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Jiang X, Liang W, Zhao Z, Zhao B, Yan L, Mang J. Angiographic Pattern of M1 Stenosis Predicts Territorial Stroke in Patients Receiving Aggressive Medication without Stenting. World Neurosurg 2024; 182:e536-e545. [PMID: 38101545 DOI: 10.1016/j.wneu.2023.11.143] [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: 10/22/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To evaluate the relationship between different angiographic patterns of middle cerebral artery M1 segment stenosis and related territorial stroke in patients receiving aggressive medical treatment without stenting. METHODS We retrospectively reviewed our patient registry database to identify ICAS patients diagnosed by digital subtraction angiography between January 2017 and December 2020 and identified 3 different angiographic patterns (normal, shift, and dilation) in 124 patients with M1 stenosis. The association between these patterns and recurrent ischemic stroke in the M1 territory was analyzed. RESULTS The rates of recurrent M1 territorial stroke and transient ischemic attack in the normal group, shift group, dilation group and shift-dilation group were 34.5%, 35.0%, 78.3%, and 44.4% respectively. In patients with the shift pattern, the rate of recurrent stroke is significantly higher at a deflection angle ≥9.32° than at a deflection angle <9.32°(P < 0.05). In patients with dilation pattern, the rate of recurrent stroke is significantly higher than patients with non-dilation pattern (72.3% vs. 36.8%, P < 0.05). CONCLUSIONS Angiographic patterns of M1 stenosis may predict recurrent territorial strokes, thus providing a surrogate marker to identify high-risk patients for potential endovascular treatment.
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Affiliation(s)
- Xinzhao Jiang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China; Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Wenzhao Liang
- Department of Geriatric and General Medicine, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Zhongyu Zhao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Bingyang Zhao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Lei Yan
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jing Mang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
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Rundfeldt HC, Lee CM, Lee H, Jung KH, Chang H, Kim HJ. Cerebral perfusion simulation using realistically generated synthetic trees for healthy and stroke patients. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107956. [PMID: 38061114 DOI: 10.1016/j.cmpb.2023.107956] [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: 10/02/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Cerebral vascular diseases are among the most burdensome diseases faced by society. However, investigating the pathophysiology of diseases as well as developing future treatments still relies heavily on expensive in-vivo and in-vitro studies. The generation of realistic, patient-specific models of the cerebrovascular system capable of simulating hemodynamics and perfusion promises the ability to simulate diseased states, therefore accelerating development cycles using in silico studies and opening opportunities for the individual assessment of diseased states, treatment planning, and the prediction of outcomes. By providing a patient-specific, anatomically detailed and validated model of the human cerebral vascular system, we aim to provide the basis for future in silico investigations of the cerebral physiology and pathology. METHODS In this retrospective study, a processing pipeline for patient-specific quantification of cerebral perfusion was developed and applied to healthy individuals and a stroke patient. Major arteries are segmented from 3T MR angiography data. A synthetic tree generation algorithm titled tissue-growth based optimization (GBO)1 is used to extend vascular trees beyond the imaging resolution. To investigate the anatomical accuracy of the generated trees, morphological parameters are compared against those of 7 T MRI, 9.4 T MRI, and dissection data. Using the generated vessel model, hemodynamics and perfusion are simulated by solving one-dimensional blood flow equations combined with Darcy flow equations. RESULTS Morphological data of three healthy individuals (mean age 47 years ± 15.9 [SD], 2 female) was analyzed. Bifurcation and physiological characteristics of the synthetically generated vessels are comparable to those of dissection data. The inability of MRI based segmentation to resolve small branches and the small volume investigated cause a mismatch in the comparison to MRI data. Cerebral perfusion was estimated for healthy individuals and a stroke patient. The simulated perfusion is compared against Arterial-Spin-Labeling MRI perfusion data. Good qualitative agreement is found between simulated and measured cerebral blood flow (CBF)2. Ischemic regions are predicted well, however ischemia severity is overestimated. CONCLUSIONS GBO successfully generates detailed cerebral vascular models with realistic morphological parameters. Simulations based on the resulting networks predict perfusion territories and ischemic regions successfully.
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Affiliation(s)
- Hans Christian Rundfeldt
- Korea Advanced Institute of Science and Technology, Mechanical Engineering, Republic of Korea; Karlsruhe Institute of Technology, Mechanical Engineering, Germany
| | - Chang Min Lee
- Korea Advanced Institute of Science and Technology, Mechanical Engineering, Republic of Korea
| | - Hanyoung Lee
- Chung-ang University, College of Pharmacy, Republic of Korea
| | - Keun-Hwa Jung
- Seoul National University Hospital, Department of Neurology, Republic of Korea
| | - Hyeyeon Chang
- Konyang University Hospital, Department of Neurology, Republic of Korea
| | - Hyun Jin Kim
- Korea Advanced Institute of Science and Technology, Mechanical Engineering, Republic of Korea.
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Zarrinkoob L, Myrnäs S, Wåhlin A, Eklund A, Malm J. Cerebral Blood Flow Patterns in Patients With Low-Flow Carotid Artery Stenosis, a 4D-PCMRI Assessment. J Magn Reson Imaging 2024. [PMID: 38168876 DOI: 10.1002/jmri.29216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Compromised cerebral blood flow can contribute to future ischemic events in patients with symptomatic carotid artery disease. However, there is limited knowledge of the effects on cerebral hemodynamics resulting from a reduced internal carotid artery (ICA) blood flow rate (BFR). PURPOSE Investigate how reduced ICA-BFR, relates to BFR in the cerebral arteries. STUDY TYPE Prospective. SUBJECTS Thirty-eight patients, age 72 ± 6 years (11 female). FIELD STRENGTH/SEQUENCE 3-Tesla, four-dimensional phase-contrast magnetic resonance imaging (4D-PCMRI). ASSESSMENT Patients with ischemic stroke or transient ischemic attack were evaluated regarding the degree of stenosis. 4D-PCMRI was used to measure cerebral BFR in 38 patients with symptomatic carotid stenosis (≥50%). BFR in the cerebral arteries was assessed in two subgroups based on symptomatic ICA-BFR: reduced ICA-flow (<160 mL/minutes) and preserved ICA-flow (≥160 mL/minutes). BFR laterality was defined as a difference in the paired ipsilateral-contralateral arteries. STATISTICAL TESTS Patients were grouped based on ICA-BFR (reduced vs. preserved). Statistical tests (independent sample t-test/paired t-test) were used to compare groups and hemispheres. Significance was determined at P < 0.05. RESULTS The degree of stenosis was not significantly different, 80% (95% confidence interval [CI] = 73%-87%) in the reduced ICA-flow vs. 72% (CI = 66%-76%) in the preserved ICA-flow; P = 0.09. In the reduced ICA-flow group, a significantly reduced BFR was found in the ipsilateral middle cerebral artery and anterior cerebral artery (A1), while significantly increased in the contralateral A1. Retrograde BFR was found in the posterior communicating artery and ophthalmic artery. Significant BFR laterality was present in all paired arteries in the reduced ICA-flow group, contrasting the preserved ICA-flow group (P = 0.14-0.93). DATA CONCLUSIONS 4D-PCMRI revealed compromised cerebral BFR due to carotid stenosis, not possible to detect by solely analyzing the degree of stenosis. In patients with reduced ICA-flow, collaterals were not sufficient to maintain symmetrical BFR distribution to the two hemispheres. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Laleh Zarrinkoob
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine Unit, Umeå University, Umeå, Sweden
| | - Sanne Myrnäs
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine Unit, Umeå University, Umeå, Sweden
| | - Anders Wåhlin
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
- Centre for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
| | - Anders Eklund
- Centre for Biomedical Engineering and Physics, 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
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Ivanova MV, Pappas I, Inglis B, Pracar AL, Herron TJ, Baldo JV, Kayser AS, D’Esposito M, Dronkers NF. Cerebral perfusion in post-stroke aphasia and its relationship to residual language abilities. Brain Commun 2023; 6:fcad252. [PMID: 38162898 PMCID: PMC10757451 DOI: 10.1093/braincomms/fcad252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/26/2023] [Accepted: 09/28/2023] [Indexed: 01/03/2024] Open
Abstract
Stroke alters blood flow to the brain resulting in damaged tissue and cell death. Moreover, the disruption of cerebral blood flow (perfusion) can be observed in areas surrounding and distal to the lesion. These structurally preserved but suboptimally perfused regions may also affect recovery. Thus, to better understand aphasia recovery, the relationship between cerebral perfusion and language needs to be systematically examined. In the current study, we aimed to evaluate (i) how stroke affects perfusion outside of lesioned areas in chronic aphasia and (ii) how perfusion in specific cortical areas and perilesional tissue relates to language outcomes in aphasia. We analysed perfusion data from a large sample of participants with chronic aphasia due to left hemisphere stroke (n = 43) and age-matched healthy controls (n = 25). We used anatomically defined regions of interest that covered the frontal, parietal, and temporal areas of the perisylvian cortex in both hemispheres, areas typically known to support language, along with several control regions not implicated in language processing. For the aphasia group, we also looked at three regions of interest in the perilesional tissue. We compared perfusion levels between the two groups and investigated the relationship between perfusion levels and language subtest scores while controlling for demographic and lesion variables. First, we observed that perfusion levels outside the lesioned areas were significantly reduced in frontal and parietal regions in the left hemisphere in people with aphasia compared to the control group, while no differences were observed for the right hemisphere regions. Second, we found that perfusion in the left temporal lobe (and most strongly in the posterior part of both superior and middle temporal gyri) and inferior parietal areas (supramarginal gyrus) was significantly related to residual expressive and receptive language abilities. In contrast, perfusion in the frontal regions did not show such a relationship; no relationship with language was also observed for perfusion levels in control areas and all right hemisphere regions. Third, perilesional perfusion was only marginally related to language production abilities. Cumulatively, the current findings demonstrate that blood flow is reduced beyond the lesion site in chronic aphasia and that hypoperfused neural tissue in critical temporoparietal language areas has a negative impact on behavioural outcomes. These results, using perfusion imaging, underscore the critical and general role that left hemisphere posterior temporal regions play in various expressive and receptive language abilities. Overall, the study highlights the importance of exploring perfusion measures in stroke.
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Affiliation(s)
- Maria V Ivanova
- Department of Psychology, University of California, Berkeley, CA 94720, USA
- Research Service, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Ioannis Pappas
- Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA 90033, USA
| | - Ben Inglis
- Henry H. Wheeler, Jr. Brain Imaging Center, University of California, Berkeley, CA 94720, USA
| | - Alexis L Pracar
- Department of Psychology, University of California, Berkeley, CA 94720, USA
| | - Timothy J Herron
- Research Service, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Juliana V Baldo
- Research Service, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Andrew S Kayser
- Division of Neurology, San Francisco VA Health Care System, San Francisco, CA 94121, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Mark D’Esposito
- Department of Psychology, University of California, Berkeley, CA 94720, USA
- Neurology Service, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Nina F Dronkers
- Department of Psychology, University of California, Berkeley, CA 94720, USA
- Depertment of Neurology, University of California, Davis, CA 95817, USA
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Takeuchi K, Isozaki M, Higashino Y, Kosaka N, Kikuta KI, Ishida S, Kanamoto M, Takei N, Okazawa H, Kimura H. The Utility of Arterial Transit Time Measurement for Evaluating the Hemodynamic Perfusion State of Patients with Chronic Cerebrovascular Stenosis or Occlusive Disease: Correlative Study between MR Imaging and 15O-labeled H 2O Positron Emission Tomography. Magn Reson Med Sci 2023; 22:289-300. [PMID: 35545508 PMCID: PMC10449557 DOI: 10.2463/mrms.mp.2020-0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/07/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To verify whether arterial transit time (ATT) mapping can correct arterial spin labeling-cerebral blood flow (ASL-CBF) values and to verify whether ATT is a parameter that correlates with positron emission tomography (PET)-oxygen extraction fraction (OEF) and PET-mean transit time (MTT). METHODS Eleven patients with unilateral major cerebral artery stenosis or occlusion underwent MRI and PET in the chronic or asymptomatic phase. ASL-MRI acquisitions were conducted with each of two post-label delay (PLD) settings (0.7s and 2.0s) using a pseudo-continuous ASL pulse sequence and 3D-spin echo spiral readout with vascular crusher gradient. ATT maps were obtained using a low-resolution pre-scan approach with five PLD settings. Using the ASL perfusion images and ATT mapping, ATT-corrected ASL-CBF images were obtained. Four kinds of ASL-CBF methods (PLD 0.7s with or without ATT correction and PLD 2.0s with or without ATT correction) were compared to PET-CBF, using vascular territory ROIs. ATT and OEF were compared for all ROIs, unaffected side ROIs, and affected side ROIs, respectively. ATT and MTT were compared by the ratio of the affected side to the unaffected side. Transit time-based ROIs were used for the comparison with ATT. RESULTS Comparing ASL-CBF and PET-CBF, the correlation was higher with ATT correction than without correction, and for a PLD of 2.0s compared with 0.7s. The best correlation was for PLD of 2.0s with ATT correction (R2 = 0.547). ROIs on the affected side showed a low but significant correlation between ATT and PET-OEF (R2 = 0.141). There was a low correlation between the ATT ratio and the MTT ratio (R2 = 0.133). CONCLUSION Low-resolution ATT correction may increase the accuracy of ASL-CBF measurements in patients with unilateral major cerebral artery stenosis or occlusion. In addition, ATT itself might have a potential role in detecting compromised hemodynamic state.
