1
|
Kidoguchi M, Akazawa A, Komori O, Isozaki M, Higashino Y, Kawajiri S, Yamada S, Kodera T, Arishima H, Tsujikawa T, Kimura H, Kikuta K. Prediction of Occurrence of Cerebral Infarction After Successful Mechanical Thrombectomy for Ischemic Stroke in the Anterior Circulation by Arterial Spin Labeling. Clin Neuroradiol 2023; 33:965-971. [PMID: 37280389 PMCID: PMC10654162 DOI: 10.1007/s00062-023-01295-x] [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: 11/30/2022] [Accepted: 03/28/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The overall goal of our study is to create modified Alberta Stroke Program Early Computed Tomography Score (ASPECTS) determined by the findings on arterial spin labeling imaging (ASL) to predict the prognosis of patients with acute ischemic stroke after successful mechanical thrombectomy (MT). Prior to that, we examined predictive factors including the value of cerebral blood flow (CBF) measured by ASL for occurrence of cerebral infarction at the region of interest (ROI) used in the ASPECTS after successful MT. METHODS Of the 92 consecutive patients with acute ischemic stroke treated with MT at our institution between April 2013 and April 2021, a total of 26 patients who arrived within 8 h after stroke onset and underwent MT resulting in a thrombolysis in cerebral infarction score of 2B or 3 were analyzed. Magnetic resonance imaging, including diffusion-weighted imaging (DWI) and ASL, was performed on arrival and the day after MT. The asymmetry index (AI) of CBF by ASL (ASL-CBF) before MT was calculated for 11 regions of interest using the DWI-Alberta Stroke Program Early CT Score. RESULTS Occurrence of infarction after successful MT for ischemic stroke in the anterior circulation can be expected when the formula 0.3211 × history of atrial fibrillation +0.0096 × the AI of ASL-CBF before MT (%) +0.0012 × the time from onset to reperfusion (min) yields a value below 1.0 or when the AI of ASL-CBF before MT is below 61.5%. CONCLUSION The AI of ASL-CBF before MT or a combination of a history of atrial fibrillation, the AI of ASL-CBF before MT, and the time from onset to reperfusion can be used to predict the occurrence of infarction in patients arriving within 8 h after stroke onset in which reperfusion with MT was successful.
Collapse
Affiliation(s)
- Masamune Kidoguchi
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji, 910-1193, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Ayumi Akazawa
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji, 910-1193, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Osamu Komori
- Department of Computer and Information Science, Faculty of Science and Technology, Seikei University, Musashino, Tokyo, Japan
| | - Makoto Isozaki
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji, 910-1193, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Yoshifumi Higashino
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji, 910-1193, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Satoshi Kawajiri
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji, 910-1193, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Shinsuke Yamada
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji, 910-1193, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Toshiaki Kodera
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji, 910-1193, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Hidetaka Arishima
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji, 910-1193, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Tetsuya Tsujikawa
- Department of Radiology, Division of Medicine Radiology and Laboratory Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Hirohiko Kimura
- Department of Radiology, Division of Medicine Radiology and Laboratory Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Kenichiro Kikuta
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji, 910-1193, Eiheiji-cho, Yoshida-gun, Fukui, Japan.
| |
Collapse
|
2
|
Domingos C, Fouto AR, Nunes RG, Ruiz-Tagle A, Esteves I, Silva NA, Vilela P, Gil-Gouveia R, Figueiredo P. Impact of susceptibility-induced distortion correction on perfusion imaging by pCASL with a segmented 3D GRASE readout. Magn Reson Imaging 2023:S0730-725X(23)00104-2. [PMID: 37343905 DOI: 10.1016/j.mri.2023.06.010] [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: 02/07/2023] [Revised: 05/18/2023] [Accepted: 06/17/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE The consensus for the clinical implementation of arterial spin labeling (ASL) perfusion imaging recommends a segmented 3D Gradient and Spin-Echo (GRASE) readout for optimal signal-to-noise-ratio(SNR). The correction of the associated susceptibility-induced geometric distortions has been shown to improve diagnostic precision, but its impact on ASL data has not been systematically assessed and it is not consistently part of pre-processing pipelines. Here, we investigate the effects of susceptibility-induced distortion correction on perfusion imaging by pseudo-continuous ASL (pCASL) with a segmented 3D GRASE readout. METHODS Data acquired from 28 women using pCASL with 3D GRASE at 3T was analyzed using three pre-processing options: without distortion correction, with distortion correction, and with spatial smoothing (without distortion correction) matched to control for blurring effects induced by distortion correction. Maps of temporal SNR (tSNR) and relative perfusion were analyzed in eight regions-of-interest (ROIs) across the brain. RESULTS Distortion correction significantly affected tSNR and relative perfusion across the brain. Increases in tSNR were like those produced by matched spatial smoothing in most ROIs, indicating that they were likely due to blurring effects. However, that was not the case in the frontal and temporal lobes, where we also found increased relative perfusion with distortion correction even compared with matched spatial smoothing. These effects were found in both controls and patients, with no interactions with the participant group. CONCLUSION Correction of Susceptibility-induced distortions significantly impacts ASL perfusion imaging using a segmented 3D GRASE readout, and this step should therefore be considered in ASL pre-processing pipelines. This is of special importance in clinical studies, reporting perfusion across ROIs defined on relatively undistorted images and when conducting group analyses requiring the alignment of images across different subjects.
Collapse
Affiliation(s)
- Catarina Domingos
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal; Agência Regional para o Desenvolvimento da Investigação, Tecnologia e Inovação, Funchal, Portugal.
| | - Ana R Fouto
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Rita G Nunes
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Amparo Ruiz-Tagle
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Inês Esteves
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | | | - Pedro Vilela
- Neurology Department, Hospital da Luz, Lisbon, Portugal
| | - Raquel Gil-Gouveia
- Neurology Department, Hospital da Luz, Lisbon, Portugal.; Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Patrícia Figueiredo
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
3
|
Huang D, Guo Y, Guan X, Pan L, Zhu Z, Chen Z, Dijkhuizen RM, Duering M, Yu F, Boltze J, Li P. Recent advances in arterial spin labeling perfusion MRI in patients with vascular cognitive impairment. J Cereb Blood Flow Metab 2023; 43:173-184. [PMID: 36284489 PMCID: PMC9903225 DOI: 10.1177/0271678x221135353] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/01/2022] [Accepted: 09/21/2022] [Indexed: 01/24/2023]
Abstract
Cognitive impairment (CI) is a major health concern in aging populations. It impairs patients' independent life and may progress to dementia. Vascular cognitive impairment (VCI) encompasses all cerebrovascular pathologies that contribute to cognitive impairment (CI). Moreover, the majority of CI subtypes involve various aspects of vascular dysfunction. Recent research highlights the critical role of reduced cerebral blood flow (CBF) in the progress of VCI, and the detection of altered CBF may help to detect or even predict the onset of VCI. Arterial spin labeling (ASL) is a non-invasive, non-ionizing perfusion MRI technique for assessing CBF qualitatively and quantitatively. Recent methodological advances enabling improved signal-to-noise ratio (SNR) and data acquisition have led to an increase in the use of ASL to assess CBF in VCI patients. Combined with other imaging modalities and biomarkers, ASL has great potential for identifying early VCI and guiding prediction and prevention strategies. This review focuses on recent advances in ASL-based perfusion MRI for identifying patients at high risk of VCI.
