheme: group 0, without plaque; group 1, with plaque but without infarct; group 2, with plaque and infarct in the supplying territories. Data on AC, VR, blood flow, and pulsatility index (PI) were obtained based on 4D flow magnetic resonance imaging (MRI) and the Windkessel model. Results A total of 63 patients were recruited. After 17 MCAs were excluded (occlusion, n=6; poor image quality, n=11), datasets on 109 MCAs were finally collected and classified into group 0 (n=39), group 1 (n=40), and group 2 (n=30). From groups 0 to 2, there was a decrease in AC (0.0060±0.0031 vs. 0.0052±0.0029 vs. 0.0026±0.0020 mL/mmHg) and an increase in VR [28.65±16.11 vs. 42.59±27.53 vs. 63.21±40.37 mmHg/(mL/s)]. Compared to group 1, group 2 had significantly decreased AC (0.0052±0.0029 vs. 0.0026±0.0020 mL/mmHg; P=0.003) and increased VR [42.59±27.53 vs. 63.21±40.37 mmHg/(mL/s); P=0.021]. From group 0 to group 2, there was a decrease in blood flow (179.29±73.57 vs. 125.11±59.04 vs. 92.05±48.79 mL/min; P<0.001). The PI varied significantly among the 3 groups (0.86±0.20 vs. 1.12±0.50 vs. 0.79±0.16; P<0.001), with group 1 having the highest PI. Conclusions With the occurrence of plaque and infarct, AC and blood flow progressively decrease while VR increases. The PI was the highest in the group with plaque and without infarct. Assessments of vascular function and hemodynamics in a single artery territory can clarify comprehensive alterations in the cerebral vascular system (CVS).
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Affiliation(s)
- Wenwen Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xiaowei Song
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Hanyu Wei
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Mingzhu Fu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Chenming Wei
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhuozhao Zheng
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- IDG/McGovern Institute for Brain Research at Tsinghua University, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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Roberts GS, Peret A, Jonaitis EM, Koscik RL, Hoffman CA, Rivera-Rivera LA, Cody KA, Rowley HA, Johnson SC, Wieben O, Johnson KM, Eisenmenger LB. Normative Cerebral Hemodynamics in Middle-aged and Older Adults Using 4D Flow MRI: Initial Analysis of Vascular Aging. Radiology 2023; 307:e222685. [PMID: 36943077 PMCID: PMC10140641 DOI: 10.1148/radiol.222685] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/06/2023] [Accepted: 02/06/2023] [Indexed: 03/23/2023]
Abstract
Background Characterizing cerebrovascular hemodynamics in older adults is important for identifying disease and understanding normal neurovascular aging. Four-dimensional (4D) flow MRI allows for a comprehensive assessment of cerebral hemodynamics in a single acquisition. Purpose To establish reference intracranial blood flow and pulsatility index values in a large cross-sectional sample of middle-aged (45-65 years) and older (>65 years) adults and characterize the effect of age and sex on blood flow and pulsatility. Materials and Methods In this retrospective study, patients aged 45-93 years (cognitively unimpaired) underwent cranial 4D flow MRI between March 2010 and March 2020. Blood flow rates and pulsatility indexes from 13 major arteries and four venous sinuses and total cerebral blood flow were collected. Intraobserver and interobserver reproducibility of flow and pulsatility measures was assessed in 30 patients. Descriptive statistics (mean ± SD) of blood flow and pulsatility were tabulated for the entire group and by age and sex. Multiple linear regression and linear mixed-effects models were used to assess the effect of age and sex on total cerebral blood flow and vessel-specific flow and pulsatility, respectively. Results There were 759 patients (mean age, 65 years ± 8 [SD]; 506 female patients) analyzed. For intra- and interobserver reproducibility, median intraclass correlation coefficients were greater than 0.90 for flow and pulsatility measures across all vessels. Regression coefficients β ± standard error from multiple linear regression showed a 4 mL/min decrease in total cerebral blood flow each year (age β = -3.94 mL/min per year ± 0.44; P < .001). Mixed effects showed a 1 mL/min average annual decrease in blood flow (age β = -0.95 mL/min per year ± 0.16; P < .001) and 0.01 arbitrary unit (au) average annual increase in pulsatility over all vessels (age β = 0.011 au per year ± 0.001; P < .001). No evidence of sex differences was observed for flow (β = -1.60 mL/min per male patient ± 1.77; P = .37), but pulsatility was higher in female patients (sex β = -0.018 au per male patient ± 0.008; P = .02). Conclusion Normal reference values for blood flow and pulsatility obtained using four-dimensional flow MRI showed correlations with age. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Steinman in this issue.