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Affiliation(s)
- Kayo Takeuchi
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Makoto Isozaki
- Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Yoshifumi Higashino
- Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Nobuyuki Kosaka
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Ken-ichiro Kikuta
- Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Shota Ishida
- Radiological Center, University of Fukui Hospital, Yoshida-gun, Fukui, Japan
| | - Masayuki Kanamoto
- Radiological Center, University of Fukui Hospital, Yoshida-gun, Fukui, Japan
| | - Naoyuki Takei
- Global MR Applications and Workflow, GE Healthcare, Tokyo, Japan
| | - Hidehiko Okazawa
- Biomedical Imaging Research Center, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
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Ivanova MV, Pappas I. Understanding recovery of language after stroke: insights from neurovascular MRI studies. FRONTIERS IN LANGUAGE SCIENCES 2023; 2:1163547. [PMID: 38162928 PMCID: PMC10757818 DOI: 10.3389/flang.2023.1163547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Stroke causes a disruption in blood flow to the brain that can lead to profound language impairments. Understanding the mechanisms of language recovery after stroke is crucial for the prognosis and effective rehabilitation of people with aphasia. While the role of injured brain structures and disruptions in functional connectivity have been extensively explored, the relationship between neurovascular measures and language recovery in both early and later stages has not received sufficient attention in the field. Fully functioning healthy brain tissue requires oxygen and nutrients to be delivered promptly via its blood supply. Persistent decreases in blood flow after a stroke to the remaining non-lesioned tissue have been shown to contribute to poor language recovery. The goal of the current paper is to critically examine stroke studies looking at the relationship between different neurovascular measures and language deficits and mechanisms of language recovery via changes in neurovascular metrics. Measures of perfusion or cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) provide complementary approaches to understanding neurovascular mechanisms post stroke by capturing both cerebral metabolic demands and mechanical vascular properties. While CBF measures indicate the amount of blood delivered to a certain region and serve as a proxy for metabolic demands of that area, CVR indices reflect the ability of the vasculature to recruit blood flow in response to a shortage of oxygen, such as when one is holding their breath. Increases in CBF during recovery beyond the site of the lesion have been shown to promote language gains. Similarly, CVR changes, when collateral vessels are recruited to help reorganize the flow of blood in hypoperfused regions, have been related to functional recovery post stroke. In the current review, we highlight the main findings in the literature investigating neurovascular changes in stroke recovery with a particular emphasis on how language abilities can be affected by changes in CBF and CVR. We conclude by summarizing existing methodological challenges and knowledge gaps that need to be addressed in future work in this area, outlining a promising avenue of research.
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Affiliation(s)
- Maria V. Ivanova
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Ioannis Pappas
- USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
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7
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Takata K, Kimura H, Ishida S, Isozaki M, Higashino Y, Kikuta KI, Okazawa H, Tsujikawa T. Assessment of Arterial Transit Time and Cerebrovascular Reactivity in Moyamoya Disease by Simultaneous PET/MRI. Diagnostics (Basel) 2023; 13:diagnostics13040756. [PMID: 36832244 PMCID: PMC9955140 DOI: 10.3390/diagnostics13040756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
We investigated the relationship between MRI-arterial spin labeling (ASL) parameters and PET-cerebral blood flow (CBF)/cerebrovascular reactivity (CVR) simultaneously obtained by PET/MRI in Moyamoya disease. Twelve patients underwent 15O-water PET/MRI with the acetazolamide (ACZ) challenge test. PET-CBF and PET-CVR were measured using 15O-water PET. Pseudo-continuous ASL obtained the robust arterial transit time (ATT) and ASL-CBF estimation. ASL parameters were compared with PET-CBF and PET-CVR. Before ACZ loading, absolute and relative ASL-CBF were significantly correlated with absolute and relative PET-CBF (r = 0.44, p < 0.0001, and r = 0.55, p < 0.0001, respectively). After ACZ loading, absolute and relative ASL-CBF were significantly correlated with absolute and relative PET-CBF (r = 0.56, p < 0.001, and r = 0.75, p < 0.0001, respectively), and ΔASL-CBF was significantly correlated with ΔPET-CBF (r = 0.65, p < 0.0001). Baseline ASL-ATT had strong negative correlations with ΔPET-CBF and PET-CVR (r = -0.72, p < 0.0001, and r = -0.66, p < 0.0001, respectively). Baseline ASL-ATT of MCA territories with CVR <30% (1546 ± 79 ms) was significantly higher than that with CVR > 30% (898 ± 197 ms). ASL-ATT ratio of MCA territories with CVR < 30% (94.0 ± 10.5%) was significantly higher than that with CVR > 30% (81.4 ± 11.3%). ATT correction using multiple postlabeling delays increased the accuracy of ASL-CBF quantitation. Baseline ASL-ATT is a hemodynamic parameter and may represent an efficient alternative to PET-CVR.
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Affiliation(s)
- Kenji Takata
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Shota Ishida
- Department of Radiological Technology, Faculty of Medical Sciences, Kyoto College of Medical Science, Kyoto 622-0041, Japan
| | - Makoto Isozaki
- Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Yoshifumi Higashino
- Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Ken-Ichiro Kikuta
- Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Hidehiko Okazawa
- Biomedical Imaging Research Center, University of Fukui, Fukui 910-1193, Japan
| | - Tetsuya Tsujikawa
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
- Correspondence: ; Tel.: +81-776-61-3111; Fax: +81-776-61-8137
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8
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Diop S, Pelissou-Guyotat I, Thioub M, Mbaye M, Thiam AB, Diop AA, Ba MC, Guyotat J. Temporo-Sylvian anastomosis in the management of internal carotid system occlusions: Patient series. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Sato S, Kokubo Y, Kawanami K, Itagaki H, Yamada Y, Sonoda Y. A case report: A preoperative increase in cerebral blood volume, not the oxygen extraction fraction, induces postoperative cerebral hyperperfusion syndrome regardless of procedure for revascularization. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Xu X, Li X, Shi J, Mo D, Miao Z, He W. Evolution of the Flow Patterns After Endovascular Treatment in Patients with High-Grade Carotid Artery Stenosis - the Clinical Value of Insonation of the Supratrochlear Artery and Alternating Flow. J Stroke Cerebrovasc Dis 2022; 31:106542. [PMID: 35569403 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106542] [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: 01/15/2022] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 11/19/2022] Open
Abstract
AIM We aimed to describe the evolution of flow pattern in the ophthalmic artery (OA) and supratrochlear artery (SA) by transcranial Doppler (TCD) ipsilateral to a severe proximal carotid artery stenosis before and after staged endovascular treatment (EVT). METHODS We insonated and recorded the flow patterns of OA and SA in 63 patients with ≥ 80% carotid artery stenosis before and after staged carotid angioplasty and stenting at 2-4 weeks apart. Based on the direction of OA and SA blood flow, we categorized patients into (1) reversed, (2) alternating, or (3) forward flow, groups. We evaluated the evolving sonographic flow patterns in OA and SA at the 3-time points and correlated them with the stenotic and flow velocity change. RESULTS Despite the disconcordance between OA and SA, the evolution of flow direction were evoluted from reversed to alternating or from alternating to forward in both OA and SA. OA and SA's disagreement rate at three-time points was 19.1%, 49.2%, and 28.6%, respectively. After angioplasty alone, we detected an alternating flow in 21 (33.3%) and 46 (73.0%) patients in OA and SA, respectively. Alternating flow patterns in SA persisted in 20 patients (31.7%) after stenting. The post-angioplasty residual stenosis did not differ between the three flow pattern groups (p>0.05). CONCLUSIONS An alternating flow in OA or SA might mark the hemodynamic recovery after EVT. Insonation of SA may provide supporting evidence for hemodynamic change in patients with carotid artery stenosis undergoing EVT.
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Affiliation(s)
- Xiaotong Xu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, Fengtai district, Beijing 100070, China
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jianwei Shi
- Department of Ultrasound, Huaian Hospital of Huaian City, Huaian, Jiangsu, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, Fengtai district, Beijing 100070, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, Fengtai district, Beijing 100070, China.
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing 100070, China.
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11
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Schneider SC, Archila-Meléndez ME, Göttler J, Kaczmarz S, Zott B, Priller J, Kallmayer M, Zimmer C, Sorg C, Preibisch C. Resting-state BOLD functional connectivity depends on the heterogeneity of capillary transit times in the human brain A combined lesion and simulation study about the influence of blood flow response timing. Neuroimage 2022; 255:119208. [PMID: 35427773 DOI: 10.1016/j.neuroimage.2022.119208] [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: 11/04/2021] [Revised: 02/23/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
Functional connectivity (FC) derived from blood oxygenation level dependent (BOLD) functional magnetic resonance imaging at rest (rs-fMRI), is commonly interpreted as indicator of neuronal connectivity. In a number of brain disorders, however, metabolic, vascular, and hemodynamic impairments can be expected to alter BOLD-FC independently from neuronal activity. By means of a neurovascular coupling (NVC) model of BOLD-FC, we recently demonstrated that aberrant timing of cerebral blood flow (CBF) responses may influence BOLD-FC. In the current work, we support and extend this finding by empirically linking BOLD-FC with capillary transit time heterogeneity (CTH), which we consider as an indicator of delayed and broadened CBF responses. We assessed 28 asymptomatic patients with unilateral high-grade internal carotid artery stenosis (ICAS) as a hemodynamic lesion model with largely preserved neurocognitive functioning and 27 age-matched healthy controls. For each participant, we obtained rs-fMRI, arterial spin labeling, and dynamic susceptibility contrast MRI to study the dependence of left-right homotopic BOLD-FC on local perfusion parameters. Additionally, we investigated the dependency of BOLD-FC on CBF response timing by detailed simulations. Homotopic BOLD-FC was negatively associated with increasing CTH differences between homotopic brain areas. This relation was more pronounced in asymptomatic ICAS patients even after controlling for baseline CBF and relative cerebral blood volume influences. These findings match simulation results that predict an influence of delayed and broadened CBF responses on BOLD-FC. Results demonstrate that increasing CTH differences between homotopic brain areas lead to BOLD-FC reductions. Simulations suggest that CTH increases correspond to broadened and delayed CBF responses to fluctuations in ongoing neuronal activity.
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Affiliation(s)
- Sebastian C Schneider
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany
| | - Mario E Archila-Meléndez
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany
| | - Jens Göttler
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany
| | - Stephan Kaczmarz
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany; Philips GmbH Market DACH, Hamburg, Germany
| | - Benedikt Zott
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany
| | - Josef Priller
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Psychiatry, Ismaningerstr. 22, 81675, Munich, Munich, Germany
| | - Michael Kallmayer
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Vascular and Endovascular Surgery, Ismaningerstr. 22, 81675, Munich, Munich, Germany
| | - Claus Zimmer
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany
| | - Christian Sorg
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany
| | - Christine Preibisch
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Neurology, Ismaningerstr. 22, 81675, Munich, Munich, Germany.