Collapse
Affiliation(s)
- Dan Huang
- Department of Anesthesiology, Clinical Research Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunlu Guo
- Department of Anesthesiology, Clinical Research Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyu Guan
- Department of Anesthesiology, Clinical Research Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijun Pan
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyu Zhu
- Department of Anesthesiology, Clinical Research Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zeng’ai Chen
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Marco Duering
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany
- Medical Image Analysis Center (MIAC) and qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Fang Yu
- Department of Anesthesiology, Westchester Medical Center, New York Medical College, NY, USA
| | - Johannes Boltze
- School of Life Sciences, University of Warwick, Coventry, UK
| | - Peiying Li
- Department of Anesthesiology, Clinical Research Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
4
|
Sutherland B, Premilovac D. Acute and long-term changes in blood flow after ischemic stroke: challenges and opportunities. Neural Regen Res 2023; 18:799-800. [PMID: 36204841 PMCID: PMC9700091 DOI: 10.4103/1673-5374.350699] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
|
5
|
Liu S, Fan D, Zang F, Gu N, Yin Y, Ge X, Zhang L, Chen X, Zhang Z, Xie C. Collateral circulation detected by arterial spin labeling predicts outcome in acute ischemic stroke. Acta Neurol Scand 2022; 146:635-642. [PMID: 36062837 DOI: 10.1111/ane.13694] [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: 04/26/2022] [Revised: 07/16/2022] [Accepted: 08/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Robust collateral circulation is strongly associated with good outcomes in acute ischemic stroke (AIS). AIMS To determine whether collateral circulation detected by arterial spin labeling (ASL) magnetic resonance imaging could predict good clinical outcome in AIS patients with 90 days follow-up. MATERIALS AND METHODS Total 58 AIS patients with anterior circulation stroke were recruited. Collateral circulation was defined as arterial transit artifact in ASL images. Modified Rankin Scale (mRS), the Barthel Index, and National Institutes of Health Stroke Scale (NIHSS) were employed to evaluate neurological function for the baseline and 90 days follow-up. The percent changes of these scores were also calculated, respectively. Finally, a support vector classifier model of machine learning and receiver operating characteristic curve were employed to estimate the power of ASL collaterals (ASLcs) predicting the clinical outcome. RESULTS Patients with ASLcs represented higher rate of good outcome (83.30% vs. 31.25%, p < .001) and lower follow-up mRS scores (p < .001), when compared to patients without ASLcs. There were significant differences for percent changes of mRS scores and NIHSS scores between these two groups. Further, the presence of ASLcs could predict good clinical outcome (OR, 1.54; 95% CI, 1.10-2.16), even after controlling for baseline NIHSS scores. The SVC model incorporating baseline NIHSS scores and ASLcs had significant predictive effect (accuracy, 79.3%; AUC, 0.806) on clinical prognosis for AIS patients. DISCUSSION We targeted on the non-invasive assessment of collateral circulation using ASL technique and found that patients with ASLcs were more likely to have a good clinical outcome after AIS. This finding is of guiding significance for treatment selection and prognostic prediction. CONCLUSIONS Early ASLcs assessment provides a good powerful tool to predict clinical outcome for AIS patients with 90 days follow-up.
Collapse
Affiliation(s)
- Sangni Liu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Dandan Fan
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Feifei Zang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Nan Gu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yun Yin
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiao Ge
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ling Zhang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiang Chen
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhengsheng Zhang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.,Neuropsychiatric Institute, Affiliated ZhongDa Hospital, Southeast University, Nanjing, China
| | - Chunming Xie
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.,Neuropsychiatric Institute, Affiliated ZhongDa Hospital, Southeast University, Nanjing, China.,The Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, China
| |
Collapse
|
6
|
Multiphase arterial spin labeling imaging to predict early recurrent ischemic lesion in acute ischemic stroke. Sci Rep 2022; 12:1456. [PMID: 35087157 PMCID: PMC8795409 DOI: 10.1038/s41598-022-05465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/03/2021] [Indexed: 11/21/2022] Open
Abstract
In acute ischemic stroke (AIS), the hemodynamics around the lesion are important because they determine the recurrence or prognosis of the disease. This study evaluated the effects of perfusion deficits in multiphase arterial spin labeling (ASL) and related radiological parameters on the occurrence of early recurrent ischemic lesions (ERILs) in AIS. We assessed AIS patients who underwent multiphase ASL within 24 h of symptom onset and follow-up diffusion-weighted imaging within 7 days. ASL perfusion deficit, arterial transit artifact (ATA), and intra-arterial high-intensity signal (IAS) were manually rated as ASL parameters. A total of 134 patients were evaluated. In the multivariable analyses, ASL perfusion deficit [adjusted odds ratio (aOR) = 2.82, 95% confidence interval = 1.27–6.27] was positively associated with ERIL. Furthermore, when ATA was accompanied, the ASL perfusion deficit was not associated with ERIL occurrence. Meanwhile, IAS showed a synergistic effect with ASL perfusion deficit on the occurrence of ERIL. In conclusion, we demonstrated the association between perfusion deficits in multiphase ASL with ERIL in patients with AIS. This close association was attenuated by ATA and was enhanced by IAS. ASL parameters may help identify high-risk patients of ERIL occurrence during the acute period.
Collapse
|
7
|
Lin Z, Wang T, Li Y. Reduced Cerebral Blood Flow in Benign Oligemia Relates to Poor Clinical Outcome in Acute Ischemic Stroke Patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:3358-3361. [PMID: 34891959 DOI: 10.1109/embc46164.2021.9630180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The imaging of cerebral blow flow (CBF) has shown great promise in predicting the tissue outcome or functional outcome of acute ischemic stroke patients. Arterial spin labeling (ASL) provides a noninvasive tool for quantitative CBF measurement and does not require a contrast agent, which makes it an attractive technology for perfusion imaging in clinical settings. Previous studies have shown the feasibility of using ASL for acute stroke imaging and its potential in stroke outcome prediction. However, the relationship between the tissue-level CBF reduction in hypoperfused region and clinical outcome in acute stroke patients remains not well understood. In this study, we obtained the quantitative measurements of CBF in acute ischemic stroke patients (N = 18) using pseudocontinuous ASL (pCASL) perfusion imaging technology. The tissue-level CBF changes were evaluated and their correlations with patient clinical outcome were explored. Our results showed different CBF values between hypoperfused tissues recruited into infarction and those that survived. Moreover, a significant correlation was found specifically between the CBF reduction in benign oligemia area and patient neurological deficit severity. These findings showed the validity of pCASL perfusion imaging in the assessment of tissue-level CBF information in acute stroke. The association of CBF with patient clinical outcome might provide useful insights in early diagnosis of acute stroke patients.
