The 23rd International Symposium on Cerebral Blood Flow, Metabolism and Function

Non-Invasive and Minimally-Invasive Cerebral Autoregulation Assessment: A Narrative Review of Techniques and Implications for Clinical Research

The process of cerebral vessels regulating constant cerebral blood flow over a wide range of systemic arterial pressures is termed cerebral autoregulation (CA). Static and dynamic autoregulation are two types of CA measurement techniques, with the main difference between these measures relating to the time scale used. Static autoregulation looks at the long-term change in blood pressures, while dynamic autoregulation looks at the immediate change. Techniques that provide regularly updating measures are referred to as continuous, whereas intermittent techniques take a single at point in time. However, a technique being continuous or intermittent is not implied by if the technique measures autoregulation statically or dynamically. This narrative review outlines technical aspects of non-invasive and minimally-invasive modalities along with providing details on the non-invasive and minimally-invasive measurement techniques used for CA assessment. These non-invasive techniques include neuroimaging methods, transcranial Doppler, and near-infrared spectroscopy while the minimally-invasive techniques include positron emission tomography along with magnetic resonance imaging and radiography methods. Further, the advantages and limitations are discussed along with how these methods are used to assess CA. At the end, the clinical considerations regarding these various techniques are highlighted.

K⁺ dynamics in ischemic rat brain in vivo by ⁸⁷Rb MRI at 7 T

The aims of the present study were as follows: (i) to perform the first (87)Rb MRI in live rats with focal ischemic stroke; and (ii) to test the hypothesis that K(+) egress from the brain in this model is quantifiable in individual animals by high-field (7-T) K/Rb substitution MRI. Rats preloaded with dietary Rb(+) (resulting in Rb/(K + Rb) replacement ratios of 0.1-0.2 in the brain) were subjected to permanent occlusion of the middle cerebral artery, and (87)Rb MRI was implemented with 13-min temporal resolution using a dedicated RF coil and a spiral ultrashort-TE sequence (TR/TE = 3/0.07 ms). The ischemic core was localized by apparent diffusion coefficient mapping, by microtubule-associated protein-2 immunohistochemistry and by changes in surface reflectivity. [K], [Na] and [Rb] were determined independently in the micropunched samples by post-mortem flame photometry. Both techniques were generally in agreement in the nonischemic cortex; however, the MRI-assessed [K(+) + Rb(+)] drop in ischemic brain was less pronounced (average efflux rate of 4.8 ± 0.2 nEq/mm(3) /h versus 10 ± 1 nEq/mm(3)/h by flame photometry; p < 0.0001). The use of higher field gradients for better spatial resolution, and hence more accurate quantification, is suggested.