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12
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Powers WJ, An H, Diringer MN. Cerebral Blood Flow and Metabolism. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Bonati LH, Brown MM. Carotid Artery Disease. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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14
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Onkenhout L, Arts T, Ferro D, Oudeman E, van Osch M, Zwanenburg J, Hendrikse J, Kappelle L, Biessels GJ. Perforating artery flow velocity and pulsatility in patients with carotid occlusive disease. A 7 tesla MRI study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100143. [PMID: 36324413 PMCID: PMC9616320 DOI: 10.1016/j.cccb.2022.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 12/02/2022]
Abstract
Patients with COD show lower perforating artery flow velocity in watershed areas. Reduced perforating artery flow seems to be related to subcortical ischemic burden. Perforating artery function may be relevant for clinical outcome in COD patients.
Patients with carotid occlusive disease express altered hemodynamics in the post-occlusive vasculature and lesions commonly attributed to cerebral small vessel disease (SVD). We addressed the question if cerebral perforating artery flow measures, using a novel 7T MRI technique, are altered and related to SVD lesion burden in patients with carotid occlusive disease. 21 patients were included with a uni- (18) or bilateral (3) carotid occlusion (64±7 years) and 19 controls (65±10 years). Mean flow velocity and pulsatility in the perforating arteries in the semi-oval center (CSO) and basal ganglia (BG), measured with a 2D phase contrast 7T MRI sequence, were compared between patients and controls, and between hemispheres in patients with unilateral carotid occlusive disease. In patients, relations were assessed between perforating artery flow measures and SVD burden score and white matter hyperintensity (WMH) volume. CSO perforating artery flow velocity was lower in patients than controls, albeit non-significant (mean difference [95% confidence interval] 0.08 cm/s [0.00–0.16]; p = 0.053), but pulsatility was similar (0.07 [-0.04–0.18]; p = 0.23). BG flow velocity and pulsatility did not differ between patients and controls (velocity = 0.28 cm/s [-0.32–0.88]; p = 0.34; pulsatility = 0.00 [-0.10–0.11]; p = 0.97). Patients with unilateral carotid occlusive disease showed no significant interhemispheric flow differences. Though non-significant, within patients lower CSO (p = 0.06) and BG (p = 0.11) flow velocity related to larger WMH volume. Our findings suggest that carotid occlusive disease may be associated with abnormal cerebral perforating artery flow and that this relates to SVD lesion burden in these patients, although our observations need corroboration in larger study populations.
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Affiliation(s)
- L.P. Onkenhout
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tine Arts
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3508 GA, the Netherlands
- Corresponding author.
| | - D. Ferro
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - E.A. Oudeman
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - M.J.P. van Osch
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - J.J.M. Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3508 GA, the Netherlands
| | - J. Hendrikse
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3508 GA, the Netherlands
| | - L.J. Kappelle
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - GJ. Biessels
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
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15
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Reduced magnetic resonance angiography signal intensity in the middle cerebral artery ipsilateral to severe carotid stenosis may be a practical index of high oxygen extraction fraction. Eur Radiol 2021; 32:2023-2029. [PMID: 34642810 PMCID: PMC8831255 DOI: 10.1007/s00330-021-08272-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 12/04/2022]
Abstract
Objectives Angiographic “slow flow” in the middle cerebral artery (MCA), caused by carotid stenosis, may be associated with high oxygen extraction fraction (OEF). If the MCA slow flow is associated with a reduced relative signal intensity (rSI) of the MCA on MR angiography, the reduced rSI may be associated with a high OEF. We investigated whether the MCA slow flow ipsilateral to carotid stenosis was associated with a high OEF and aimed to create a practical index to estimate the high OEF. Methods We included patients who underwent digital subtraction angiography (DSA) and MRA between 2015 and 2019 to evaluate carotid stenosis. MCA slow flow by image count using DSA, MCA rSI, minimal luminal diameter (MLD) of the carotid artery, carotid artery stenosis rate (CASr), and whole-brain OEF (wb-OEF) was evaluated. When MCA slow flow was associated with a high wb-OEF, the determinants of MCA slow flow were identified, and their association with high wb-OEF was evaluated. Results One hundred and twenty-seven patients met our inclusion criteria. Angiographic MCA slow flow was associated with high wb-OEF. We identified MCA rSI and MLD as determinants of angiographic MCA slow flow. The upper limits of MCA rSI and MLD for angiographic MCA slow flow were 0.89 and 1.06 mm, respectively. The wb-OEF was higher in patients with an MCA rSI ≤ 0.89 and ipsilateral MLD ≤ 1.06 mm than patients without this combination. Conclusions The combination of reduced MCA rSI and ipsilateral narrow MLD is a straightforward index of high wb-OEF. Key Points • The whole-brain OEF in patients with angiographic slow flow in the MCA ipsilateral to high-grade carotid stenosis was higher than in patients without it. • Independent determinants of MCA slow flow were MCA relative signal intensity (rSI) on MRA or minimal luminal diameter (MLD) of the carotid stenosis. • The wb-OEF was higher in patients with an MCA rSI ≤ 0.89 and ipsilateral MLD ≤ 1.06 mm than patients without this combination. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08272-3.
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16
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Differences in Hemodynamic Alteration between Atherosclerotic Occlusive Lesions and Moyamoya Disease: A Quantitative 15O-PET Study. Diagnostics (Basel) 2021; 11:diagnostics11101820. [PMID: 34679518 PMCID: PMC8535090 DOI: 10.3390/diagnostics11101820] [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: 09/07/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
To clarify the differences in hemodynamic status between atherosclerotic steno-occlusive lesions (SOL) and moyamoaya disease (MMD), hemodynamic parameters were compared using 15O-PET. Twenty-four patients with unilateral SOL (67 ± 11 y) and eighteen with MMD (33 ± 16 y) were assigned to this study. MMD patients were divided into twelve unilateral and six bilateral lesions. All patients underwent 15O-PET to measure cerebral blood flow (CBF), blood volume (CBV), oxygen extraction fraction (OEF), and metabolic rate (CMRO2). Acetazolamide was administered after the baseline scan and the second 15O-water PET was performed to evaluate cerebrovascular reactivity (CVR). For the CBF calculation in 15O-water PET, the three-weighted integral method was applied based on a one-tissue compartment model with pixel-by-pixel delay correction to measure precise CBF and arterial-to-capillary blood volume (V0). Baseline hemodynamic parameters showed significantly lower CBF, V0, and CMRO2, but greater CBV, OEF, and delay (p < 0.01) in the affected hemispheres than in the unaffected hemispheres. After ACZ administration, both hemispheres showed a significant increase in CBF (p < 0.0001), but not in V0. CVR differed significantly between the hemispheres. The arterial perfusion pressure of the functioning arterial part tended to be reduced after acetazolamide administration in patients with past neurologic events caused by hemodynamic impairment. MMD patients showed greater inactive vascular and venous volumes compared with common atherosclerotic SOL patients. The hemodynamic status of cerebral circulation may vary according to the chronic process of steno-occlusive change and the development of collateral circulation. In order to evaluate physiologic differences between the two diseases, 15O-PET with an acetazolamide challenge test is useful.
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17
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István L, Czakó C, Élő Á, Mihály Z, Sótonyi P, Varga A, Ungvári Z, Csiszár A, Yabluchanskiy A, Conley S, Csipő T, Lipecz Á, Kovács I, Nagy ZZ. Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment. GeroScience 2021; 43:1703-1723. [PMID: 34100219 PMCID: PMC8492863 DOI: 10.1007/s11357-021-00392-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Carotid artery stenosis (CAS) is a consequence of systemic atherosclerotic disease affecting the aging populations of the Western world. CAS is frequently associated with cognitive impairment. However, the mechanisms contributing to the development of vascular cognitive impairment (VCI) associated with CAS are multifaceted and not fully understood. In addition to embolization and decreased blood flow due to the atherosclerotic lesion in the carotid artery, microcirculatory dysfunction in the cerebral circulation also plays a critical role in CAS-related VCI. To better understand the microvascular contributions to cognitive decline associated with CAS and evaluate microvascular protective effects of therapeutic interventions, it is essential to examine the structural and functional changes of the microvessels in the central nervous system (CNS). However, there are some limitations of in vivo brain vascular imaging modalities. The retinal microvasculature provides a unique opportunity to study pathogenesis of cerebral small vessel disease and VCI, because the cerebral circulation and the retinal circulation share similar anatomy, physiology and embryology. Similar microvascular pathologies may manifest in the brain and the retina, thus ocular examination can be used as a noninvasive screening tool to investigate pathological changes in the CNS associated with CAS. In this review, ocular signs of CAS and the retinal manifestations of CAS-associated microvascular dysfunction are discussed. The advantages and limitation of methods that are capable of imaging the ocular circulation (including funduscopy, fluorescein angiography, Doppler sonography, optical coherence tomography [OCT] and optical coherence tomography angiography [OCTA]) are discussed. The potential use of dynamic retinal vessel analysis (DVA), which allows for direct visualization of neurovascular coupling responses in the CNS, for understanding microvascular contributions to cognitive decline in CAS patients is also considered.
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Affiliation(s)
- Lilla István
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Cecilia Czakó
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Ágnes Élő
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Zsuzsanna Mihály
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Péter Sótonyi
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Andrea Varga
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Zoltán Ungvári
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Departments of Medical Physics and Informatics & Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
| | - Anna Csiszár
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Departments of Medical Physics and Informatics & Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Andriy Yabluchanskiy
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shannon Conley
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tamás Csipő
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Ágnes Lipecz
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Josa Andras Hospital, Nyiregyhaza, Hungary
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary.
- Department of Ophthalmology, Weill Cornell Medical College, New York City, NY, USA.
- Department of Clinical Ophtalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
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Yablonskiy DA, Wen J, Kothapalli SVVN, Sukstanskii AL. In vivo evaluation of heme and non-heme iron content and neuronal density in human basal ganglia. Neuroimage 2021; 235:118012. [PMID: 33838265 PMCID: PMC10468262 DOI: 10.1016/j.neuroimage.2021.118012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 12/16/2022] Open
Abstract
Non-heme iron is an important element supporting the structure and functioning of biological tissues. Imbalance in non-heme iron can lead to different neurological disorders. Several MRI approaches have been developed for iron quantification relying either on the relaxation properties of MRI signal or measuring tissue magnetic susceptibility. Specific quantification of the non-heme iron can, however, be constrained by the presence of the heme iron in the deoxygenated blood and contribution of cellular composition. The goal of this paper is to introduce theoretical background and experimental MRI method allowing disentangling contributions of heme and non-heme irons simultaneously with evaluation of tissue neuronal density in the iron-rich basal ganglia. Our approach is based on the quantitative Gradient Recalled Echo (qGRE) MRI technique that allows separation of the total R2* metric characterizing decay of GRE signal into tissue-specific (R2t*) and the baseline blood oxygen level-dependent (BOLD) contributions. A combination with the QSM data (also available from the qGRE signal phase) allowed further separation of the tissue-specific R2t* metric in a cell-specific and non-heme-iron-specific contributions. It is shown that the non-heme iron contribution to R2t* relaxation can be described with the previously developed Gaussian Phase Approximation (GPA) approach. qGRE data were obtained from 22 healthy control participants (ages 26-63 years). Results suggest that the ferritin complexes are aggregated in clusters with an average radius about 100nm comprising approximately 2600 individual ferritin units. It is also demonstrated that the concentrations of heme and non-heme iron tend to increase with age. The strongest age effect was seen in the pallidum region, where the highest age-related non-heme iron accumulation was observed.