Collapse
|
8
|
Li C, Sun T, Jiang C. Recent advances in nanomedicines for the treatment of ischemic stroke. Acta Pharm Sin B 2021; 11:1767-1788. [PMID: 34386320 PMCID: PMC8343119 DOI: 10.1016/j.apsb.2020.11.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/27/2020] [Accepted: 09/13/2020] [Indexed: 12/20/2022] Open
Abstract
Ischemic stroke is a cerebrovascular disease normally caused by interrupted blood supply to the brain. Ischemia would initiate the cascade reaction consisted of multiple biochemical events in the damaged areas of the brain, where the ischemic cascade eventually leads to cell death and brain infarction. Extensive researches focusing on different stages of the cascade reaction have been conducted with the aim of curing ischemic stroke. However, traditional treatment methods based on antithrombotic therapy and neuroprotective therapy are greatly limited for their poor safety and treatment efficacy. Nanomedicine provides new possibilities for treating stroke as they could improve the pharmacokinetic behavior of drugs in vivo, achieve effective drug accumulation at the target site, enhance the therapeutic effect and meanwhile reduce the side effect. In this review, we comprehensively describe the pathophysiology of stroke, traditional treatment strategies and emerging nanomedicines, summarize the barriers and methods for transporting nanomedicine to the lesions, and illustrate the latest progress of nanomedicine in treating ischemic stroke, with a view to providing a new feasible path for the treatment of cerebral ischemia.
Collapse
Key Words
- AEPO, asialo-erythropoietin
- APOE, apolipoprotein E
- BBB, blood‒brain barrier
- BCECs, brain capillary endothelial cells
- Blood‒brain barrier
- CAT, catalase
- COX-1, cyclooxygenase-1
- CXCR-4, C-X-C chemokine receptor type 4
- Ce-NPs, ceria nanoparticles
- CsA, cyclosporine A
- DAMPs, damage-associated molecular patterns
- GFs, growth factors
- GPIIb/IIIa, glycoprotein IIb/IIIa
- HMGB1, high mobility group protein B1
- Hb, hemoglobin
- ICAM-1, intercellular adhesion molecule-1
- IL-1β, interleukin-1β
- IL-6, interleukin-6
- Ischemic cascade
- LFA-1, lymphocyte function-associated antigen-1
- LHb, liposomal Hb
- MCAO, middle cerebral artery occlusion
- MMPs, matrix metalloproteinases
- MSC, mesenchymal stem cell
- NF-κB, nuclear factor-κB
- NGF, nerve growth factor
- NMDAR, N-methyl-d-aspartate receptor
- NOS, nitric oxide synthase
- NPs, nanoparticles
- NSCs, neural stem cells
- Nanomedicine
- Neuroprotectant
- PBCA, poly-butylcyanoacrylate
- PCMS, poly (chloromethylstyrene)
- PEG, poly-ethylene-glycol
- PEG-PLA, poly (ethylene-glycol)-b-poly (lactide)
- PLGA NPs, poly (l-lactide-co-glycolide) nanoparticles
- PSD-95, postsynaptic density protein-95
- PSGL-1, P-selectin glycoprotein ligand-1
- RBCs, red blood cells
- RES, reticuloendothelial system
- RGD, Arg-Gly-Asp
- ROS, reactive oxygen species
- Reperfusion
- SDF-1, stromal cell-derived factor-1
- SHp, stroke homing peptide
- SOD, superoxide dismutase
- SUR1-TRPM4, sulfonylurea receptor 1-transient receptor potential melastatin-4
- Stroke
- TEMPO, 2,2,6,6-tetramethylpiperidine-1-oxyl
- TIA, transient ischemic attack
- TNF-α, tumor necrosis factor-α
- Thrombolytics
- cRGD, cyclic Arg-Gly-Asp
- e-PAM-R, arginine-poly-amidoamine ester
- iNOS, inducible nitric oxide synthase
- miRNAs, microRNAs
- nNOS, neuron nitric oxide synthase
- siRNA, small interfering RNA
Collapse
|
9
|
Bohara M, Nakajo M, Kamimura K, Yoneyama T, Ayukawa T, Yoshiura T. Visualization of incidentally imaged pituitary gland on three-dimensional arterial spin labeling of the brain. Br J Radiol 2021; 94:20201311. [PMID: 33914621 DOI: 10.1259/bjr.20201311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the visualization of incidentally imaged normal pituitary gland on three-dimensional (3D) pseudo continuous arterial spin labeling (PCASL) perfusion imaging of the brain. METHODS Ninety-three patients with a normal pituitary gland who underwent 3D PCASL for suspected brain diseases were retrospectively included. Visualization of the pituitary gland on PCASL cerebral blood flow (CBF) maps was assessed independently by two observers using a three-point grading system: Grade 1, pituitary CBF ≤ CBF of the cerebral white matter (WM); Grade 2, CBF of WM < pituitary CBF ≤ CBF of the cortical gray matter (GM); and Grade 3, CBF of GM < pituitary CBF. The interobserver agreement of visual grading was determined using weighted κ statistic. The associations of visual grades with age, sex, and pituitary volume were assessed using multivariate logistic regression. Pituitary glands were divided equally into three groups (small, medium, and large) according to their volume for categorization. RESULTS The interobserver agreement for visual rating was excellent (weighted κ = 0.823). Of the 93 cases, Grades 1, 2, and 3 included 17 (18.3%), 41 (44.1%), and 35 cases (37.6%), respectively. Medium and large pituitary volume were significantly associated with Grade 3 visualization (p = 0.0153, OR = 4.8323; 95% CI: 1.3525, 17.2649 and p = 0.0009; OR = 9.0299; 95% CI: 2.4663, 33.0614, respectively), whereas there was no significant association for age or sex. CONCLUSION The normal pituitary gland is often visualized with higher CBF than cortical GM on 3D PCASL, especially in individuals with larger pituitary volume. ADVANCES IN KNOWLEDGE Appearance of the normal pituitary gland on 3D PCASL has been documented for the first time.