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Affiliation(s)
- Grant S. Roberts
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Anthony Peret
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Erin M. Jonaitis
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Rebecca L. Koscik
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Carson A. Hoffman
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Leonardo A. Rivera-Rivera
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Karly A. Cody
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Howard A. Rowley
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Sterling C. Johnson
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Oliver Wieben
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Kevin M. Johnson
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
| | - Laura B. Eisenmenger
- From the Department of Medical Physics (G.S.R., L.A.R.R., O.W.,
K.M.J.), Department of Radiology (A.P., C.A.H., H.A.R., O.W., K.M.J., L.B.E.),
Wisconsin Alzheimer’s Institute (E.M.J., R.L.K., S.C.J.), and Wisconsin
Alzheimer’s Disease Research Center (E.M.J., L.A.R.R., K.A.C., S.C.J.),
University of Wisconsin School of Medicine and Public Health, 600 Highland Ave,
Madison, WI 53792-3252; and Geriatric Research Education and Clinical Center,
William S. Middleton Memorial Veterans Hospital, Madison, Wis (S.C.J.)
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9
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van den Kerkhof M, Jansen JFA, van Oostenbrugge RJ, Backes WH. 1D versus 3D blood flow velocity and pulsatility measurements of lenticulostriate arteries at 7T MRI. Magn Reson Imaging 2023; 96:144-150. [PMID: 36473545 DOI: 10.1016/j.mri.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE 7T MRI enables measurements of blood flow velocity waveforms in small, perforating cerebral arteries. As these vessels can be tortuous, acquisition methods sensitive to flow in only one direction may not be sufficient to accurately determine the dynamic blood flow velocity. In this study, we compared 1D with 3D velocity encoding to measure the blood flow velocity and pulsatility in the lenticulostriate arteries (LSAs). METHODS Blood flow velocity waveforms were measured in the LSAs of 18 subjects (age range: 20-74 years) using prospectively gated single-slice phase contrast (PC) MRI at 7T. For each subject, blood flow velocity waveforms were acquired in a single slice with one velocity encoding as well as three orthogonal velocity encodings. The peak velocity and pulsatility index (PI) were determined in the largest, perpendicularly planned LSA, one obliquely planned LSA and three smaller LSAs. The peak velocity and PI were compared between 1D and 3D measurements using Bland-Altman analysis, with the 95% limits of agreement (LOA) taken into account. RESULTS For the largest, perpendicularly planned LSA, the peak velocity was slightly lower (0.2 cm/s, 1.7%) for 1D compared to 3D measurements, with an LOA range from the mean difference of (-0.27;0.27). The PI was slightly higher (0.01, 1.6%) for the 1D measurement, and an LOA range from the mean difference in PI of (-0.045;0.045). The obliquely planned LSA and three smaller LSAs demonstrated larger deviations (range mean percentage difference: 3.9-8.2%). CONCLUSION 1D velocity encoding using 2D PC MRI provides sufficiently accurate dynamic velocity and pulsatility measurements in slices perpendicularly planned to single, large LSAs compared to 3D velocity encoding, while increasing errors are obtained with obliquely planned slices. A greater error is indicated when measuring multiple (possibly tortuous or obliquely planned) smaller LSAs in one scan using one-directional single-slice PC MRI.
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Affiliation(s)
- Marieke van den Kerkhof
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Jacobus F A Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Electrical Engineering, University of Eindhoven, PO Box 513, 5600 MB Eindhoven, the Netherlands
| | - Robert J van Oostenbrugge
- School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands; School for Cardiovascular Diseases, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Walter H Backes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands; School for Cardiovascular Diseases, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.
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10
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Maruyama M, Aso H, Araki H, Yoshida R, Ando S, Nakamura M, Yoshizako T, Kaji Y. Three-dimensional velocity vector image obtained via 4-dimensional flow magnetic resonance imaging for in-stent flow visualization in the superficial femoral artery. Radiol Case Rep 2023; 18:1302-1305. [PMID: 36684633 PMCID: PMC9853143 DOI: 10.1016/j.radcr.2022.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023] Open
Abstract
The assessment of stent lumen patency via non-contrast-enhanced 2-dimensional time-of-flight magnetic resonance angiography (2D TOF MRA) is complex due to stent-related artifacts. However, an imaging technique using the phase-contrast method, which can reduce susceptibility to artifact, is available. Herein, we report the use of 3-dimensional velocity vector image obtained via 4-dimensional flow magnetic resonance imaging (4D flow MRI) for in-stent flow visualization after stent development in the right superficial femoral artery. Hence, instead of 2D TOF MRA, 4D flow MRI using the phase-contrast method can be performed to assess stent lumen patency as it reduces stent-related artifacts.