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Affiliation(s)
- Dmitriy A Yablonskiy
- Department of Radiology, Washington University in St. Louis, 4525 Scott Ave. Room 3216, St. Louis, MO 63110, United States.
| | - Jie Wen
- Department of Radiology, The First Affiliated Hospital of USTC, Hefei, Anhui 230001, China
| | - Satya V V N Kothapalli
- Department of Radiology, Washington University in St. Louis, 4525 Scott Ave. Room 3216, St. Louis, MO 63110, United States
| | - Alexander L Sukstanskii
- Department of Radiology, Washington University in St. Louis, 4525 Scott Ave. Room 3216, St. Louis, MO 63110, United States
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Sebök M, van Niftrik CHB, Winklhofer S, Wegener S, Esposito G, Stippich C, Luft A, Regli L, Fierstra J. Mapping Cerebrovascular Reactivity Impairment in Patients With Symptomatic Unilateral Carotid Artery Disease. J Am Heart Assoc 2021; 10:e020792. [PMID: 34102856 PMCID: PMC8477889 DOI: 10.1161/jaha.121.020792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Comprehensive hemodynamic impairment mapping using blood oxygenation‐level dependent (BOLD) cerebrovascular reactivity (CVR) can be used to identify hemodynamically relevant symptomatic unilateral carotid artery disease. Methods and Results This prospective cohort study was conducted between February 2015 and July 2020 at the Clinical Neuroscience Center of the University Hospital Zurich, Zurich, Switzerland. One hundred two patients with newly diagnosed symptomatic unilateral internal carotid artery (ICA) occlusion or with 70% to 99% ICA stenosis were included. An age‐matched healthy cohort of 12 subjects underwent an identical BOLD functional magnetic resonance imaging examination. Using BOLD functional magnetic resonance imaging with a standardized CO2 stimulus, CVR impairment was evaluated. Moreover, embolic versus hemodynamic ischemic patterns were evaluated on diffusion‐weighted imaging. Sixty‐seven patients had unilateral ICA occlusion and 35 patients unilateral 70% to 99% ICA stenosis. Patients with ICA occlusion exhibited lower whole‐brain and ipsilateral hemisphere mean BOLD‐CVR values as compared with healthy subjects (0.12±0.08 versus 0.19±0.04, P=0.004 and 0.09±0.09 versus 0.18±0.04, P<0.001) and ICA stenosis cohort (0.12±0.08 versus 0.16±0.05, P=0.01 and 0.09±0.09 versus 0.15±0.05, P=0.01); however, only 40 (58%) patients of the cohort showed significant BOLD‐CVR impairment. Conversely, there was no difference in mean BOLD‐CVR values between healthy patients and patients with ICA stenosis, although 5 (14%) patients with ICA stenosis showed a significant BOLD‐CVR impairment. No significant BOLD‐CVR difference was discernible between patients with hemodynamic ischemic infarcts versus those with embolic infarct distribution (0.11±0.08 versus 0.13±0.06, P=0.12). Conclusions Comprehensive BOLD‐CVR mapping allows for identification of hemodynamically relevant symptomatic unilateral carotid artery stenosis or occlusion.
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Affiliation(s)
- Martina Sebök
- Department of Neurosurgery University Hospital ZurichUniversity of Zurich Switzerland.,Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery University Hospital ZurichUniversity of Zurich Switzerland.,Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland
| | - Sebastian Winklhofer
- Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland.,Department of Neuroradiology University Hospital ZurichUniversity of Zurich Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland.,Department of Neurology University Hospital ZurichUniversity of Zurich Switzerland
| | - Giuseppe Esposito
- Department of Neurosurgery University Hospital ZurichUniversity of Zurich Switzerland.,Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland
| | - Christoph Stippich
- Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland.,Neuroradiology and Radiology Schmieder Clinic Allensbach Germany
| | - Andreas Luft
- Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland.,Department of Neurology University Hospital ZurichUniversity of Zurich Switzerland.,Cereneo Center for Neurology and Rehabilitation Vitznau Switzerland
| | - Luca Regli
- Department of Neurosurgery University Hospital ZurichUniversity of Zurich Switzerland.,Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery University Hospital ZurichUniversity of Zurich Switzerland.,Clinical Neuroscience Center University Hospital ZurichUniversity of Zurich Switzerland
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20
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Xiao J, Liang H, Wang Y, Wang S, Wang Y, Bi Y. Risk Factors of Hypoperfusion on MRI of Ischemic Stroke Patients Within 7 Days of Onset. Front Neurol 2021; 12:668360. [PMID: 34025571 PMCID: PMC8137898 DOI: 10.3389/fneur.2021.668360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Hypoperfusion is an important factor determining the prognosis of ischemic stroke patients. The present study aimed to investigate possible predictors of hypoperfusion on MRI of ischemic stroke patients within 7 days of stroke onset. Methods: Ischemic stroke patients, admitted to the comprehensive Stroke Center of Shanghai Fourth People's Hospital affiliated to Tongji University within 7 days of onset between January 2016 and June 2017, were recruited to the present study. Magnetic resonance imaging (MRI), including both diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI), was performed within 7 days of the symptom onset. Time to maximum of the residue function (Tmax) maps were automatically evaluated using the RAPID software. The volume of hypoperfusion was measured outside the infarct area based on ADC < 620 × 10−6 mm2/s. The 90 d mRS score was assessed through either clinic visits or telephone calls. Multivariate step-wise analysis was used to assess the correlation between MR findings and clinical variables, including the demographic information, cardio-metabolic characteristics, and functional outcomes. Results: Among 635 patients admitted due to acute ischemic stroke within 7 days of onset, 241 met the inclusion criteria. Hypoperfusion volume of 38 ml was the best cut-off value for predicting poor prognosis of patients with cerebral infarction (90 d-mRS score ≥ 2). The incidences of MR perfusion Tmax > 4–6 s maps with a volume of 0–38 mL or >38 mL were 51.9% (125/241) and 48.1% (116/241), respectively. Prior stroke and vascular stenosis (≥70%) were associated with MR hypoperfusion. Multivariate step-wise analysis showed that prior stroke and vascular stenosis (≥70%) were risk factors of Tmax > 4–6 s maps, and the odds ratios (OR) were 3.418 (adjusted OR 95% CI: 1.537–7.600), and 2.265 (adjusted OR, 95% CI: 1.199–4.278), respectively. Conclusion: Our results suggest that prior stroke and vascular stenosis (≥70%) are strong predictors of hypoperfusion in patients with acute ischemic stroke within 7 days of stroke onset.
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Affiliation(s)
- Jingjing Xiao
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Huazheng Liang
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.,Department of Neurology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Yue Wang
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Shaoshi Wang
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Yi Wang
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.,College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yong Bi
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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21
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Zarrinkoob L, Wåhlin A, Ambarki K, Eklund A, Malm J. Quantification and mapping of cerebral hemodynamics before and after carotid endarterectomy, using four-dimensional flow magnetic resonance imaging. J Vasc Surg 2021; 74:910-920.e1. [PMID: 33812036 DOI: 10.1016/j.jvs.2021.01.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carotid stenosis can profoundly affect cerebral hemodynamics, which cannot simply be inferred from the degree of stenosis. We quantified and mapped the distribution of the blood flow rate (BFR) in the cerebral arteries before and after carotid endarterectomy using four-dimensional (4D) phase-contrast (PC) magnetic resonance imaging (MRI). METHODS Nineteen patients (age, 71 ± 6 years; 2 women) with symptomatic carotid stenosis (≥50%) undergoing carotid endarterectomy (CEA) were investigated using 4D PC-MRI before and after surgery. The BFR was measured in 17 cerebral arteries and the ophthalmic arteries. Collateral recruitment through the anterior and posterior communicating arteries, ophthalmic arteries, and leptomeningeal arteries was quantified. BFR laterality was significantly different between the paired contralateral and ipsilateral arteries. Subgroups were defined according to the presence of collateral recruitment. RESULTS The total cerebral blood flow had increased by 15% (P < .01) after CEA. Before CEA, laterality was seen in the internal carotid artery, anterior cerebral artery, and middle cerebral artery (MCA). On the ipsilateral side, an increased BFR was found after CEA in the internal carotid artery (246 ± 62 mL/min vs 135 ± 80 mL/min; P < .001), anterior cerebral artery (87 ± mL/min vs 38 ± 58 mL/min; P < .01), and MCA (149 ± 43 mL/min vs 119 ± 34 mL/min; P < .01), resulting in a postoperative BFR distribution without signs of laterality. In the nine patients with preoperatively recruited collaterals, BFR laterality was found in the MCA before, but not after, CEA (P < .01). This laterality was not found in the 10 patients without collateral recruitment (P = .2). The degree of stenosis did not differ between the groups with and without collateral recruitment (P = .85). CONCLUSIONS Using 4D PC-MRI, we have presented a comprehensive and noninvasive method to evaluate the cerebral hemodynamics due to carotid stenosis before and after CEA. MCA laterality, seen in the patients with collateral recruitment before CEA, pointed toward a hemodynamic disturbance in MCA territory for those patients. This methodologic advancement provides an insight into the pathophysiology of cerebral hemodynamics in patients with carotid stenosis.
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Affiliation(s)
- Laleh Zarrinkoob
- Division of Neuroscience, Department of Clinical Sciences, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
| | - Anders Wåhlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden; Centre for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden; Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
| | - Khalid Ambarki
- Department of Radiation Sciences, Umeå University, Umeå, Sweden; Centre for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden; Centre for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden
| | - Jan Malm
- Division of Neuroscience, Department of Clinical Sciences, Umeå University, Umeå, Sweden
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22
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Kaczmarz S, Göttler J, Petr J, Hansen MB, Mouridsen K, Zimmer C, Hyder F, Preibisch C. Hemodynamic impairments within individual watershed areas in asymptomatic carotid artery stenosis by multimodal MRI. J Cereb Blood Flow Metab 2021; 41:380-396. [PMID: 32237952 PMCID: PMC7812517 DOI: 10.1177/0271678x20912364] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Improved understanding of complex hemodynamic impairments in asymptomatic internal carotid artery stenosis (ICAS) is crucial to better assess stroke risks. Multimodal MRI is ideal for measuring brain hemodynamics and has the potential to improve diagnostics and treatment selections. We applied MRI-based perfusion and oxygenation-sensitive imaging in ICAS with the hypothesis that the sensitivity to hemodynamic impairments will improve within individual watershed areas (iWSA). We studied cerebral blood flow (CBF), cerebrovascular reactivity (CVR), relative cerebral blood volume (rCBV), relative oxygen extraction fraction (rOEF), oxygen extraction capacity (OEC) and capillary transit-time heterogeneity (CTH) in 29 patients with asymptomatic, unilateral ICAS (age 70.3 ± 7.0 y) and 30 age-matched healthy controls. In ICAS, we found significant impairments of CBF, CVR, rCBV, OEC, and CTH (strongest lateralization ΔCVR = -24%), but not of rOEF. Although the spatial overlap of compromised hemodynamic parameters within each patient varied in a complex manner, most pronounced changes of CBF, CVR and rCBV were detected within iWSAs (strongest effect ΔCVR = +117%). At the same time, CTH impairments were iWSA independent, indicating widespread dysfunction of capillary-level oxygen diffusivity. In summary, complementary MRI-based perfusion and oxygenation parameters offer deeper perspectives on complex microvascular impairments in individual patients. Furthermore, knowledge about iWSAs improves the sensitivity to hemodynamic impairments.
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Affiliation(s)
- Stephan Kaczmarz
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany.,MRRC, Yale University, New Haven, CT, USA
| | - Jens Göttler
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany.,MRRC, Yale University, New Haven, CT, USA.,Department of Radiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Jan Petr
- PET Center, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Mikkel Bo Hansen
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Kim Mouridsen
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Claus Zimmer
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | | | - Christine Preibisch
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany.,Clinic for Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
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23
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Zhuang C, Poublanc J, Mcketton L, Venkatraghavan L, Sobczyk O, Duffin J, Crawley AP, Fisher JA, Wu R, Mikulis DJ. The value of a shorter-delay arterial spin labeling protocol for detecting cerebrovascular impairment. Quant Imaging Med Surg 2021; 11:608-619. [PMID: 33532261 DOI: 10.21037/qims-20-148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The aim of this study was to determine the relationship between blood oxygen level dependent (BOLD) cerebrovascular reactivity (CVR) and cerebral blood flow (CBF) obtained from arterial spin labeling (ASL) using different post labeling delays (PLD). Methods Forty-two patients with steno-occlusive diseases and impaired CVR were divided into two groups, one scanned with a 1.5-second (1.5-s) and the other with a 2.5-second (2.5-s) PLD ASL protocol. For all patients, a region of interest (ROI) was drawn around the CVR impairment. This affected ROI was then left-right flipped across the brain midline to obtain the control ROI. For both groups, the difference in grey matter CVR between affected and control ROI was first tested to confirm significance. The average grey matter CBF of affected and control ROIs were then compared. The same analysis method was used to compare affected and control hemispheres. Results In both groups of 1.5-s and 2.5-s PLD, CVR values in the affected ROI (-0.049±0.055 and -0.042±0.074%/mmHg, respectively) were significantly lower compared to that in the control ROI (0.152±0.054 and 0.152±0.053%/mmHg, respectively, P<0.0001). In the group with the 1.5-s PLD, CBF in the affected ROI (37.62±11.37 mL/100 g/min) was significantly lower compared to CBF in the control ROI (44.13±11.58 mL/100 g/min, P<0.05). However, in the group with the 2.5-s PLD, no significant differences could be seen between CBF in the affected ROI (40.50±14.82 mL/100 g/min) and CBF in the control ROI (39.68±12.49 mL/100 g/min, P=0.73). In the hemisphere-based analysis, CBF was significantly lower in the affected side than in the control side for the group with the 1.5-s PLD (P<0.05) when CVR was impaired (P<0.0001), but not for the group with the 2.5-s PLD (P=0.49). Conclusions In conclusion, our study reveals and highlights the value of a shorter-PLD ASL protocol, which is able to reflect CVR impairment. At the same time, we offer a better understanding of the relationship between BOLD CVR and CBF obtained from ASL.