Collapse
Affiliation(s)
- Manisha Bohara
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masanori Nakajo
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kiyohisa Kamimura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomohide Yoneyama
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takuro Ayukawa
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takashi Yoshiura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| |
Collapse
|
10
|
Suri S, Bulte D, Chiesa ST, Ebmeier KP, Jezzard P, Rieger SW, Pitt JE, Griffanti L, Okell TW, Craig M, Chappell MA, Blockley NP, Kivimäki M, Singh-Manoux A, Khir AW, Hughes AD, Deanfield JE, Jensen DEA, Green SF, Sigutova V, Jansen MG, Zsoldos E, Mackay CE. Study Protocol: The Heart and Brain Study. Front Physiol 2021; 12:643725. [PMID: 33868011 PMCID: PMC8046163 DOI: 10.3389/fphys.2021.643725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/03/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND It is well-established that what is good for the heart is good for the brain. Vascular factors such as hypertension, diabetes, and high cholesterol, and genetic factors such as the apolipoprotein E4 allele increase the risk of developing both cardiovascular disease and dementia. However, the mechanisms underlying the heart-brain association remain unclear. Recent evidence suggests that impairments in vascular phenotypes and cerebrovascular reactivity (CVR) may play an important role in cognitive decline. The Heart and Brain Study combines state-of-the-art vascular ultrasound, cerebrovascular magnetic resonance imaging (MRI) and cognitive testing in participants of the long-running Whitehall II Imaging cohort to examine these processes together. This paper describes the study protocol, data pre-processing and overarching objectives. METHODS AND DESIGN The 775 participants of the Whitehall II Imaging cohort, aged 65 years or older in 2019, have received clinical and vascular risk assessments at 5-year-intervals since 1985, as well as a 3T brain MRI scan and neuropsychological tests between 2012 and 2016 (Whitehall II Wave MRI-1). Approximately 25% of this cohort are selected for the Heart and Brain Study, which involves a single testing session at the University of Oxford (Wave MRI-2). Between 2019 and 2023, participants will undergo ultrasound scans of the ascending aorta and common carotid arteries, measures of central and peripheral blood pressure, and 3T MRI scans to measure CVR in response to 5% carbon dioxide in air, vessel-selective cerebral blood flow (CBF), and cerebrovascular lesions. The structural and diffusion MRI scans and neuropsychological battery conducted at Wave MRI-1 will also be repeated. Using this extensive life-course data, the Heart and Brain Study will examine how 30-year trajectories of vascular risk throughout midlife (40-70 years) affect vascular phenotypes, cerebrovascular health, longitudinal brain atrophy and cognitive decline at older ages. DISCUSSION The study will generate one of the most comprehensive datasets to examine the longitudinal determinants of the heart-brain association. It will evaluate novel physiological processes in order to describe the optimal window for managing vascular risk in order to delay cognitive decline. Ultimately, the Heart and Brain Study will inform strategies to identify at-risk individuals for targeted interventions to prevent or delay dementia.
Collapse
Affiliation(s)
- Sana Suri
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Daniel Bulte
- Oxford Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Scott T. Chiesa
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Klaus P. Ebmeier
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Peter Jezzard
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Sebastian W. Rieger
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jemma E. Pitt
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Ludovica Griffanti
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Thomas W. Okell
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Martin Craig
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottingham Biomedical Research Centre, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Michael A. Chappell
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottingham Biomedical Research Centre, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | | | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Archana Singh-Manoux
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Ashraf W. Khir
- Mechanical Engineering, Brunel University London, Uxbridge, United Kingdom
| | - Alun D. Hughes
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - John E. Deanfield
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Daria E. A. Jensen
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Sebastian F. Green
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Veronika Sigutova
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Michelle G. Jansen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Enikő Zsoldos
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Clare E. Mackay
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
11
|
Ter Schiphorst A, Charron S, Hassen WB, Provost C, Naggara O, Benzakoun J, Seners P, Turc G, Baron JC, Oppenheim C. Tissue no-reflow despite full recanalization following thrombectomy for anterior circulation stroke with proximal occlusion: A clinical study. J Cereb Blood Flow Metab 2021; 41:253-266. [PMID: 32960688 PMCID: PMC8370008 DOI: 10.1177/0271678x20954929] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite early thrombectomy, a sizeable fraction of acute stroke patients with large vessel occlusion have poor outcome. The no-reflow phenomenon, i.e. impaired microvascular reperfusion despite complete recanalization, may contribute to such "futile recanalizations". Although well reported in animal models, no-reflow is still poorly characterized in man. From a large prospective thrombectomy database, we included all patients with intracranial proximal occlusion, complete recanalization (modified thrombolysis in cerebral infarction score 2c-3), and availability of both baseline and 24 h follow-up MRI including arterial spin labeling perfusion mapping. No-reflow was operationally defined as i) hypoperfusion ≥40% relative to contralateral homologous region, assessed with both visual (two independent investigators) and automatic image analysis, and ii) infarction on follow-up MRI. Thirty-three patients were eligible (median age: 70 years, NIHSS: 18, and stroke onset-to-recanalization delay: 208 min). The operational criteria were met in one patient only, consistently with the visual and automatic analyses. This patient recanalized 160 min after stroke onset and had excellent functional outcome. In our cohort of patients with complete and stable recanalization following thrombectomy for intracranial proximal occlusion, severe ipsilateral hypoperfusion on follow-up imaging associated with newly developed infarction was a rare occurrence. Thus, no-reflow may be infrequent in human stroke and may not substantially contribute to futile recanalizations.
Collapse
Affiliation(s)
- Adrien Ter Schiphorst
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neurology, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Sylvain Charron
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Wagih Ben Hassen
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Corentin Provost
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Olivier Naggara
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Joseph Benzakoun
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Pierre Seners
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neurology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Guillaume Turc
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neurology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Jean-Claude Baron
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neurology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| | - Catherine Oppenheim
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France.,Department of Neuroradiology, Hôpital Sainte-Anne, Université de Paris, Paris, France
| |
Collapse
|
12
|
Jiang Z, Alamuri TT, Muir ER, Choi DW, Duong TQ. Longitudinal multiparametric MRI study of hydrogen-enriched water with minocycline combination therapy in experimental ischemic stroke in rats. Brain Res 2020; 1748:147122. [DOI: 10.1016/j.brainres.2020.147122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022]
|
13
|
Premilovac D, Blackwood SJ, Ramsay CJ, Keske MA, Howells DW, Sutherland BA. Transcranial contrast-enhanced ultrasound in the rat brain reveals substantial hyperperfusion acutely post-stroke. J Cereb Blood Flow Metab 2020; 40:939-953. [PMID: 32063081 PMCID: PMC7181087 DOI: 10.1177/0271678x20905493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Direct and real-time assessment of cerebral hemodynamics is key to improving our understanding of cerebral blood flow regulation in health and disease states such as stroke. While a number of sophisticated imaging platforms enable assessment of cerebral perfusion, most are limited either spatially or temporally. Here, we applied transcranial contrast-enhanced ultrasound (CEU) to measure cerebral perfusion in real-time through the intact rat skull before, during and after ischemic stroke, induced by intraluminal filament middle cerebral artery occlusion (MCAO). We demonstrate expected decreases in cortical and striatal blood volume, flow velocity and perfusion during MCAO. After filament retraction, blood volume and perfusion increased two-fold above baseline, indicative of acute hyperperfusion. Adjacent brain regions to the ischemic area and the contralateral hemisphere had increased blood volume during MCAO. We assessed our data using wavelet analysis to demonstrate striking vasomotion changes in the ischemic and contralateral cortices during MCAO and reperfusion. In conclusion, we demonstrate the application of CEU for real-time assessment of cerebral hemodynamics and show that the ischemic regions exhibit striking hyperemia post-MCAO. Whether this post-stoke hyperperfusion is sustained long-term and contributes to stroke severity is not known.
