Acute-stage MRI cerebral oxygen consumption biomarkers predict 24-hour neurological outcome in a rat cardiac arrest model

Brain injury following cardiac arrest (CA) is thought to be caused by a sudden loss of blood flow resulting in disruption in oxygen delivery, neural function and metabolism. However, temporal trajectories of the brain's physiology in the first few hours following CA have not been fully characterized. Furthermore, the extent to which these early measures can predict future neurological outcomes has not been determined. The present study sought to perform dynamic measurements of cerebral blood flow (CBF), oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO₂ ) with MRI in the first 3 hours following the return of spontaneous circulation (ROSC) in a rat CA model. It was found that CBF, OEF and CMRO₂ all revealed a time-dependent increase during the first 3 hours after the ROSC. Furthermore, the temporal trajectories of CBF and CMRO₂ , but not OEF, were different across rats and related to neurologic outcomes at a later time (24 hours after the ROSC) (P < .001). Rats who manifested better outcomes revealed faster increases in CBF and CMRO₂ during the acute stage. When investigating physiological parameters measured at a single time point, CBF (ρ = 0.82, P = .004) and CMRO₂ (ρ = 0.80, P = .006) measured at ~ 3 hours post-ROSC were positively associated with neurologic outcome scores at 24 hours. These findings shed light on brain physiological changes following CA, and suggest that MRI measures of brain perfusion and metabolism may provide a potential biomarker to guide post-CA management.

Optimization of phase-contrast MRI for the estimation of global cerebral blood flow of mice at 11.7T

PURPOSE

To optimize phase-contrast (PC) MRI for the measurement of global cerebral blood flow (CBF) in the mouse at 11.7T.

METHODS

We determined proper velocity encoding (VENC) for internal carotid arteries (ICAs) and vertebral arteries (VAs). Next, we optimized spatial resolution of the sequence. To shorten scan time without compromising data quality, we further optimized repetition time and developed a reduced field-of-view (FOV) scheme for ICA and VA PC MRI. Whole-brain volume was determined with T₂ -weighted image to obtain unit-volume CBF.

RESULTS

Peak flow velocities were 13.8 ± 1.7, 14.4 ± 0.6, 6.5 ± 1.7, and 6.7 ± 1.3 cm/s for left ICA, right ICA, left VA, and right VA, respectively. Thus, VENC values of 20 and 10 cm/s were chosen for ICA and VA PC MRI, respectively. An in-plane spatial resolution of 50 × 50 μm² was found to provide a reasonable trade-off between reducing partial-volume effects and maintaining signal-to-noise ratio. Because of the fact that saturated spins in the imaging slice are rapidly replaced by fresh spins, TR of the sequence can be decreased to as short as 15 ms without reducing signal intensity, thereby substantially lowering scan time. Moreover, reduced FOV along the phase-encoding direction was able to shorten scan time by 33.3% while maintaining measurement accuracy. With these optimizations, it took 96 seconds to evaluate CBF with a test-retest variability of approximately 5% and an inter-rater correlation of >0.95. Global unit-volume CBF was found to be 279.5 ± 11.1 mL of blood/100 ml of tissue/min.

CONCLUSION

We have optimized PC MRI for noninvasive quantification of blood flow in mice at 11.7T.

In vivo observation of cerebral microcirculation after experimental subarachnoid hemorrhage in mice

Acute brain injury caused by subarachnoid hemorrhage is the major cause of poor prognosis. The pathology of subarachnoid hemorrhage likely involves major morphological changes in the microcirculation. However, previous studies primarily used fixed tissue or delayed injury models. Therefore, in the present study, we used in vivo imaging to observe the dynamic changes in cerebral microcirculation after subarachnoid hemorrhage. Subarachnoid hemorrhage was induced by perforation of the bifurcation of the middle cerebral and anterior cerebral arteries in male C57/BL6 mice. The diameter of pial arterioles and venules was measured by in vivo fluorescence microscopy at different time points within 180 minutes after subarachnoid hemorrhage. Cerebral blood flow was examined and leukocyte adhesion/albumin extravasation was determined at different time points before and after subarachnoid hemorrhage. Cerebral pial microcirculation was abnormal and cerebral blood flow was reduced after subarachnoid hemorrhage. Acute vasoconstriction occurred predominantly in the arterioles instead of the venules. A progressive increase in the number of adherent leukocytes in venules and substantial albumin extravasation were observed between 10 and 180 minutes after subarachnoid hemorrhage. These results show that major changes in microcirculation occur in the early stage of subarachnoid hemorrhage. Our findings may promote the development of novel therapeutic strategies for the early treatment of subarachnoid hemorrhage.