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Affiliation(s)
- Caiyu Zhuang
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.,Department of Medical Imaging, the First Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Julien Poublanc
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Larissa Mcketton
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | | | - Olivia Sobczyk
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - James Duffin
- Department of Anaesthesia, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University Health Network, Toronto, Canada
| | - Adrian P Crawley
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Joseph A Fisher
- Department of Anaesthesia, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University Health Network, Toronto, Canada
| | - Renhua Wu
- Department of Medical Imaging, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - David J Mikulis
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
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24
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Seiler A, Brandhofe A, Gracien RM, Pfeilschifter W, Hattingen E, Deichmann R, Nöth U, Wagner M. DSC perfusion-based collateral imaging and quantitative T2 mapping to assess regional recruitment of leptomeningeal collaterals and microstructural cortical tissue damage in unilateral steno-occlusive vasculopathy. J Cereb Blood Flow Metab 2021; 41:67-81. [PMID: 31987009 PMCID: PMC7747159 DOI: 10.1177/0271678x19898148] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Leptomeningeal collateral supply is considered pivotal in steno-occlusive vasculopathy to prevent chronic microstructural ischaemic tissue damage. The aim of this study was to assess the alleged protective role of leptomeningeal collaterals in patients with unilateral high-grade steno-occlusive vasculopathy using quantitative (q)T2 mapping and perfusion-weighted imaging (PWI)-based collateral abundance. High-resolution qT2 was used to estimate microstructural damage of the segmented normal-appearing cortex. Volumetric abundance of collaterals was assessed based on PWI source data. The ratio relative cerebral blood flow/relative cerebral blood volume (rCBF/rCBV) as a surrogate of relative cerebral perfusion pressure (rCPP) was used to investigate the intravascular hemodynamic competency of pial collateral vessels and the hemodynamic state of brain parenchyma. Within the dependent vascular territory with increased cortical qT2 values (P = 0.0001) compared to the contralateral side, parenchymal rCPP was decreased (P = 0.0001) and correlated negatively with increase of qT2 (P < 0.05). Furthermore, volumetric abundance of adjacent leptomeningeal collaterals was significantly increased (P < 0.01) and negatively correlated with changes of parenchymal rCPP (P = 0.01). Microstructural cortical damage is closely related to restrictions of antegrade blood flow despite increased pial collateral vessel abundance. Therefore, increased leptomeningeal collateral supply cannot necessarily be regarded as a sign of effective compensation in patients with high-grade steno-occlusive vasculopathy.
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Affiliation(s)
- Alexander Seiler
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Alexander Seiler, Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528 Frankfurt, Germany.
| | - Annemarie Brandhofe
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Elke Hattingen
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
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25
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Battaglia C, Battaglia B, Casadio P, Rizzo R, Artini PG. Metformin metabolic and vascular effects in normal weight hyperinsulinemic polycystic ovary syndrome patients treated with contraceptive vaginal ring. A pilot study. Gynecol Endocrinol 2020; 36:1062-1069. [PMID: 32544018 DOI: 10.1080/09513590.2020.1770213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The aim of this longitudinal, controlled, and retrospective pilot study was to assess how metformin, associated with a contraceptive vaginal ring, may influence lipid and carbohydrate metabolism, and surrogate markers of arterial function in normal weight polycystic ovary syndrome patients. MATERIAL AND METHODS Among 28 lean patients, 15 were treated with vaginal ring plus metformin and 13 women with only vaginal ring. The effects were assessed after six months. The patients were submitted to evaluation of lipid and carbohydrate metabolism; Doppler analysis of ophthalmic artery; brachial artery flow-mediated vasodilatation; and oral glucose tolerance test. RESULTS After six months, the fasting insulin, glucose/insulin ratio, and homeostatic model assessment estimates for insulin resistance were significantly improved in metformin group. The ophthalmic artery pulsatility index did not significantly improve in either group. The brachial artery vasodilation was better in metformin treated patients. CONCLUSION Metformin, associated with vaginal ring, improves the insulin and carbohydrate metabolism. This, associated with the significant improvements of surrogate markers of arterial function, may be responsible of a slight possible cardiovascular and cerebrovascular protective effect.
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Affiliation(s)
- Cesare Battaglia
- Department of Obstetrics and Perinatal Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Bruno Battaglia
- Department of Ophthalmology, University of Modena-Reggio-Emilia, Italy
| | - Paolo Casadio
- Department of Gynecology and Pathophysiology of Human Reproduction, Alma Mater Studiorum-University of Bologna, Italy
| | - Roberta Rizzo
- Department of Obstetrics and Perinatal Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Paolo G Artini
- Department of Obstetrics and Gynecology "P. Fioretti" University of Pisa, Italy
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26
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Songsaeng D, Sriyapai A, Sakarunchai I, Yokubol B, Nanta-Aree S, Tisavipat N. Fate of Patients with Chronic Cerebrovascular Steno-occlusive Disease According to Change of Cerebral Perfusion, Cerebrovascular Reserved, and Incidence of Recurrent Ischemic Stroke. Asian J Neurosurg 2020; 15:566-572. [PMID: 33145208 PMCID: PMC7591172 DOI: 10.4103/ajns.ajns_223_20] [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: 05/10/2020] [Revised: 05/31/2020] [Accepted: 06/11/2020] [Indexed: 11/04/2022] Open
Abstract
Objective The objective is to demonstrate change of cerebral perfusion and cerebrovascular reserve (CVR) in treating patients with cerebrovascular steno-occlusive disease stratified by change of cerebral perfusion and CVR. Methods Retrospective review patients with radiographic proven major cerebrovascular steno-occlusive disease whom underwent cerebral perfusion imaging with vasoactive stimuli stress test in Siriraj Hospital and Bangkok General Hospital during 2010-2018. Medical records were also reviewed. Radiographic findings, cerebral perfusion parameters and signal change during the stress test were reviewed and used to categorize into three groups. Results There were 40 patients sent to radiology department for the evaluation of CVR. One patient had airway problem during the procedure and was excluded. Remaining 39 patients were included in this study (32 males and 7 females, mean age of 54.55 years). In 42 sites involved, 28 (66%) were internal carotid artery, 14 (33%) were middle cerebral arteries. Laterality is left side in 20 cases, right side in 14 cases, and bilateral in 5 cases. Poor CVR response (increased cerebral blood flow <10%) was found in 9 patients (2 severe stenoses and 7 total occlusions). The mean follow-up time was 28.9 months. Eight cases (20.5%) underwent surgical treatment; surgical bypasses and endovascular interventions. Only one patient had subsequential ischemic symptom at immediate postoperative vascular bypass surgery. The remaining patients had no report of progressive or recurrent neurological deficit symptom. Conclusion Poor CVR response is more often found in higher degree of steno-occlusion. Even inconclusive predicting incidence of recurrent ischemic stroke, CVR that reflects the capacity of neuro-autoregulation.
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Affiliation(s)
- Dittapong Songsaeng
- Department of Radiology, Division of Diagnostic Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Athaporn Sriyapai
- Department of Radiology, Division of Diagnostic Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ittichai Sakarunchai
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Bencharatana Yokubol
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sarun Nanta-Aree
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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27
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Fan AP, An H, Moradi F, Rosenberg J, Ishii Y, Nariai T, Okazawa H, Zaharchuk G. Quantification of brain oxygen extraction and metabolism with [ 15O]-gas PET: A technical review in the era of PET/MRI. Neuroimage 2020; 220:117136. [PMID: 32634594 PMCID: PMC7592419 DOI: 10.1016/j.neuroimage.2020.117136] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 12/31/2022] Open
Abstract
Oxygen extraction fraction (OEF) and the cerebral metabolic rate of oxygen (CMRO2) are key cerebral physiological parameters to identify at-risk cerebrovascular patients and understand brain health and function. PET imaging with [15O]-oxygen tracers, either through continuous or bolus inhalation, provides non-invasive assessment of OEF and CMRO2. Numerous tracer delivery, PET acquisition, and kinetic modeling approaches have been adopted to map brain oxygenation. The purpose of this technical review is to critically evaluate different methods for [15O]-gas PET and its impact on the accuracy and reproducibility of OEF and CMRO2 measurements. We perform a meta-analysis of brain oxygenation PET studies in healthy volunteers and compare between continuous and bolus inhalation techniques. We also describe OEF metrics that have been used to detect hemodynamic impairment in cerebrovascular disease. For these patients, advanced techniques to accelerate the PET scans and potential synthesis with MRI to avoid arterial blood sampling would facilitate broader use of [15O]-oxygen PET for brain physiological assessment.
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Affiliation(s)
- Audrey P Fan
- Department of Radiology, Stanford University, Stanford, CA, USA; Department of Biomedical Engineering and Department of Neurology, University of California Davis, Davis, CA, USA.
| | - Hongyu An
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Farshad Moradi
- Department of Radiology, Stanford University, Stanford, CA, USA
| | | | - Yosuke Ishii
- Department of Radiology, Stanford University, Stanford, CA, USA; Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hidehiko Okazawa
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA, USA
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28
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Nakamizo A, Amano T, Matsuo S, Kuwashiro T, Yasaka M, Okada Y. Common carotid flow velocity is associated with cognitive function after carotid endarterectomy. J Clin Neurosci 2020; 76:53-57. [PMID: 32307301 DOI: 10.1016/j.jocn.2020.04.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/09/2020] [Indexed: 11/24/2022]
Abstract
The relationship between ultrasonographic flow parameters and cognitive function has not been well studied. This study aimed to clarify associations between carotid flow velocity (FV) and cognitive function in patients with a history of carotid endarterectomy (CEA). Ninety-four patients who previously underwent CEA participated in this study. The Neurobehavioral Cognitive Status Examination (Cognistat) and Frontal Assessment Battery (FAB) were adopted to assess cognitive functions at a mean of 6.5 ± 3.2 years after CEA. End-diastolic flow velocity (EDV) of the left and right common carotid artery (CCA) was significantly associated with total Cognistat score (p < 0.001) and total FAB score (p < 0.05). Pulsatility index (PI) of the left CCA was significantly associated with total Cognistat score and total FAB score (p < 0.01). A cut-off right CCA EDV of 14.5 cm/s offered the most reliable predictor of the bottom 25th percentile of total Cognistat score (sensitivity 83.3%, specificity 61.0%, area under the curve (AUC) 0.731, p = 0.0060), while a cut-off left CCA PI of 1.83 was the most reliable predictor of the bottom 25th percentile of total FAB score (sensitivity 73.3%, specificity 60.0%, AUC 0.679, p = 0.0179). Left and right CCA EDV correlated with sub-components of comprehension, construction, judgment, programming (p < 0.01), and conceptualization (p < 0.05). Right CCA EDV correlated with similarity (p < 0.01), repetition, naming, and memory (p < 0.05). Left CCA PI correlated with attention, conceptualization (p < 0.01), repetition, construction, similarity, and mental flexibility (p < 0.05), while right CCA PI correlated with construction (p < 0.05). CCA FV may offer useful markers of cognitive functions in patients with a history of CEA.