Collapse
Affiliation(s)
- Dino Premilovac
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Sarah J Blackwood
- Åstrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden
| | - Ciaran J Ramsay
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Michelle A Keske
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - David W Howells
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Brad A Sutherland
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| |
Collapse
|
14
|
Zhang H, Pan Q, Xie Z, Chen Y, Wang J, Bihl J, Zhong W, Chen Y, Zhao B, Ma X. Implication of MicroRNA503 in Brain Endothelial Cell Function and Ischemic Stroke. Transl Stroke Res 2020; 11:1148-1164. [PMID: 32285355 DOI: 10.1007/s12975-020-00794-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
The role of miR-503 in brain endothelium and ischemic stroke (IS) remains unclear. We aimed to study the relationship between plasma miR-503 and the onset time, severity, subtypes, and von Willebrand Factor (vWF) level in IS patients and to investigate the roles and underlying mechanisms of miR-503 in middle cerebral artery occlusion (MCAO) mice and cultured cerebral vascular endothelial cells (ECs). In MCAO mice, the effects of plasma from acute severe IS patients (ASS) with or without miR-503 antagomir on brain and ECs damage were determined. In cultured human ECs, the effects of miR-503 overexpression or knockdown on the monolayer permeability, apoptosis, ROS, and NO generation were investigated. For mechanism study, the PI3K/Akt/eNOS pathway, cleaved caspase-3, and bcl-2 were analyzed. Results showed that plasma miR-503 was significantly increased in IS patients, especially in acute period and severe cases and subtypes of LAA and TACI, and was positively correlated with vWF. Logistic analysis indicated that miR-503 was an independent risk factor for IS, with the area under curve of 0.796 in ROC analysis. In MCAO mice, ASS pretreatment aggravated neurological injury, BBB damage, brain edema, CBF reduction, and decreased NO production while increased apoptosis and ROS generation in brain ECs, which were partly abolished by miR-503 antagomir. In cultured ECs, miR-503 overexpression and knockdown confirmed its effects on regulating monolayer permeability, cell apoptosis, NO, and ROS generation via PI3K/Akt/eNOS pathway or bcl-2 and cleaved caspase-3 proteins. These together indicate that miR-503 is a promising biomarker and novel therapeutic target for IS.
Collapse
Affiliation(s)
- Huiting Zhang
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, 57 South Renmin Road, Zhanjiang, 524001, China
| | - Qunwen Pan
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, 57 South Renmin Road, Zhanjiang, 524001, China
| | - Zi Xie
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, 57 South Renmin Road, Zhanjiang, 524001, China
| | - Yanyu Chen
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, 57 South Renmin Road, Zhanjiang, 524001, China
| | - Jinju Wang
- Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45430, USA
| | - Ji Bihl
- Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45430, USA
| | - Wangtao Zhong
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, 57 South Renmin Road, Zhanjiang, 524001, China
| | - Yanfang Chen
- Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45430, USA
| | - Bin Zhao
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, 57 South Renmin Road, Zhanjiang, 524001, China.
| | - Xiaotang Ma
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, 57 South Renmin Road, Zhanjiang, 524001, China.
| |
Collapse
|
15
|
Fan AP, Khalil AA, Fiebach JB, Zaharchuk G, Villringer A, Villringer K, Gauthier CJ. Elevated brain oxygen extraction fraction measured by MRI susceptibility relates to perfusion status in acute ischemic stroke. J Cereb Blood Flow Metab 2020; 40:539-551. [PMID: 30732551 PMCID: PMC7026852 DOI: 10.1177/0271678x19827944] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent clinical trials of new revascularization therapies in acute ischemic stroke have highlighted the importance of physiological imaging to identify optimal treatments for patients. Oxygen extraction fraction (OEF) is a hallmark of at-risk tissue in stroke, and can be quantified from the susceptibility effect of deoxyhemoglobin molecules in venous blood on MRI phase scans. We measured OEF within cerebral veins using advanced quantitative susceptibility mapping (QSM) MRI reconstructions in 20 acute stroke patients. Absolute OEF was elevated in the affected (29.3 ± 3.4%) versus the contralateral hemisphere (25.5 ± 3.1%) of patients with large diffusion-perfusion lesion mismatch (P = 0.032). In these patients, OEF negatively correlated with relative CBF measured by dynamic susceptibility contrast MRI (P = 0.004), suggesting compensation for reduced flow. Patients with perfusion-diffusion match or no hypo-perfusion showed less OEF difference between hemispheres. Nine patients received longitudinal assessment and showed OEF ratio (affected to contralateral) of 1.2 ± 0.1 at baseline that normalized (decreased) to 1.0 ± 0.1 at follow-up three days later (P = 0.03). Our feasibility study demonstrates that QSM MRI can non-invasively quantify OEF in stroke patients, relates to perfusion status, and is sensitive to OEF changes over time. Clinical trial registration: Longitudinal MRI examinations of patients with brain ischemia and blood brain barrier permeability; clinicaltrials.org :NCT02077582.