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11
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Chen KK, Lin CJ, Chu WF. Dispersion of Heterogeneous Medium in Pulsatile Blood Flow and Absolute Pulsatile Flow Velocity Quantification. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:170-182. [PMID: 36094983 DOI: 10.1109/tmi.2022.3206241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Heterogeneous medium enhanced angiogr- ams are key diagnostic tools in clinical practice; the associated hemodynamic information is crucial for diagnosing cardiovascular diseases. However, the dynamics of such medium in physiological blood flow are poorly understood. Herein, we report a previously unnoticed dispersion pattern, which is a universal phenomenon, of a medium in pulsatile blood flow. We present a physical theory for studying the dispersion of a steadily injected heterogeneous medium into a thin tubular blood vessel in which the blood flow is pulsatile. In a thin tubular blood vessel, we demonstrate that variations of concentration associated with the heterogeneous medium obey a one-dimensional advection diffusion equation, and the diffusion has limited effect whenever a short vascular segment is considered. A distinct feature of the distribution of the medium in the axial distance-time plane is a "dilation-retraction" pattern. The time evolution signals at different axial positions exhibit distinct concentration waveforms. A numerical scheme is proposed for exploiting this information to estimate the pulsatile velocity. Artificial data are adopted to validate the scheme. Real X-ray angiography is also analyzed to support our theory and method. The theory is applicable whenever imaging protocols involve a heterogeneous medium in pulsatile flow.
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12
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Holmgren M, Holmlund P, Støverud KH, Zarrinkoob L, Wåhlin A, Malm J, Eklund A. Prediction of cerebral perfusion pressure during carotid surgery - A computational fluid dynamics approach. Clin Biomech (Bristol, Avon) 2022; 100:105827. [PMID: 36435076 DOI: 10.1016/j.clinbiomech.2022.105827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/09/2022] [Accepted: 11/18/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Maintaining cerebral perfusion pressure in the brain when a carotid artery is closed during vascular surgery is critical for avoiding intraoperative hypoperfusion and risk of ischemic stroke. Here we propose and evaluate a method based on computational fluid dynamics for predicting patient-specific cerebral perfusion pressures at carotid clamping during carotid endarterectomy. METHODS The study consisted of 22 patients with symptomatic carotid stenosis who underwent carotid endarterectomy (73 ± 5 years, 59-80 years, 17 men). The geometry of the circle of Willis was obtained preoperatively from computed tomography angiography and corresponding flow rates from four-dimensional flow magnetic resonance imaging. The patients were also classified as having a present or absent ipsilateral posterior communicating artery based on computed tomography angiography. The predicted mean stump pressures from computational fluid dynamics were compared with intraoperatively measured stump pressures from carotid endarterectomy. FINDINGS On group level, there was no difference between the predicted and measured stump pressures (-0.5 ± 13 mmHg, P = 0.86) and the pressures were correlated (r = 0.44, P = 0.039). Omitting two outliers, the correlation increased to r = 0.78 (P < 0.001) (-1.4 ± 8.0 mmHg, P = 0.45). Patients with a present ipsilateral posterior communicating artery (n = 8) had a higher measured stump pressure than those with an absent artery (n = 12) (P < 0.001). INTERPRETATION The stump pressure agreement indicates that the computational fluid dynamics approach was promising in predicting cerebral perfusion pressures during carotid clamping, which may prove useful in the preoperative planning of vascular interventions.