Early Cranioplasty in Patients With Posttraumatic Decompressive Craniectomy and Its Correlation with Changes in Cerebral Perfusion Parameters and Neurocognitive Outcome

BACKGROUND

Decompressive craniectomy is a life-saving procedure in many patients after traumatic brain injury. Delayed recovery in such patients can be attributed to various causes. Cranioplasty (CP) helps in early improvement of neurocognitive function along with better brain protection and cosmesis. The mechanism responsible for this functional improvement and the ideal time to perform cranial reconstruction is less understood.

METHODS

We studied 16 patients who underwent CP after decompressive craniectomy (DC) for traumatic brain injury. These patients were divided in 2 groups, early and late CP, depending on the interval between DC and CP. Three months was the cutoff time for early CP. Neurocognitive status was assessed by Glasgow Coma Scale, Glasgow Outcome Scale, and Mini-Mental State Examination scores prior to and after CP. Computed tomography (CT) perfusion was done to correlate the improvement in neurologic status and CT perfusion parameters.

RESULTS

We observed that there was a positive influence of CP on neurologic and psychologic function in all of the patients. The neurocognitive improvement after CP was more remarkable in the early CP group. More complications were noted in patients in the late CP group. Brain perfusion after CP showed improvement in all parameters in both of the groups, both on the operated and contralateral side.

CONCLUSIONS

Neurocognitive improvement is noted after CP in all of the patients. CP should be offered once the brain edema subsides, at the earliest. Improved cerebral perfusion may be the key factor for the improved functional outcome.

Depth selective acousto-optic flow measurement

Optical based methods for non-invasive measurement of regional blood flow tend to incorrectly assess cerebral blood flow, due to contribution of extra-cerebral tissues to the obtained signal. We demonstrate that spectral analysis of phase-coded light signals, tagged by specific ultrasound patterns, enables differentiation of flow patterns at different depths. Validation of the model is conducted by Monte Carlo simulation. In-vitro experiments demonstrate good agreement with the simulations' results and provide a solid validation to depth discrimination ability. These results suggest that signal contamination originating from extra-cerebral tissue may be eliminated using spectral analysis of ultrasonically tagged light.

A new technology for detecting cerebral blood flow: a comparative study of ultrasound tagged NIRS and 133Xe-SPECT

There is a need for real-time non-invasive, continuous monitoring of cerebral blood flow (CBF) during surgery, in intensive care units and clinical research. We investigated a new non-invasive hybrid technology employing ultrasound tagged near infrared spectroscopy (UT-NIRS) that may estimate changes in CBF using a cerebral blood flow index (CFI). Changes over time for UT-NIRS CFI and 133Xenon single photon emission computer tomography (133Xe-SPECT) CBF data were assessed in 10 healthy volunteers after an intravenous bolus of acetazolamide. UT-NIRS CFI was measured continuously and SPECT CBF was measured at baseline, 15 and 60 min after acetazolamide. We found significant changes over time in CFI by UT-NIRS and CBF by SPECT after acetazolamide (P ≤ 0.001). Post hoc tests showed a significant increase in CFI (P = 0.011) and SPECT CBF (P < 0.001) at 15 min after acetazolamide injection. There was a significant correlation between CFI and SPECT CBF values (r = 0.67 and P ≤ 0.033) at 15 min, but not at 60 min (P ≥ 0.777). UT-NIRS detected an increase in CFI following an acetazolamide bolus, which correlated with CBF measured with 133Xe-SPECT. This study demonstrates that UT-NIRS technology may be a promising new technique for non-invasive and real-time bedside CBF monitoring.

Nanoscale NMR velocimetry by means of slowly diffusing tracer particles

The resolution of NMR velocimetry is inherently limited by random displacements due to molecular self-diffusion, and has so far not extended below a few tens of microns. We report here an extension to the nanoscale domain, a result achieved by the use of slowly diffusing, NMR-visible core-shell latex particles. These particles comprise an oil core surrounded by a solid polymer shell, making spheres of diameter 370 nm. Using these particles in the annulus of a concentric cylinder Couette cell, we have measured flow-induced displacements down to a few hundreds of nanometers, allowing the observation of the solid-to-liquid transition of a glassy system. We envisage new possibilities for NMR velocimetry as an experimental tool for colloidal chemistry and physics.