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Affiliation(s)
- Akira Nakamizo
- Departments of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1, Jigyo-hama, Chuo-ku, Fukuoka 810-8563, Japan.
| | - Toshiyuki Amano
- Departments of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1, Jigyo-hama, Chuo-ku, Fukuoka 810-8563, Japan
| | - Satoshi Matsuo
- Departments of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1, Jigyo-hama, Chuo-ku, Fukuoka 810-8563, Japan
| | - Takahiro Kuwashiro
- Departments of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1, Jigyo-hama, Chuo-ku, Fukuoka 810-8563, Japan
| | - Masahiro Yasaka
- Departments of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1, Jigyo-hama, Chuo-ku, Fukuoka 810-8563, Japan
| | - Yasushi Okada
- Departments of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1, Jigyo-hama, Chuo-ku, Fukuoka 810-8563, Japan
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29
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Dehkharghani S, Qiu D. MR Thermometry in Cerebrovascular Disease: Physiologic Basis, Hemodynamic Dependence, and a New Frontier in Stroke Imaging. AJNR Am J Neuroradiol 2020; 41:555-565. [PMID: 32139425 DOI: 10.3174/ajnr.a6455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/02/2020] [Indexed: 01/20/2023]
Abstract
The remarkable temperature sensitivity of the brain is widely recognized and has been studied for its role in the potentiation of ischemic and other neurologic injuries. Pyrexia frequently complicates large-vessel acute ischemic stroke and develops commonly in critically ill neurologic patients; the profound sensitivity of the brain even to minor intraischemic temperature changes, together with the discovery of brain-to-systemic as well as intracerebral temperature gradients, has thus compelled the exploration of cerebral thermoregulation and uncovered its immutable dependence on cerebral blood flow. A lack of pragmatic and noninvasive tools for spatially and temporally resolved brain thermometry has historically restricted empiric study of cerebral temperature homeostasis; however, MR thermometry (MRT) leveraging temperature-sensitive nuclear magnetic resonance phenomena is well-suited to bridging this long-standing gap. This review aims to introduce the reader to the following: 1) fundamental aspects of cerebral thermoregulation, 2) the physical basis of noninvasive MRT, and 3) the physiologic interdependence of cerebral temperature, perfusion, metabolism, and viability.
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Affiliation(s)
- S Dehkharghani
- From the Department of Radiology (S.D.), New York University Langone Health, New York, New York
| | - D Qiu
- Department of Radiology (D.Q.), Emory University Hospital, Atlanta, Georgia
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30
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Zarrinkoob L, Wåhlin A, Ambarki K, Birgander R, Eklund A, Malm J. Blood Flow Lateralization and Collateral Compensatory Mechanisms in Patients With Carotid Artery Stenosis. Stroke 2020; 50:1081-1088. [PMID: 30943887 PMCID: PMC6485302 DOI: 10.1161/strokeaha.119.024757] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background and Purpose- Four-dimensional phase-contrast magnetic resonance imaging enables quantification of blood flow rate (BFR; mL/min) in multiple cerebral arteries simultaneously, making it a promising technique for hemodynamic investigation in patients with stroke. The aim of this study was to quantify the hemodynamic disturbance and the compensatory pattern of collateral flow in patients with symptomatic carotid stenosis. Methods- Thirty-eight patients (mean, 72 years; 27 men) with symptomatic carotid stenosis (≥50%) or occlusion were investigated using 4-dimensional phase-contrast magnetic resonance imaging. For each patient, BFR was measured in 19 arteries/locations. The ipsilateral side to the symptomatic carotid stenosis was compared with the contralateral side. Results- Internal carotid artery BFR was lower on the ipsilateral side (134±87 versus 261±95 mL/min; P<0.001). BFR in anterior cerebral artery (A1 segment) was lower on ipsilateral side (35±58 versus 119±72 mL/min; P<0.001). Anterior cerebral artery territory bilaterally was primarily supplied by contralateral internal carotid artery. The ipsilateral internal carotid artery mainly supplied the ipsilateral middle cerebral artery (MCA) territory. MCA was also supplied by a reversed BFR found in the ophthalmic and the posterior communicating artery routes on the ipsilateral side (-5±28 versus 10±28 mL/min, P=0.001, and -2±12 versus 6±6 mL/min, P=0.03, respectively). Despite these compensations, BFR in MCA was lower on the ipsilateral side, and this laterality was more pronounced in patients with severe carotid stenosis (≥70%). Although comparing ipsilateral MCA BFR between stenosis groups (<70% and ≥70%), there was no difference ( P=0.95). Conclusions- With a novel approach using 4-dimensional phase-contrast magnetic resonance imaging, we could simultaneously quantify and rank the importance of collateral routes in patients with carotid stenosis. An important observation was that contralateral internal carotid artery mainly secured the bilateral anterior cerebral artery territory. Because of the collateral recruitment, compromised BFR in MCA is not necessarily related to the degree of carotid stenosis. These findings highlight the importance of simultaneous investigation of the hemodynamics of the entire cerebral arterial tree.
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Affiliation(s)
- Laleh Zarrinkoob
- From the Department of Pharmacology and Clinical Neuroscience, Umeå, Sweden (L.Z., J.M.).,Department of Surgical and Perioperative Sciences, Umeå, Sweden (L.Z.)
| | - Anders Wåhlin
- Department of Radiation Science, Umeå, Sweden (A.W., K.A., R.B., A.E.).,Centre for Biomedical Engineering and Physics, Umeå, Sweden (A.W., K.A., A.E.).,Umeå Center for Functional Brain Imaging, Sweden (A.W., A.E.)
| | - Khalid Ambarki
- Department of Radiation Science, Umeå, Sweden (A.W., K.A., R.B., A.E.).,Centre for Biomedical Engineering and Physics, Umeå, Sweden (A.W., K.A., A.E.)
| | - Richard Birgander
- Department of Radiation Science, Umeå, Sweden (A.W., K.A., R.B., A.E.)
| | - Anders Eklund
- Department of Radiation Science, Umeå, Sweden (A.W., K.A., R.B., A.E.).,Centre for Biomedical Engineering and Physics, Umeå, Sweden (A.W., K.A., A.E.).,Umeå Center for Functional Brain Imaging, Sweden (A.W., A.E.)
| | - Jan Malm
- From the Department of Pharmacology and Clinical Neuroscience, Umeå, Sweden (L.Z., J.M.)
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31
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Hashem SES, Belal ES, Hegazy MM, El-Bassiony AA, Ahmed SM, Zaid II. Cerebrovascular reactivity recovery following carotid angioplasty and stenting. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0071-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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32
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Morotti E, Giovanni Artini P, Persico N, Battaglia C. Metformin metabolic and vascular effects in overweight/moderately obese hyperinsulinemic PCOS patients treated with contraceptive vaginal ring: a pilot study. Gynecol Endocrinol 2019; 35:854-861. [PMID: 31081406 DOI: 10.1080/09513590.2019.1613361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of this pilot study was to assess how metformin, associated with a contraceptive vaginal ring, may influence lipid and carbohydrate metabolism, fat distribution, and surrogate markers of arterial function. Among 62 patients, 25 were treated with vaginal ring plus metformin and 37 women with only vaginal ring. The effects were assessed after 6 months. The patients were submitted to evaluation of lipid and carbohydrate metabolism; extended view ultrasonographic evaluation of fat distribution; Doppler analysis of ophthalmic artery; brachial artery flow-mediated vasodilatation; oral glucose tolerance test. After 6 months, the body mass index and waist/hip ratio resulted significantly better in patients who associated metformin to vaginal ring. The fasting glucose, insulin, and glucose/insulin ratio, HOMA-IR, glucose, and insulin AUC 120 were significantly improved in metformin group. The ultrasonographic fat analysis resulted significantly better after metformin. The ophthalmic artery PI significantly improved in metformin group. The brachial artery vasodilation was better in metformin treated patients. In conclusion, metformin, associated with vaginal ring, improves the insulin and carbohydrate metabolism, reduces the body weight and android fat distribution. This, associated with the significant improvements of surrogate markers of arterial function, may be responsible of possible cardiovascular and cerebrovascular protective effects.
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Affiliation(s)
- Elena Morotti
- Department of Obstetrics and Gynecology, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | | | - Nicola Persico
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Cesare Battaglia
- Department of Obstetrics and Gynecology, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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33
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Eker OF, Ameli R, Makris N, Jurkovic T, Montigon O, Barbier EL, Cho TH, Nighoghossian N, Berthezène Y. MRI Assessment of Oxygen Metabolism and Hemodynamic Status in Symptomatic Intracranial Atherosclerotic Stenosis: A Pilot Study. J Neuroimaging 2019; 29:467-475. [DOI: 10.1111/jon.12615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/14/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Omer F. Eker
- Department of NeuroradiologyHospices Civils de Lyon Bron France
- CREATIS CNRS UMR 5220, INSERM U1044 Villeurbanne cedex France
| | - Roxana Ameli
- Department of NeuroradiologyHospices Civils de Lyon Bron France
| | - Nikolaos Makris
- CREATIS CNRS UMR 5220, INSERM U1044 Villeurbanne cedex France
| | - Thomas Jurkovic
- Department of NeuroradiologyHospices Civils de Lyon Bron France
| | - Olivier Montigon
- INSERM U1216Grenoble Institut des Neurosciences La Tronche France
| | - Emmanuel L. Barbier
- INSERM U1216Grenoble Institut des Neurosciences La Tronche France
- Université Grenoble Alpes Saint‐Martin‐d'Hères France
| | - Tae Hee Cho
- CREATIS CNRS UMR 5220, INSERM U1044 Villeurbanne cedex France
| | | | - Yves Berthezène
- Department of NeuroradiologyHospices Civils de Lyon Bron France
- CREATIS CNRS UMR 5220, INSERM U1044 Villeurbanne cedex France
- Department of Vascular Neurology, Hospices Civils de LyonHôpital Pierre Wertheimer Bron France
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Factors related to improvement of cerebrovascular reserve after superficial temporal artery to middle cerebral artery anastomosis for patients with atherosclerotic steno-occlusive disease. Acta Neurochir (Wien) 2019; 161:799-805. [PMID: 30778681 DOI: 10.1007/s00701-019-03841-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aimed to investigate factors related to improvement of hemodynamics and evaluated the usefulness of intraoperative Doppler for predicting postoperative hemodynamics in patients with cerebrovascular atherosclerotic steno-occlusive disease (CASD) of the internal carotid artery (ICA) or middle cerebral artery (MCA) who were treated with extracranial-intracranial (EC-IC) bypass surgery. METHOD Forty-eight patients with CASD of the ICA or MCA who were treated by superficial temporal artery to middle cerebral artery bypass with a follow-up longer than 12 months were enrolled. Repeated transient ischemic attack or completed ischemic stroke was observed under optimal medical therapy in all patients. Intraoperative blood flow velocity of the MCA was evaluated by a Doppler flowmeter. Cerebral blood flow and cerebrovascular reserve (CVR) were evaluated using N-isopropyl-[123I] p-iodoamphetamine (IMP) single photon emission computed tomography (SPECT) preoperatively and 3 months after surgery. Imaging and clinical data were retrospectively reviewed. RESULTS CVR was significantly increased postoperatively (p = 0.03). One year after the operation, two (4.2%) patients developed cerebral infarction. The change in MCA flow velocity just after anastomosis compared with pre-anastomosis proximal and distal of the anastomosis site was a median of 3.0 and 2.6 times, respectively. However, there was no significant association between changes in intraoperative MCA flow velocity and postoperative CVR. Multivariate analysis showed that the presence of a lower estimated glomerular filtration rate (eGFR) was an independent risk factor for a decrease in CVR (p = 0.036). CONCLUSIONS A higher eGFR might have prognostic value for improvement in CVR after EC-IC bypass surgery in patients with CASD and misery perfusion.