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Affiliation(s)
- Madelene Holmgren
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, SE 901 87 Umeå University, Umeå, Sweden..
| | - Petter Holmlund
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, SE 901 87 Umeå University, Umeå, Sweden
| | - Karen-Helene Støverud
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, SE 901 87 Umeå University, Umeå, Sweden.; Department of Health Research, SINTEF Digital, NO 7465 Trondheim, Norway
| | - Laleh Zarrinkoob
- Department of Clinical Science, Neurosciences, Umeå University, SE 901 87 Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, SE 901 87 Umeå, Sweden
| | - Anders Wåhlin
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, SE 901 87 Umeå University, Umeå, Sweden.; Department of Applied Physics and Electronics, Umeå University, SE 901 87 Umeå, Sweden; Umeå Center for Functional Brain Imaging, Umeå University, SE 901 87 Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science, Neurosciences, Umeå University, SE 901 87 Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, SE 901 87 Umeå University, Umeå, Sweden.; Umeå Center for Functional Brain Imaging, Umeå University, SE 901 87 Umeå, Sweden
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Bourquin C, Poree J, Lesage F, Provost J. In Vivo Pulsatility Measurement of Cerebral Microcirculation in Rodents Using Dynamic Ultrasound Localization Microscopy. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:782-792. [PMID: 34710041 DOI: 10.1109/tmi.2021.3123912] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
An increased pulse pressure, due to arteries stiffening with age and cardiovascular disease, may lead to downstream brain damage in microvessels and cognitive decline. Brain-wide imaging of the pulsatility propagation from main feeding arteries to capillaries in small animals could improve our understanding of the link between pulsatility and cognitive decline. However, it requires higher spatiotemporal resolution and penetration depth than currently available with existing brain imaging techniques. Herein, we show the feasibility of performing Dynamic Ultrasound Localization Microscopy (DULM), a novel imaging approach to capture hemodynamics with a subwavelength resolution. By producing cine-loops of flowing microbubbles in 2D in the whole rodent brain lasting several cardiac cycles, DULM performed pulsatility measurements in microvessels in-depth, in vivo, with and without craniotomy. Cortical veins and arteries were shown to have a significatively different pulsatility index and the method was compared against Contrast Enhanced Ultrafast Ultrasound Doppler (CEUFD) pulsatility measurements.
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14
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Hufnagel A, Fernandez-Twinn DS, Blackmore HL, Ashmore TJ, Heaton RA, Jenkins B, Koulman A, Hargreaves IP, Aiken CE, Ozanne SE. Maternal but not fetoplacental health can be improved by metformin in a murine diet-induced model of maternal obesity and glucose intolerance. J Physiol 2022; 600:903-919. [PMID: 34505282 PMCID: PMC7612651 DOI: 10.1113/jp281902] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/26/2021] [Indexed: 12/19/2022] Open
Abstract
Maternal obesity is a global problem that increases the risk of short- and long-term adverse outcomes for mother and child, many of which are linked to gestational diabetes mellitus. Effective treatments are essential to prevent the transmission of poor metabolic health from mother to child. Metformin is an effective glucose lowering drug commonly used to treat gestational diabetes mellitus; however, its wider effects on maternal and fetal health are poorly explored. In this study we used a mouse (C57Bl6/J) model of diet-induced (high sugar/high fat) maternal obesity to explore the impact of metformin on maternal and feto-placental health. Metformin (300 mg kg-1 day-1 ) was given to obese females via the diet and was shown to achieve clinically relevant concentrations in maternal serum (1669 ± 568 nM in late pregnancy). Obese dams developed glucose intolerance during pregnancy and had reduced uterine artery compliance. Metformin treatment of obese dams improved maternal glucose tolerance, reduced maternal fat mass and restored uterine artery function. Placental efficiency was reduced in obese dams, with increased calcification and reduced labyrinthine area. Consequently, fetuses from obese dams weighed less (P < 0.001) at the end of gestation. Despite normalisation of maternal parameters, metformin did not correct placental structure or fetal growth restriction. Metformin levels were substantial in the placenta and fetal circulation (109.7 ± 125.4 nmol g-1 in the placenta and 2063 ± 2327 nM in fetal plasma). These findings reveal the distinct effects of metformin administration during pregnancy on mother and fetus and highlight the complex balance of risk vs. benefits that are weighed in obstetric medical treatments. KEY POINTS: Maternal obesity and gestational diabetes mellitus have detrimental short- and long-term effects for mother and child. Metformin is commonly used to treat gestational diabetes mellitus in many populations worldwide but the effects on fetus and placenta are unknown. In a mouse model of diet-induced obesity and glucose intolerance in pregnancy we show reduced uterine artery compliance, placental structural changes and reduced fetal growth. Metformin treatment improved maternal metabolic health and uterine artery compliance but did not rescue obesity-induced changes in the fetus or placenta. Metformin crossed the placenta into the fetal circulation and entered fetal tissue. Metformin has beneficial effects on maternal health beyond glycaemic control. However, despite improvements in maternal physiology, metformin did not prevent fetal growth restriction or placental ageing. The high uptake of metformin into the placental and fetal circulation highlights the potential for direct immediate effects of metformin on the fetus with possible long-term consequences postnatally.