Collapse
Affiliation(s)
- Audrey P Fan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Ahmed A Khalil
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Berlin School of Mind and Brain, Humboldt-Universitaet zu Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Arno Villringer
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Berlin School of Mind and Brain, Humboldt-Universitaet zu Berlin, Berlin, Germany
| | - Kersten Villringer
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Claudine J Gauthier
- Department of Physics, Concordia University, Montreal, Canada.,Montreal Heart Institute, Montreal, Canada
| |
Collapse
|
16
|
Khalil AA, Villringer K, Filleböck V, Hu JY, Rocco A, Fiebach JB, Villringer A. Non-invasive monitoring of longitudinal changes in cerebral hemodynamics in acute ischemic stroke using BOLD signal delay. J Cereb Blood Flow Metab 2020; 40:23-34. [PMID: 30334657 PMCID: PMC6928563 DOI: 10.1177/0271678x18803951] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Relative delays in blood-oxygen-level-dependent (BOLD) signal oscillations can be used to assess cerebral perfusion without using contrast agents. However, little is currently known about the utility of this method in detecting clinically relevant perfusion changes over time. We investigated the relationship between longitudinal BOLD delay changes, vessel recanalization, and reperfusion in 15 acute stroke patients with vessel occlusion examined within 24 h of symptom onset (D0) and one day later (D1). We created BOLD delay maps using time shift analysis of resting-state functional MRI data and quantified perfusion lesion volume changes (using the D1/D0 volume ratio) and severity changes (using a linear mixed model) over time. Between baseline and follow-up, BOLD delay lesions shrank (median D1/D0 ratio = 0.2, IQR = 0.03-0.7) and BOLD delay severity decreased (b = -4.4 s) in patients with recanalization, whereas they grew (median D1/D0 ratio = 1.47, IQR = 1.1-1.7) and became more severe (b = 4.3 s) in patients with persistent vessel occlusion. Clinically relevant changes in cerebral perfusion in early stroke can be detected using BOLD delay, making this non-invasive method a promising option for detecting tissue at risk of infarction and monitoring stroke patients following recanalization therapy.
Collapse
Affiliation(s)
- Ahmed A Khalil
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kersten Villringer
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vivien Filleböck
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jiun-Yiing Hu
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Rocco
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Arno Villringer
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Mind, Brain, Body Institute, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
17
|
Thamm T, Guo J, Rosenberg J, Liang T, Marks MP, Christensen S, Do HM, Kemp SM, Adair E, Eyngorn I, Mlynash M, Jovin TG, Keogh BP, Chen HJ, Lansberg MG, Albers GW, Zaharchuk G. Contralateral Hemispheric Cerebral Blood Flow Measured With Arterial Spin Labeling Can Predict Outcome in Acute Stroke. Stroke 2019; 50:3408-3415. [PMID: 31619150 DOI: 10.1161/strokeaha.119.026499] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background and Purpose- Imaging is frequently used to select acute stroke patients for intra-arterial therapy. Quantitative cerebral blood flow can be measured noninvasively with arterial spin labeling magnetic resonance imaging. Cerebral blood flow levels in the contralateral (unaffected) hemisphere may affect capacity for collateral flow and patient outcome. The goal of this study was to determine whether higher contralateral cerebral blood flow (cCBF) in acute stroke identifies patients with better 90-day functional outcome. Methods- Patients were part of the prospective, multicenter iCAS study (Imaging Collaterals in Acute Stroke) between 2013 and 2017. Consecutive patients were enrolled after being diagnosed with anterior circulation acute ischemic stroke. Inclusion criteria were ischemic anterior circulation stroke, baseline National Institutes of Health Stroke Scale score ≥1, prestroke modified Rankin Scale score ≤2, onset-to-imaging time <24 hours, with imaging including diffusion-weighted imaging and arterial spin labeling. Patients were dichotomized into high and low cCBF groups based on median cCBF. Outcomes were assessed by day-1 and day-5 National Institutes of Health Stroke Scale; and day-30 and day-90 modified Rankin Scale. Multivariable logistic regression was used to test whether cCBF predicted good neurological outcome (modified Rankin Scale score, 0-2) at 90 days. Results- Seventy-seven patients (41 women) met the inclusion criteria with median (interquartile range) age of 66 (55-76) yrs, onset-to-imaging time of 4.8 (3.6-7.7) hours, and baseline National Institutes of Health Stroke Scale score of 13 (9-20). Median cCBF was 38.9 (31.2-44.5) mL per 100 g/min. Higher cCBF predicted good outcome at day 90 (odds ratio, 4.6 [95% CI, 1.4-14.7]; P=0.01), after controlling for baseline National Institutes of Health Stroke Scale, diffusion-weighted imaging lesion volume, and intra-arterial therapy. Conclusions- Higher quantitative cCBF at baseline is a significant predictor of good neurological outcome at day 90. cCBF levels may inform decisions regarding stroke triage, treatment of acute stroke, and general outcome prognosis. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT02225730.
Collapse
Affiliation(s)
- Thoralf Thamm
- From the Department of Radiology, Stanford University, CA (T.T., J.G., J.R., T.L., M.P.M., H.M.D., G.Z.)
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (T.T.)
| | - Jia Guo
- From the Department of Radiology, Stanford University, CA (T.T., J.G., J.R., T.L., M.P.M., H.M.D., G.Z.)
- Department of Bioengineering, University of California Riverside, Riverside (J.G.)
| | - Jarrett Rosenberg
- From the Department of Radiology, Stanford University, CA (T.T., J.G., J.R., T.L., M.P.M., H.M.D., G.Z.)
| | - Tie Liang
- From the Department of Radiology, Stanford University, CA (T.T., J.G., J.R., T.L., M.P.M., H.M.D., G.Z.)
| | - Michael P Marks
- From the Department of Radiology, Stanford University, CA (T.T., J.G., J.R., T.L., M.P.M., H.M.D., G.Z.)
| | - Soren Christensen
- Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, CA (S.C., S.M.K., E.A., I.E., M.M., M.G.L., G.W.A.)
| | - Huy M Do
- From the Department of Radiology, Stanford University, CA (T.T., J.G., J.R., T.L., M.P.M., H.M.D., G.Z.)
| | - Stephanie M Kemp
- Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, CA (S.C., S.M.K., E.A., I.E., M.M., M.G.L., G.W.A.)
| | - Emma Adair
- Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, CA (S.C., S.M.K., E.A., I.E., M.M., M.G.L., G.W.A.)
| | - Irina Eyngorn
- Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, CA (S.C., S.M.K., E.A., I.E., M.M., M.G.L., G.W.A.)
| | - Michael Mlynash
- Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, CA (S.C., S.M.K., E.A., I.E., M.M., M.G.L., G.W.A.)
| | - Tudor G Jovin
- Department of Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (T.G.J.)
| | - Bart P Keogh
- Department of Radiology, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA (B.P.K.)
| | - Hui J Chen
- Department of Radiology, Eden Medical Center, Castro Valley, CA (H.J.C.)
| | - Maarten G Lansberg
- Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, CA (S.C., S.M.K., E.A., I.E., M.M., M.G.L., G.W.A.)
| | - Gregory W Albers
- Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, CA (S.C., S.M.K., E.A., I.E., M.M., M.G.L., G.W.A.)
| | - Greg Zaharchuk
- From the Department of Radiology, Stanford University, CA (T.T., J.G., J.R., T.L., M.P.M., H.M.D., G.Z.)