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35
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Evaluation of cerebrovascular reserve in patients with cerebrovascular diseases using resting-state MRI: A feasibility study. Magn Reson Imaging 2019; 59:46-52. [PMID: 30849484 DOI: 10.1016/j.mri.2019.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/03/2019] [Accepted: 03/04/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To demonstrate the feasibility of mapping cerebrovascular reactivity (CVR) using resting-state functional MRI (fMRI) data without gas or other challenges in patients with cerebrovascular diseases and to show that brain regions affected by the diseases have diminished vascular reactivity. MATERIALS AND METHODS Two sub-studies were performed on patients with stroke and Moyamoya disease. In Study 1, 20 stroke patients (56.3 ± 9.7 years, 7 females) were enrolled and resting-state blood‑oxygenation-level-dependent (rs-BOLD) fMRI data were collected, from which CVR maps were computed. CVR values were compared across lesion, perilesional and control ROIs defined on anatomic images. Reproducibility of the CVR measurement was tested in 6 patients with follow-up scans. In Study 2, rs-BOLD fMRI and dynamic susceptibility contrast (DSC) MRI scans were collected in 5 patients with Moyamoya disease (32.4 ± 8.2 years, 4 females). Cerebral blood flow (CBF), cerebral blood volume (CBV), and time-to-peak (TTP) maps were obtained from the DSC MRI data. CVR values were compared between stenotic brain regions and control regions perfused by non-stenotic arteries. RESULTS In stroke patients, lesion CVR (0.250 ± 0.055 relative unit (r.u.)) was lower than control CVR (0.731 ± 0.088 r.u., p = 0.0002). CVR was also lower in the perilesional regions in a graded manner (perilesion 1 CVR = 0.422 ± 0.051 r.u., perilesion 2 CVR = 0.492 ± 0.046 r.u.), relative to that in the control regions (p = 0.005 and 0.036, respectively). In the repeatability analysis, a strong correlation was observed between lesion CVR (r2 = 0.91, p = 0.006) measured at two time points, as well as between control CVR (r2 = 0.79, p = 0.036) at two time points. In Moyamoya patients, CVR in the perfusion deficit regions delineated by DSC TTP maps (0.178 ± 0.189 r.u.) was lower than that in the control regions (0.868 ± 0.214 r.u., p = 0.013). Furthermore, the extent of reduction in CVR was significantly correlated with the extent of lengthening in TTP (r2 = 0.91, p = 0.033). CONCLUSION Our findings suggested that rs-BOLD data can be used to reproducibly evaluate CVR in patients with cerebrovascular diseases without the use of any vasoactive challenges.
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Effect of Extra-intracranial Bypass on Cerebral Hemodynamics in Treatment of Occlusion-stenotic Disorder of Brahio-cephal Arteries: Applying of Perfusion Computed Tomography. Fam Med 2018. [DOI: 10.30841/2307-5112.4.2018.160823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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37
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Seiler A, Deichmann R, Nöth U, Lauer A, Pfeilschifter W, Singer OC, Wagner M. Extent of Microstructural Tissue Damage Correlates with Hemodynamic Failure in High-Grade Carotid Occlusive Disease: An MRI Study Using Quantitative T2 and DSC Perfusion. AJNR Am J Neuroradiol 2018; 39:1273-1279. [PMID: 29748200 DOI: 10.3174/ajnr.a5666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/15/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Chronic hemodynamic impairment in high-grade carotid occlusive disease is thought to cause microstructural abnormalities that might be subclinical or lead to subtle symptoms including cognitive impairment. Quantitative MR imaging allows assessing pathologic structural changes beyond macroscopically visible tissue damage. In this study, high-resolution quantitative T2 mapping combined with DSC-based PWI was used to investigate quantitative T2 changes as a potential marker of microstructural damage in relation to hemodynamic impairment in patients with unilateral high-grade carotid occlusive disease. MATERIALS AND METHODS Eighteen patients with unilateral high-grade ICA or MCA stenosis/occlusion were included in the study. T2 values and deconvolved perfusion parameters, including relative CBF, relative CBV, and the relative CBF/relative CBV ratio as a potential indicator of local cerebral perfusion pressure, were determined within areas with delayed TTP and compared with values from contralateral unaffected areas after segmentation of normal-appearing hypoperfused WM and cortical regions. Hemispheric asymmetry indices were calculated for all parameters. RESULTS Quantitative T2 was significantly prolonged (P < .01) in hypoperfused tissue and correlated significantly (P < .01) with TTP delay and relative CBF/relative CBV reduction in WM. Significant correlations (P < .001) between TTP delay and the relative CBF/relative CBV ratio were found both in WM and in cortical areas. CONCLUSIONS Quantitative T2 can be used as a marker of microstructural tissue damage even in normal-appearing GM and WM within a vascular territory affected by high-grade carotid occlusive disease. Furthermore, the extent of damage correlates with the degree of hemodynamic failure measured by DSC perfusion parameters.
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Affiliation(s)
- A Seiler
- From the Department of Neurology (A.S., W.P., O.C.S.)
| | | | - U Nöth
- Brain Imaging Center (R.D., U.N.)
| | - A Lauer
- Institute of Neuroradiology (A.L., M.W.), Goethe University Frankfurt, Frankfurt, Germany
| | | | - O C Singer
- From the Department of Neurology (A.S., W.P., O.C.S.)
| | - M Wagner
- Institute of Neuroradiology (A.L., M.W.), Goethe University Frankfurt, Frankfurt, Germany
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Functional State of the Mitochondria from Tissues of the Rat Brain after Chronic Occlusion of the Common Carotid Artery: Role of Lysyl Oxidase. NEUROPHYSIOLOGY+ 2018. [DOI: 10.1007/s11062-018-9705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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39
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[Revascularization experience and results in ischaemic cerebrovascular disease: Moyamoya disease and carotid occlusion]. Neurocirugia (Astur) 2018; 29:170-186. [PMID: 29550248 DOI: 10.1016/j.neucir.2018.01.006] [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: 12/20/2017] [Revised: 01/24/2018] [Accepted: 01/31/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cerebral revascularization techniques are an indispensable tool in the current armamentarium of vascular neurosurgeons. We present revascularization surgery experience and results in both moyamoya disease and occlusive cerebral ischaemia. PATIENTS AND METHODS Patients with ischaemic occlusive disease and moyamoya disease who underwent microsurgical revascularization between October 2014 and September 2017 were analysed. RESULTS In the study period, 23 patients with occlusive ischaemic disease underwent microsurgical revascularization. Three patients presented with serious postoperative complications (2 intraparenchymal haemorrhages in the immediate postoperative period and one thrombosis of the femoral artery). All patients, except one, achieved normalization of the cerebral hemodynamic reserve (CHR) in the SPECT study. Twenty patients had a good neurological result, with no ischaemic recurrence of the revascularized territory. Among patients with moyamoya, 20 had moyamoya disease and 5 had moyamoya syndrome with unilateral involvement. Five patients were treated at paediatric age. Haemorrhagic onset occurred in 2 patients. The CHR study showed hemodynamic compromise in all patients. Cerebral SPECT at one year showed resolution of the hemodynamic failure in all patients. There have been 4 postoperative complications (acute subdural hematoma, two subdural collections and one dehiscence of the surgical wound). No patient presented with neurological worsening at 6 and 12months of follow-up. CONCLUSIONS Cerebral revascularization through end-to-side anastomosis between the superficial temporal artery and a cortical branch of the middle cerebral artery is an indisputable technique in the treatment of moyamoya disease and possibly in a subgroup of patients with symptomatic occlusive ischaemic cerebrovascular disease.
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Fierstra J, van Niftrik C, Warnock G, Wegener S, Piccirelli M, Pangalu A, Esposito G, Valavanis A, Buck A, Luft A, Bozinov O, Regli L. Staging Hemodynamic Failure With Blood Oxygen-Level–Dependent Functional Magnetic Resonance Imaging Cerebrovascular Reactivity. Stroke 2018; 49:621-629. [DOI: 10.1161/strokeaha.117.020010] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/03/2017] [Accepted: 11/29/2017] [Indexed: 12/20/2022]
Abstract
Background and Purpose—
Increased stroke risk correlates with hemodynamic failure, which can be assessed with (
15
O-)H
2
O positron emission tomography (PET) cerebral blood flow (CBF) measurements. This gold standard technique, however, is not established for routine clinical imaging. Standardized blood oxygen-level–dependent (BOLD) functional magnetic resonance imaging+CO
2
is a noninvasive and potentially widely applicable tool to assess whole-brain quantitative cerebrovascular reactivity (CVR). We examined the agreement between the 2 imaging modalities and hypothesized that quantitative CVR can be a surrogate imaging marker to assess hemodynamic failure.
Methods—
Nineteen data sets of subjects with chronic cerebrovascular steno-occlusive disease (age, 60±11 years; 4 women) and unilaterally impaired perfusion reserve on Diamox-challenged (
15
O-)H
2
O PET were studied and compared with a standardized BOLD functional magnetic resonance imaging+CO
2
examination within 6 weeks (8±19 days). Agreement between quantitative CBF- and CVR-based perfusion reserve was assessed. Hemodynamic failure was staged according to PET findings: stage 0: normal CBF, normal perfusion reserve; stage I: normal CBF, decreased perfusion reserve; and stage II: decreased CBF, decreased perfusion reserve. The BOLD CVR data set of the same subjects was then matched to the corresponding stage of hemodynamic failure.
Results—
PET-based stage I versus stage II could also be clearly separated with BOLD CVR measurements (CVR for stage I 0.11 versus CVR for stage II −0.03;
P
<0.01). Hemispheric and middle cerebral artery territory difference analyses (ie, affected versus unaffected side) showed a significant correlation for CVR impairment in the affected hemisphere and middle cerebral artery territory (
P
<0.01,
R
2
=0.47 and
P
=0.02,
R
2
= 0.25, respectively).
Conclusions—
BOLD CVR corresponded well to CBF perfusion reserve measurements obtained with (
15
O-)H
2
O-PET, especially for detecting hemodynamic failure in the affected hemisphere and middle cerebral artery territory and for identifying hemodynamic failure stage II. BOLD CVR may, therefore, be considered for prospective studies assessing stroke risk in patients with chronic cerebrovascular steno-occlusive disease, in particular because it can potentially be implemented in routine clinical imaging.
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Affiliation(s)
- Jorn Fierstra
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Christiaan van Niftrik
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Geoffrey Warnock
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Susanne Wegener
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Marco Piccirelli
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Athina Pangalu
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Giuseppe Esposito
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Antonios Valavanis
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Alfred Buck
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Andreas Luft
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Oliver Bozinov
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Luca Regli
- From the Departments of Neurosurgery (J.F., C.v.N., G.E., O.B., L.R.), Neuroradiology (M.P., A.V.), Neurology (S.W., A.L.), Pharmacology and Toxicology (G.W.), and Nuclear Medicine (A.B.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
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Wu X, Wang L, Zhong J, Ko J, Shi L, Soo Y, Leung T, Wong KS, Abrigo J, Chen X. Impact of intracranial artery calcification on cerebral hemodynamic changes. Neuroradiology 2018; 60:357-363. [DOI: 10.1007/s00234-018-1988-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
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Xu B, Li C, Guo Y, Xu K, Yang Y, Yu J. Current understanding of chronic total occlusion of the internal carotid artery. Biomed Rep 2017; 8:117-125. [PMID: 29435269 PMCID: PMC5776422 DOI: 10.3892/br.2017.1033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 01/08/2023] Open
Abstract
At present, there is limited understanding of chronic total occlusion (CTO) of the internal carotid artery (ICA). Therefore, the present report collected related cases from PubMed and reviewed the literature. Cerebral vessels may form collateral circulation immediately or gradually following CTO of the ICA. The natural history of CTO of the ICA includes a variety of outcomes, all of which are biased toward a non-benign progressive process and are characterized by insufficient cerebral perfusion, embolus detachment and cognitive dysfunction. The majority of cases of CTO of the ICA require treatment. In early studies, the results of external-ICA bypass were unsatisfactory, while recanalization is now considered the only viable option. The current treatment indications mainly depend on the degree of injury to the cerebrovascular reserve and the extent to which the oxygen extraction fraction is increased. The length, height and duration of ICA occlusion are also relevant, though more frequently, the condition depends on multiple factors. Endovascular interventional recanalization, carotid endarterectomy (CEA) and hybrid surgery may be conducted in a select group of patients. As novel materials are developed, the success rate of simple recanalization may gradually increase; however, hybrid surgery may be more representative of the current trend, as advanced CEA can remove carotid atherosclerosis plaques, thus reducing the technological demands of the subsequent interventional recanalization. There are many complications that may result from recanalization following CTO of the ICA, including hyperperfusion and technical errors; therefore, the operation must be conducted carefully. If the recanalization is successful, it typically results in a stable improvement of patient condition in the long term. However, despite these conclusions, more studies are required in the future to further improve current understanding of CTO of the ICA.