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Affiliation(s)
- Antonia Hufnagel
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Level 4, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, United Kingdom, CB22 0QQ
| | - Denise S Fernandez-Twinn
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Level 4, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, United Kingdom, CB22 0QQ
| | - Heather L Blackmore
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Level 4, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, United Kingdom, CB22 0QQ
| | - Thomas J Ashmore
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Level 4, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, United Kingdom, CB22 0QQ
| | - Robert A Heaton
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Benjamin Jenkins
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Level 4, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, United Kingdom, CB22 0QQ
| | - Albert Koulman
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Level 4, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, United Kingdom, CB22 0QQ
| | - Iain P Hargreaves
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Catherine E Aiken
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, University of Cambridge, United Kingdom
| | - Susan E Ozanne
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Level 4, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, United Kingdom, CB22 0QQ
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15
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Moura FS, Beraldo RG, Ferreira LA, Siltanen S. Anatomical atlas of the upper part of the human head for electroencephalography and bioimpedance applications. Physiol Meas 2021; 42. [PMID: 34673557 DOI: 10.1088/1361-6579/ac3218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/21/2021] [Indexed: 11/11/2022]
Abstract
Objective.The objective of this work is to develop a 4D (3D+T) statistical anatomical atlas of the electrical properties of the upper part of the human head for cerebral electrophysiology and bioimpedance applications.Approach.The atlas was constructed based on 3D magnetic resonance images (MRI) of 107 human individuals and comprises the electrical properties of the main internal structures and can be adjusted for specific electrical frequencies. T1w+T2w MRI images were used to segment the main structures of the head while angiography MRI was used to segment the main arteries. The proposed atlas also comprises a time-varying model of arterial brain circulation, based on the solution of the Navier-Stokes equation in the main arteries and their vascular territories.Main results.High-resolution, multi-frequency and time-varying anatomical atlases of resistivity, conductivity and relative permittivity were created and evaluated using a forward problem solver for EIT. The atlas was successfully used to simulate electrical impedance tomography measurements indicating the necessity of signal-to-noise between 100 and 125 dB to identify vascular changes due to the cardiac cycle, corroborating previous studies. The source code of the atlas and solver are freely available to download.Significance.Volume conductor problems in cerebral electrophysiology and bioimpedance do not have analytical solutions for nontrivial geometries and require a 3D model of the head and its electrical properties for solving the associated PDEs numerically. Ideally, the model should be made with patient-specific information. In clinical practice, this is not always the case and an average head model is often used. Also, the electrical properties of the tissues might not be completely known due to natural variability. Anatomical atlases are important tools forin silicostudies on cerebral circulation and electrophysiology that require statistically consistent data, e.g. machine learning, sensitivity analyses, and as a benchmark to test inverse problem solvers.
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Affiliation(s)
- Fernando S Moura
- Engineering, modelling and Applied Social Sciences Center, Federal University of ABC São Bernardo do Campo, São Paulo, Brazil.,Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Roberto G Beraldo
- Engineering, modelling and Applied Social Sciences Center, Federal University of ABC São Bernardo do Campo, São Paulo, Brazil
| | - Leonardo A Ferreira
- Engineering, modelling and Applied Social Sciences Center, Federal University of ABC São Bernardo do Campo, São Paulo, Brazil
| | - Samuli Siltanen
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
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16
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Arts T, Onkenhout LP, Amier RP, van der Geest R, van Harten T, Kappelle J, Kuipers S, van Osch MJP, van Bavel ET, Biessels GJ, Zwanenburg JJM. Non-Invasive Assessment of Damping of Blood Flow Velocity Pulsatility in Cerebral Arteries With MRI. J Magn Reson Imaging 2021; 55:1785-1794. [PMID: 34792263 PMCID: PMC9298760 DOI: 10.1002/jmri.27989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Abstract