| |
Collapse
|
18
|
Suri S, Topiwala A, Chappell MA, Okell TW, Zsoldos E, Singh-Manoux A, Kivimäki M, Mackay CE, Ebmeier KP. Association of Midlife Cardiovascular Risk Profiles With Cerebral Perfusion at Older Ages. JAMA Netw Open 2019; 2:e195776. [PMID: 31225888 PMCID: PMC6593638 DOI: 10.1001/jamanetworkopen.2019.5776] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/30/2019] [Indexed: 12/20/2022] Open
Abstract
Importance Poor cardiovascular health is an established risk factor for dementia, but little is known about its association with brain physiology in older adults. Objective To examine the association of cardiovascular risk factors, measured repeatedly during a 20-year period, with cerebral perfusion at older ages. Design, Setting, and Participants In this longitudinal cohort study, individuals were selected from the Whitehall II Imaging Substudy. Participants were included if they had no clinical diagnosis of dementia, had no gross brain structural abnormalities on magnetic resonance imaging scans, and had received pseudocontinuous arterial spin labeling magnetic resonance imaging. Cardiovascular risk was measured at 5-year intervals across 5 phases from September 1991 to October 2013. Arterial spin labeling scans were acquired between April 2014 and December 2014. Data analysis was performed from June 2016 to September 2018. Exposures Framingham Risk Score (FRS) for cardiovascular disease, comprising age, sex, high-density lipoprotein cholesterol level, total cholesterol level, systolic blood pressure, use of antihypertensive medications, cigarette smoking, and diabetes, was assessed at 5 visits. Main Outcomes and Measures Cerebral blood flow (CBF; in milliliters per 100 g of tissue per minute) was quantified with pseudocontinuous arterial spin labeling magnetic resonance imaging. Results Of 116 adult participants, 99 (85.3%) were men. At the first examination, mean (SD) age was 47.1 (5.0) years; at the last examination, mean (SD) age was 67.4 (4.9) years. Mean (SD) age at MRI scan was 69.3 (5.0) years. Log-FRS increased with time (B = 0.058; 95% CI, 0.044 to 0.072; P < .001). Higher cumulative FRS over the 20-year period (measured as the integral of the rate of change of log-FRS) was associated with lower gray matter CBF (B = -0.513; 95% CI -0.802 to -0.224; P < .001) after adjustment for age, sex, education, socioeconomic status, cognitive status, arterial transit time, use of statins, and weekly alcohol consumption. Voxelwise analyses revealed that this association was significant in 39.6% of gray matter regions, including the posterior cingulate, precuneus, lateral parietal cortex, occipital cortex, hippocampi, and parahippocampal gyrus. The strength of the association of higher log-FRS with lower CBF decreased progressively from the first examination (R2 = 0.253; B = -10.816; 99% CI -18.375 to -3.257; P < .001) to the last (R2 = 0.188; B = -7.139; 99% CI -14.861 to 0.582; P = .02), such that the most recent FRS measurement at mean (SD) age 67.4 (4.9) years was not significantly associated with CBF with a Bonferroni-corrected P < .01 . Conclusions and Relevance Cardiovascular risk in midlife was significantly associated with lower gray matter perfusion at older ages, but this association was not significant for cardiovascular risk in later life. This finding could inform the timing of cardiovascular interventions so as to be optimally effective.
Collapse
Affiliation(s)
- Sana Suri
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Anya Topiwala
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Michael A. Chappell
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Thomas W. Okell
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Enikő Zsoldos
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Archana Singh-Manoux
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris Descartes, Paris, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Clare E. Mackay
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Klaus P. Ebmeier
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
19
|
Measurement of collateral perfusion in acute stroke: a vessel-encoded arterial spin labeling study. Sci Rep 2019; 9:8181. [PMID: 31160620 PMCID: PMC6546933 DOI: 10.1038/s41598-019-44417-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/14/2019] [Indexed: 12/28/2022] Open
Abstract
Collateral perfusion is important for sustaining tissue viability in acute ischemic stroke. Conventional techniques for its visualization are invasive, require contrast agents and demonstrate collateral vessels, rather than measuring perfusion directly. In this study we utilize a non-invasive, non-contrast magnetic resonance imaging (MRI)-based method to directly quantify collateral perfusion in acute stroke patients. Vessel-encoded multi-postlabeling delay arterial spin labeling (ASL) was used to separately quantify the blood flow and blood arrival time from four arteries supplying the brain in patients presenting within 18 hours of stroke onset. Twenty-nine acute ischemic stroke patients were scanned with a median time of onset to first MRI of 3 hours. Collateral perfusion at presentation was associated with tissue fate at 1-week. It sustained tissue prior to reperfusion, but was less effective than direct blood flow at maintaining tissue viability in patients who did not reperfuse. Delay in the blood arrival around the ischemic region was found at presentation and reduced over time but was not consistently associated with collateral perfusion. Vessel-encoded multi-postlabeling delay ASL provides a non-invasive tool for direct measurement of collateral perfusion and delayed blood arrival in acute stroke patients.
Collapse
|
20
|
Stone AJ, Harston GWJ, Carone D, Okell TW, Kennedy J, Blockley NP. Prospects for investigating brain oxygenation in acute stroke: Experience with a non-contrast quantitative BOLD based approach. Hum Brain Mapp 2019; 40:2853-2866. [PMID: 30860660 PMCID: PMC6563088 DOI: 10.1002/hbm.24564] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022] Open
Abstract
Metabolic markers of baseline brain oxygenation and tissue perfusion have an important role to play in the early identification of ischaemic tissue in acute stroke. Although well established MRI techniques exist for mapping brain perfusion, quantitative imaging of brain oxygenation is poorly served. Streamlined-qBOLD (sqBOLD) is a recently developed technique for mapping oxygenation that is well suited to the challenge of investigating acute stroke. In this study a noninvasive serial imaging protocol was implemented, incorporating sqBOLD and arterial spin labelling to map blood oxygenation and perfusion, respectively. The utility of these parameters was investigated using imaging based definitions of tissue outcome (ischaemic core, infarct growth and contralateral tissue). Voxel wise analysis revealed significant differences between all tissue outcomes using pairwise comparisons for the transverse reversible relaxation rate (R 2 '), deoxygenated blood volume (DBV) and deoxyghaemoglobin concentration ([dHb]; p < 0.01 in all cases). At the patient level (n = 9), a significant difference was observed for [dHb] between ischaemic core and contralateral tissue. Furthermore, serial analysis at the patient level (n = 6) revealed significant changes in R 2 ' between the presentation and 1 week scans for both ischaemic core (p < 0.01) and infarct growth (p < 0.05). In conclusion, this study presents evidence supporting the potential of sqBOLD for imaging oxygenation in stroke.