Background Damping of heartbeat‐induced pressure pulsations occurs in large arteries such as the aorta and extends to the small arteries and microcirculation. Since recently, 7 T MRI enables investigation of damping in the small cerebral arteries. Purpose To investigate flow pulsatility damping between the first segment of the middle cerebral artery (M1) and the small perforating arteries using magnetic resonance imaging. Study Type Retrospective. Subjects Thirty‐eight participants (45% female) aged above 50 without history of heart failure, carotid occlusive disease, or cognitive impairment. Field Strength/Sequence 3 T gradient echo (GE) T1‐weighted images, spin‐echo fluid‐attenuated inversion recovery images, GE two‐dimensional (2D) phase‐contrast, and GE cine steady‐state free precession images were acquired. At 7 T, T1‐weighted images, GE quantitative‐flow, and GE 2D phase‐contrast images were acquired. Assessment Velocity pulsatilities of the M1 and perforating arteries in the basal ganglia (BG) and semi‐oval center (CSO) were measured. We used the damping index between the M1 and perforating arteries as a damping indicator (velocity pulsatilityM1/velocity pulsatilityCSO/BG). Left ventricular stroke volume (LVSV), mean arterial pressure (MAP), pulse pressure (PP), and aortic pulse wave velocity (PWV) were correlated with velocity pulsatility in the M1 and in perforating arteries, and with the damping index of the CSO and BG. Statistical Tests Correlations of LVSV, MAP, PP, and PWV with velocity pulsatility in the M1 and small perforating arteries, and correlations with the damping indices were evaluated with linear regression analyses. Results PP and PWV were significantly positively correlated to M1 velocity pulsatility. PWV was significantly negatively correlated to CSO velocity pulsatility, and PP was unrelated to CSO velocity pulsatility (P = 0.28). PP and PWV were uncorrelated to BG velocity pulsatility (P = 0.25; P = 0.68). PWV and PP were significantly positively correlated with the CSO damping index. Data Conclusion Our study demonstrated a dynamic damping of velocity pulsatility between the M1 and small cerebral perforating arteries in relation to proximal stress. Level of Evidence 4 Technical Efficacy Stage 1
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Affiliation(s)
- Tine Arts
- Department of Radiology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laurien P Onkenhout
- Department of Radiology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Raquel P Amier
- Department of Cardiology, Amsterdam Medical Center Location Vu, Amsterdam, The Netherlands
| | - Rob van der Geest
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Thijs van Harten
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Kappelle
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne Kuipers
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthijs J P van Osch
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ed T van Bavel
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jaco J M Zwanenburg
- Department of Radiology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Vikner T, Eklund A, Karalija N, Malm J, Riklund K, Lindenberger U, Bäckman L, Nyberg L, Wåhlin A. Cerebral arterial pulsatility is linked to hippocampal microvascular function and episodic memory in healthy older adults. J Cereb Blood Flow Metab 2021; 41:1778-1790. [PMID: 33444091 PMCID: PMC8217890 DOI: 10.1177/0271678x20980652] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Microvascular damage in the hippocampus is emerging as a central cause of cognitive decline and dementia in aging. This could be a consequence of age-related decreases in vascular elasticity, exposing hippocampal capillaries to excessive cardiac-related pulsatile flow that disrupts the blood-brain barrier and the neurovascular unit. Previous studies have found altered intracranial hemodynamics in cognitive impairment and dementia, as well as negative associations between pulsatility and hippocampal volume. However, evidence linking features of the cerebral arterial flow waveform to hippocampal function is lacking. We used a high-resolution 4D flow MRI approach to estimate global representations of the time-resolved flow waveform in distal cortical arteries and in proximal arteries feeding the brain in healthy older adults. Waveform-based clustering revealed a group of individuals featuring steep systolic onset and high amplitude that had poorer hippocampus-sensitive episodic memory (p = 0.003), lower whole-brain perfusion (p = 0.001), and weaker microvascular low-frequency oscillations in the hippocampus (p = 0.035) and parahippocampal gyrus (p = 0.005), potentially indicating compromised neurovascular unit integrity. Our findings suggest that aberrant hemodynamic forces contribute to cerebral microvascular and hippocampal dysfunction in aging.
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Affiliation(s)
- Tomas Vikner
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Nina Karalija
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Ulman Lindenberger
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany.,Max Planck, UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany.,Max Planck, UCL Centre for Computational Psychiatry and Ageing Research, London, UK
| | - Lars Bäckman
- Ageing Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lars Nyberg
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden.,Department of Integrative Medical Biology (IMB), Umeå University, Umeå, Sweden
| | - Anders Wåhlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
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18
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Afkhami R, Wong R, Ramadan S, Walker FR, Johnson S. Indexing Cerebrovascular Health Using Transcranial Doppler Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:919-927. [PMID: 33494950 DOI: 10.1016/j.ultrasmedbio.2020.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/26/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
Transcranial Doppler (TCD) blood flow velocity has been extensively used in biomedical research as it provides a cost-effective and relatively simple approach to assess changes in cerebral blood flow dynamics and track cerebrovascular health status. In this article we introduce a new TCD-based timing index, TITCD, as an indicator of vascular stiffening and vascular health. We investigate the correlations of the new index and the existing indices, namely the pulsatility index and the augmentation index, with age, cardiorespiratory fitness (CRF) and magnetic resonance imaging (MRI) blood flow pulsatility index (PIMRI). Notably, the new index showed stronger correlations with CRF (r = -0.79) and PIMRI (r = 0.53) compared with the augmentation index (r = -0.65 with CRF and no significant correlation with PIMRI) and the pulsatility index (no significant correlations with CRF or PIMRI), and a similar correlation with age as the augmentation index. The clearer relationship of the proposed timing index with vascular aging factors underlines its utility as an early indicator of vascular stiffening.
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Affiliation(s)
- Rashid Afkhami
- School of Electrical Engineering & Computing, University of Newcastle, Callaghan, New South Wales, Australia.
| | - Rachel Wong
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Saadallah Ramadan
- School of Health Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Frederick Rohan Walker
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sarah Johnson
- School of Electrical Engineering & Computing, University of Newcastle, Callaghan, New South Wales, Australia
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19
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Morgan AG, Thrippleton MJ, Wardlaw JM, Marshall I. 4D flow MRI for non-invasive measurement of blood flow in the brain: A systematic review. J Cereb Blood Flow Metab 2021; 41:206-218. [PMID: 32936731 PMCID: PMC8369999 DOI: 10.1177/0271678x20952014] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/22/2020] [Accepted: 07/05/2020] [Indexed: 01/25/2023]
Abstract
The brain's vasculature is essential for brain health and its dysfunction contributes to the onset and development of many dementias and neurological disorders. While numerous in vivo imaging techniques exist to investigate cerebral haemodynamics in humans, phase-contrast magnetic resonance imaging (MRI) has emerged as a reliable, non-invasive method of quantifying blood flow within intracranial vessels. In recent years, an advanced form of this method, known as 4D flow, has been developed and utilised in patient studies, where its ability to capture complex blood flow dynamics within any major vessel across the acquired volume has proved effective in collecting large amounts of information in a single scan. While extremely promising as a method of examining the vascular system's role in brain-related diseases, the collection of 4D data can be time-consuming, meaning data quality has to be traded off against the acquisition time. Here, we review the available literature to examine 4D flow's capabilities in assessing physiological and pathological features of the cerebrovascular system. Emerging techniques such as dynamic velocity-encoding and advanced undersampling methods, combined with increasingly high-field MRI scanners, are likely to bring 4D flow to the forefront of cerebrovascular imaging studies in the years to come.
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Affiliation(s)
- Alasdair G Morgan
- Brain Research Imaging Centre, Centre for Clinical Brain
Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute at The University of Edinburgh,
Edinburgh Medical School, Edinburgh, UK
| | - Michael J Thrippleton
- Brain Research Imaging Centre, Centre for Clinical Brain
Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute at The University of Edinburgh,
Edinburgh Medical School, Edinburgh, UK
| | - Joanna M Wardlaw
- Brain Research Imaging Centre, Centre for Clinical Brain
Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute at The University of Edinburgh,
Edinburgh Medical School, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology,
University of Edinburgh, Edinburgh, UK
| | - Ian Marshall
- Brain Research Imaging Centre, Centre for Clinical Brain
Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute at The University of Edinburgh,
Edinburgh Medical School, Edinburgh, UK
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20
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Holmgren M, Støverud KH, Zarrinkoob L, Wåhlin A, Malm J, Eklund A. Middle cerebral artery pressure laterality in patients with symptomatic ICA stenosis. PLoS One 2021; 16:e0245337. [PMID: 33417614 PMCID: PMC7793245 DOI: 10.1371/journal.pone.0245337] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022] Open
Abstract
An internal carotid artery (ICA) stenosis can potentially decrease the perfusion pressure to the brain. In this study, computational fluid dynamics (CFD) was used to study if there was a hemispheric pressure laterality between the contra- and ipsilateral middle cerebral artery (MCA) in patients with a symptomatic ICA stenosis. We further investigated if this MCA pressure laterality (ΔPMCA) was related to the hemispheric flow laterality (ΔQ) in the anterior circulation, i.e., ICA, proximal MCA and the proximal anterior cerebral artery (ACA). Twenty-eight patients (73±6 years, range 59–80 years, 21 men) with symptomatic ICA stenosis were included. Flow rates were measured using 4D flow MRI data (PC-VIPR) and vessel geometries were obtained from computed tomography angiography. The ΔPMCA was calculated from CFD, where patient-specific flow rates were applied at all input- and output boundaries. The ΔPMCA between the contra- and ipsilateral side was 6.4±8.3 mmHg (p<0.001) (median 3.9 mmHg, range -1.3 to 31.9 mmHg). There was a linear correlation between the ΔPMCA and ΔQICA (r = 0.85, p<0.001) and ΔQACA (r = 0.71, p<0.001), respectively. The correlation to ΔQMCA was weaker (r = 0.47, p = 0.011). In conclusion, the MCA pressure laterality obtained with CFD, is a promising physiological biomarker that can grade the hemodynamic disturbance in patients with a symptomatic ICA stenosis.