Collapse
Affiliation(s)
- Alan J Stone
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - George W J Harston
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Davide Carone
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas W Okell
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - James Kennedy
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas P Blockley
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|
21
|
Okell TW. Combined angiography and perfusion using radial imaging and arterial spin labeling. Magn Reson Med 2019; 81:182-194. [PMID: 30024066 PMCID: PMC6282709 DOI: 10.1002/mrm.27366] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/28/2018] [Accepted: 04/25/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To demonstrate the feasibility of a novel noninvasive MRI technique for the comprehensive evaluation of blood flow to the brain: combined angiography and perfusion using radial imaging and arterial spin labeling (CAPRIA). METHODS In the CAPRIA pulse sequence, blood labeled with a pseudocontinuous arterial spin labeling pulse train is continuously imaged as it flows through the arterial tree and into the brain tissue using a golden ratio radial readout. From a single raw data set, this flexible imaging approach allows the reconstruction of both high spatial/temporal resolution angiographic images with a high undersampling factor and low spatial/temporal resolution perfusion images with a low undersampling factor. The sparse and high SNR nature of angiographic images ensures that radial undersampling artifacts are relatively benign, even when using a simple regridding image reconstruction. Pulse sequence parameters were optimized through sampling efficiency calculations and the numerical evaluation of modified pseudocontinuous arterial spin labeling signal models. A comparison was made against conventional pseudocontinuous arterial spin labeling angiographic and perfusion acquisitions. RESULTS 2D CAPRIA data in healthy volunteers demonstrated the feasibility of this approach, with good vessel visualization in the angiographic images and clear tissue perfusion signal when reconstructed at 108-ms and 252-ms temporal resolution, respectively. Images were qualitatively similar to those from conventional acquisitions, but CAPRIA had significantly higher SNR efficiency (48% improvement on average, P = 0.02). CONCLUSION The CAPRIA technique shows potential for the efficient evaluation of both macrovascular blood flow and tissue perfusion within a single scan, with potential applications in a range of cerebrovascular diseases.
Collapse
Affiliation(s)
- Thomas W. Okell
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
| |
Collapse
|
22
|
Crisi G, Filice S, Scoditti U. Arterial Spin Labeling MRI to Measure Cerebral Blood Flow in Untreated Ischemic Stroke. J Neuroimaging 2018; 29:193-197. [PMID: 30302863 DOI: 10.1111/jon.12569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE This study aims to investigate the significance of regional hyperperfusion (RH) detected by arterial spin labeling (ASL) in a group of untreated stroke patients, within 24-36 hours after symptom onset. The relationship between RH volume and infarcted volume (DIV) as defined on diffusion weighted images (DWIs) was evaluated. METHODS Of the 346 consecutive acute stroke patients who attended our center, we retrospectively reviewed MRI studies of 47 patients who were ineligible for standard treatment with intravenous tissue plasminogen activator. The MRI study included ASL and DWI. The ASL-derived cerebral blood flow (CBF) maps were coregistered on the DWI images. RH volume and DIV were calculated and compared. Patient NIHSS scores were also evaluated at admission, discharge, and after 1 and 6-month follow-up. RESULTS Twenty-two patients showed RH with CBF twice than baseline. In all 22 patients, RH overlaps with DWI infarcted area. No significant difference (P = .94) between RH volume and DIV was found (7.2 ± 9.6 and 9.0 ± 11.9 cm3 ). The Pearson's correlation coefficient between RH and DIV was .93. On univariate analysis, a significant difference was found between patient's groups on NIHSS at any time points, after covariates adjustment NIHSS difference was significant only at admission. CONCLUSIONS The study showed that ASL perfusion could be an integral part of the MRI examination in the assessment of 24-36 hours not-treated stroke patients as sustained RH group had improved outcomes. More importantly, ASL perfusion may provide evidence of beneficial effects of reperfusion induced by recanalization treatment.
Collapse
Affiliation(s)
- Girolamo Crisi
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Silvano Filice
- Medical Physics Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Umberto Scoditti
- Neurology Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| |
Collapse
|
23
|
Dong S, Maniar S, Manole MD, Sun D. Cerebral Hypoperfusion and Other Shared Brain Pathologies in Ischemic Stroke and Alzheimer's Disease. Transl Stroke Res 2018; 9:238-250. [PMID: 28971348 PMCID: PMC9732865 DOI: 10.1007/s12975-017-0570-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/05/2017] [Accepted: 09/13/2017] [Indexed: 12/13/2022]
Abstract
Newly emerged evidence reveals that ischemic stroke and Alzheimer's disease (AD) share pathophysiological changes in brain tissue including hypoperfusion, oxidative stress, immune exhaustion, and inflammation. A mechanistic link between hypoperfusion and amyloid β accumulation can lead to cell damage as well as to motor and cognitive deficits. This review will discuss decreased cerebral perfusion and other related pathophysiological changes common to both ischemic stroke and AD, such as vascular damages, cerebral blood flow alteration, abnormal expression of amyloid β and tau proteins, as well as behavioral and cognitive deficits. Furthermore, this review highlights current treatment options and potential therapeutic targets that warrant further investigation.
Collapse
Affiliation(s)
- Shuying Dong
- Department of Pharmacology, Bengbu Medical College, Bengbu, Anhui, China
- Department of Neurology, University of Pittsburgh, S-598 South Biomedical Science Tower, 3500 Terrace St., Pittsburgh, PA, 15213, USA
| | - Shelly Maniar
- Department of Neurology, University of Pittsburgh, S-598 South Biomedical Science Tower, 3500 Terrace St., Pittsburgh, PA, 15213, USA
- Lake Erie College of Osteopathic Medicine at Seton Hill, Greensburg, Pennsylvania, 15601, USA
| | - Mioara D Manole
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dandan Sun
- Department of Neurology, University of Pittsburgh, S-598 South Biomedical Science Tower, 3500 Terrace St., Pittsburgh, PA, 15213, USA.
- Veterans Affairs Pittsburgh Health Care System, Geriatric Research, Educational and Clinical Center, Pittsburgh, PA, USA.
| |
Collapse
|
24
|
Jezzard P, Chappell MA, Okell TW. Arterial spin labeling for the measurement of cerebral perfusion and angiography. J Cereb Blood Flow Metab 2018; 38:603-626. [PMID: 29168667 PMCID: PMC5888859 DOI: 10.1177/0271678x17743240] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Arterial spin labeling (ASL) is an MRI technique that was first proposed a quarter of a century ago. It offers the prospect of non-invasive quantitative measurement of cerebral perfusion, making it potentially very useful for research and clinical studies, particularly where multiple longitudinal measurements are required. However, it has suffered from a number of challenges, including a relatively low signal-to-noise ratio, and a confusing number of sequence variants, thus hindering its clinical uptake. Recently, however, there has been a consensus adoption of an accepted acquisition and analysis framework for ASL, and thus a better penetration onto clinical MRI scanners. Here, we review the basic concepts in ASL and describe the current state-of-the-art acquisition and analysis approaches, and the versatility of the method to perform both quantitative cerebral perfusion measurement, along with quantitative cerebral angiographic measurement.
Collapse
Affiliation(s)
- Peter Jezzard
- 1 Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Thomas W Okell
- 1 Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|