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Affiliation(s)
| | | | - Laleh Zarrinkoob
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Anders Wåhlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
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21
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Youn SW, Lee J. From 2D to 4D Phase-Contrast MRI in the Neurovascular System: Will It Be a Quantum Jump or a Fancy Decoration? J Magn Reson Imaging 2020; 55:347-372. [PMID: 33236488 DOI: 10.1002/jmri.27430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022] Open
Abstract
Considering the crosstalk between the flow and vessel wall, hemodynamic assessment of the neurovascular system may offer a well-integrated solution for both diagnosis and management by adding prognostic significance to the standard CT/MR angiography. 4D flow MRI or time-resolved 3D velocity-encoded phase-contrast MRI has long been promising for the hemodynamic evaluation of the great vessels, but challenged in clinical studies for assessing intracranial vessels with small diameter due to long scan times and low spatiotemporal resolution. Current accelerated MRI techniques, including parallel imaging with compressed sensing and radial k-space undersampling acquisitions, have decreased scan times dramatically while preserving spatial resolution. 4D flow MRI visualized and measured 3D complex flow of neurovascular diseases such as aneurysm, arteriovenous shunts, and atherosclerotic stenosis using parameters including flow volume, velocity vector, pressure gradients, and wall shear stress. In addition to the noninvasiveness of the phase contrast technique and retrospective flow measurement through the wanted windows of the analysis plane, 4D flow MRI has shown several advantages over Doppler ultrasound or computational fluid dynamics. The evaluation of the flow status and vessel wall can be performed simultaneously in the same imaging modality. This article is an overview of the recent advances in neurovascular 4D flow MRI techniques and their potential clinical applications in neurovascular disease. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Sung Won Youn
- Department of Radiology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jongmin Lee
- Department of Radiology and Biomedical Engineering, Kyungpook National University School of Medicine, Daegu, Korea
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22
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Eley KA, Rossi-Espagnet MC, Schievano S, Napolitano A, Ong J, Secinaro A, Borro L, Dunaway D, Marras CE, Rennie A, Robertson F, Picardo S, Longo D, Inserra A, Rollo M, Cooper J, Mankad K, Jeelani NO, D'Arco F. Multiparametric Imaging for Presurgical Planning of Craniopagus Twins: The Experience of Two Tertiary Pediatric Hospitals with Six Sets of Twins. Radiology 2020; 298:18-27. [PMID: 33141005 DOI: 10.1148/radiol.2020202216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Conjoined twins are rare and pose a challenge to radiologists and surgeons. Craniopagus twins, where conjunction involves the cranium, are especially rare. Even in large pediatric centers, radiologists are unlikely to encounter more than one such event in their medical careers. This rarity makes it daunting to select a CT and MRI protocol for these infants. Using the experience of two tertiary pediatric hospitals with six sets of craniopagus twins, this multidisciplinary and multimodal integrated imaging approach highlights the key questions that need addressing in the decision-making process for possible surgical intervention.
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Affiliation(s)
- Karen A Eley
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Maria Camilla Rossi-Espagnet
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Silvia Schievano
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Antonio Napolitano
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Juling Ong
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Aurelio Secinaro
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Luca Borro
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - David Dunaway
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Carlo Efisio Marras
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Adam Rennie
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Fergus Robertson
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Sergio Picardo
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Daniela Longo
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Alessandro Inserra
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Massimo Rollo
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Jessica Cooper
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Kshitij Mankad
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Noor-Owase Jeelani
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Felice D'Arco
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
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