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Affiliation(s)
- Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Chao Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Multimodality Imaging Assessment of Ocular Ischemic Syndrome. J Ophthalmol 2017; 2017:4169135. [PMID: 29375911 PMCID: PMC5742453 DOI: 10.1155/2017/4169135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/14/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives To assess the underlying mechanisms of OIS and confirm the haemodynamic and retinal structure changes of early OIS. Methods An observational cross-sectional study was conducted of 60 internal carotid artery (ICA) stenosis patients, and they were divided into OIS and control group. Colour doppler imaging, optical coherence tomography, and fundus fluorescein angiography were performed. Results The middle cerebral artery (MCA) stenosis differs significantly between the two groups. More OIS patients had new collateral patency of posterior communicating artery (PCoA) and retrograde flow via the ophthalmic artery (OA) (p < 0.001). The peak systolic velocity (PSV) in central retinal artery (CRA) and choroidal thickness (CT) was significantly reduced in OIS patients (p = 0.001 and p < 0.001). The arm-retina time (ART) and the retinal arteriovenous passage time (AVP) were prolonged in OIS patients (p < 0.001 and p = 0.001). CT, ART, and PSV of the CRA showed high sensitivity, while ART and ICA stenosis grade showed high specificity for the diagnosis of OIS according to ROC curve. Conclusions Patients who suffered from severe ipsilateral ICA stenosis, new collateral patency of PCoAs, and MCA stenosis may be more susceptible to OIS. The most sensitive sign is PSV of CRA and CT, and the most specific sign is ART.
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Kunieda T, Miyake K, Sakamoto H, Iwasaki Y, Iida S, Morise S, Fujita K, Nakamura M, Kaneko S, Kusaka H. Leptomeningeal Collaterals Strongly Correlate with Reduced Cerebrovascular Reactivity Measured by Acetazolamide-challenged Single-photon Emission Computed Tomography Using a Stereotactic Extraction Estimation Analysis in Patients with Unilateral Internal Carotid Artery Stenosis. Intern Med 2017; 56:2857-2863. [PMID: 28943539 PMCID: PMC5709627 DOI: 10.2169/internalmedicine.8397-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the correlation between the angiographic appearance of cerebral collateral pathways or the degree of internal carotid artery stenosis (ICAS) and reduced cerebrovascular reactivity (CVR) estimated by single-photon emission computed tomography (SPECT) image analysis in patients with unilateral ICAS. Methods A retrospective analysis was performed in 42 patients with unilateral ICAS who underwent cerebral angiography and acetazolamide-challenged SPECT of the brain. Cerebral blood flow quantitation was performed using the quantitative SPECT/dual-table autoradiography method. The CVR in the middle cerebral artery (MCA) territory was evaluated using the stereotactic extraction estimation based on the Japanese extracranial-intracranial bypass trial (SEE-JET) program and classified as reduced (<18.4%) or non-reduced (≥18.4%). Angiographic collateralization was classified as circle of Willis (type 1), extracranial-intracranial (type 2), and leptomeningeal (type 3). The degree of ICAS was defined as severe (≥70% stenosis) or non-severe (<70%). Results Eight patients showed reduced CVR, including 6 (46%) of 13 with type 3 collaterals and 2 (7%) of 29 without type 3 collaterals (p=0.006). In contrast, type 1 and type 2 collaterals and severe ICAS were not significantly associated with reduced CVR. Conclusion In patients with unilateral ICAS, leptomeningeal collaterals are strongly correlated with reduced CVR in the MCA territory, which presumably increases the risk of cerebral hyperperfusion after carotid artery stenting (CAS). Therefore, these findings may be clinically applicable to the perioperative management of CAS.
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Affiliation(s)
| | - Kosuke Miyake
- Department of Neurology, Kansai Medical University, Japan
| | | | - Yuko Iwasaki
- Department of Neurology, Kansai Medical University, Japan
| | - Shin Iida
- Department of Neurology, Kansai Medical University, Japan
| | - Satoshi Morise
- Department of Neurology, Kansai Medical University, Japan
| | - Kengo Fujita
- Department of Neurology, Kansai Medical University, Japan
| | | | - Satoshi Kaneko
- Department of Neurology, Kansai Medical University, Japan
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45
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Hirai S, Inaji M, Tanaka Y, Hara S, Nariai T, Maehara T. Correlation between Clinical Presentations and Hemodynamic Parameters Measured by Dynamic Susceptibility Contrast Magnetic Resonance Imaging in Adult Patients with Moyamoya Disease. J Stroke Cerebrovasc Dis 2017; 26:2814-2820. [PMID: 28778721 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/19/2017] [Accepted: 06/30/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The examination of cerebral hemodynamics is indispensable for the clinical management of patients with moyamoya disease (MMD). In this study, we examined the correlation between clinical presentations and hemodynamic parameters measured by dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) in adult patients with MMD. METHODS One hundred fifty-seven hemispheres in 122 adult patients with MMD were examined by DSC-MRI to measure the regional relative cerebral blood volume (CBV) and relative mean transit time (MTT). The patients were divided into 4 groups based on their clinical presentations: a nonsymptomatic (NS), hemorrhagic (H), infarction (I), and transient ischemic attack (T) group. The regional CBV and MTT values were compared among the 4 groups. RESULTS The relative value of CBV was significantly higher in groups T and I than in the NS group (P < .01). The CBV of group H was higher than that of the NS group only in the frontal lobe cortex. There were no significant statistical differences among the 3 symptomatic groups. Prolongation of the MTT in comparison with the cerebellum (MTT delay) was significantly higher in groups T and I than in the NS group in all regions of the cerebral cortex (P < .05). The MTT delay was significantly lower in group H than in group T in the frontal lobe and the Rolandic area (P < .05). CONCLUSIONS Hemodynamic factors measured by DSC-MRI reflected the variable clinical presentations of patients with MMD. DSC-MRI is a useful modality for evaluating the clinical conditions of individual adult patients with MMD.
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Affiliation(s)
- Sakyo Hirai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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46
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Siegel JS, Shulman GL, Corbetta M. Measuring functional connectivity in stroke: Approaches and considerations. J Cereb Blood Flow Metab 2017; 37:2665-2678. [PMID: 28541130 PMCID: PMC5536814 DOI: 10.1177/0271678x17709198] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Recent research has demonstrated the importance of global changes to the functional organization of brain network following stroke. Resting functional magnetic resonance imaging (R-fMRI) is a non-invasive tool that enables the measurement of functional connectivity (FC) across the entire brain while placing minimal demands on the subject. For these reasons, it is a uniquely appealing tool for studying the distant effects of stroke. However, R-fMRI studies rely on a number of premises that cannot be assumed without careful validation in the context of stroke. Here, we describe strategies to identify and mitigate confounds specific to R-fMRI research in cerebrovascular disease. Five main topics are discussed: (a) achieving adequate co-registration of lesioned brains, (b) identifying and removing hemodynamic lags in resting BOLD, (c) identifying other vascular disruptions that affect the resting BOLD signal, (d) selecting an appropriate control cohort, and (e) acquiring sufficient fMRI data to reliably identify FC changes. For each topic, we provide guidelines for steps to improve the interpretability and reproducibility of FC-stroke research. We include a table of confounds and approaches to identify and mitigate each. Our recommendations extend to any research using R-fMRI to study diseases that might alter cerebrovascular flow and dynamics or brain anatomy.
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Affiliation(s)
- Joshua S Siegel
- 1 Department of Neurology, Washington University School of Medicine, St. Louis, USA
| | - Gordon L Shulman
- 1 Department of Neurology, Washington University School of Medicine, St. Louis, USA
| | - Maurizio Corbetta
- 1 Department of Neurology, Washington University School of Medicine, St. Louis, USA.,2 Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, USA.,3 Department of Psychology, Washington University School of Medicine, St. Louis, USA.,4 Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, USA.,5 Department of Neuroscience, University of Padua, Padua, Italy
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47
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Zaninovich OA, Ramey WL, Walter CM, Dumont TM. Completion of the Circle of Willis Varies by Gender, Age, and Indication for Computed Tomography Angiography. World Neurosurg 2017; 106:953-963. [PMID: 28736349 DOI: 10.1016/j.wneu.2017.07.084] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The circle of Willis (CoW) is the foremost anastomosis and blood distribution center of the brain. Its effectiveness depends on its completion and the size and patency of its vessels. Gender-related and age-related anatomic variations in the CoW may play an important role in the pathogenesis of cerebrovascular diseases. In this study, we analyzed computed tomography angiograms (CTAs) to assess for differences in CoW completion related to gender, age, and indication for CTA. METHODS A total of 834 CTAs were retrospectively analyzed for all CoW vessels to compare the incidence of complete CoW and variation frequency based on gender, age, and indication. RESULTS The incidence of complete CoW was 37.1% overall. CoW completion showed a statistically significant decrease with increasing age for all age groups in both men (47.0%, 29.4%, 18.8%) and women (59.1%, 44.2%, 30.9%). Completion was greater in women (43.8%) than in men (31.2%) overall and for all age groups. These gender differences were all statistically significant except for the 18-39 years age group. The most frequent of the 28 CoW variations were absent posterior communicating artery (PCOM) bilaterally (17.1%), right PCOM (15.3%), and left PCOM (10.9%). Ischemic stroke and the 18-39 years age group of hemorrhagic stroke showed a statistically significant reduction in completion relative to trauma. CONCLUSIONS The incidence of complete CoW is likely greater in women for all age groups and likely decreases with age in both genders. The most frequently absent vessel is likely the PCOM, either unilaterally or bilaterally. Completion may play a role in ischemic stroke and a subset of patients with hemorrhagic stroke.
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Affiliation(s)
| | - Wyatt L Ramey
- Division of Neurosurgery, Banner University Medical Center, Tucson, Arizona, USA
| | - Christina M Walter
- Division of Neurosurgery, Banner University Medical Center, Tucson, Arizona, USA
| | - Travis M Dumont
- Division of Neurosurgery, Banner University Medical Center, Tucson, Arizona, USA.
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48
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Changes in Hemodynamic Response Patterns in Motor Cortices Measured by Task-Based Functional Magnetic Resonance Imaging in Patients With Moyamoya Disease. J Comput Assist Tomogr 2017; 41:461-466. [PMID: 27801696 DOI: 10.1097/rct.0000000000000542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We aimed to study the value of blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) in assessing cerebral hemodynamic changes for moyamoya disease (MMD). METHODS We recruited 15 healthy volunteers, 15 patients with MMD without dyskinesia, and 30 patients with MMD who experienced paroxysmal limb dyskinesia. The BOLD-fMRI scans were obtained during grasping motions of the left or right hand. Hemodynamic response curves in the primary motor cortices were generated. Six response parameters including negative response time (Tnr), maximum signal intensity of negative response, time to peak, maximum peak arrival time, maximum signal intensity of positive response, and positive response time were measured. RESULTS The hemodynamic response curve in the primary motor cortices of MMD patients showed extended Tnr, prolonged positive response time, and delayed time to peak than those of the controls. The response curve showed longer Tnr and maximum peak arrival time in the primary motor cortices on the affected side of the dyskinesia group. CONCLUSIONS Blood oxygen level-dependent fMRI is an effective technique to assess hemodynamic changes in patients with MMD.
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49
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Chen X, Zhao H, Chen Z, Qiao H, Cui Y, Li D, Zhou Z, He L, Li R, Yuan C, Zhao X. Association between proximal internal carotid artery steno-occlusive disease and diffuse wall thickening in its petrous segment: a magnetic resonance vessel wall imaging study. Neuroradiology 2017; 59:485-490. [PMID: 28357461 DOI: 10.1007/s00234-017-1825-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/15/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE Significant stenosis or occlusion in carotid arteries may lead to diffuse wall thickening (DWT) in the arterial wall of downstream. This study aimed to investigate the correlation between proximal internal carotid artery (ICA) steno-occlusive disease and DWT in ipsilateral petrous ICA. METHODS Symptomatic patients with atherosclerotic stenosis (>0%) in proximal ICA were recruited and underwent carotid MR vessel wall imaging. The 3D motion sensitized-driven equilibrium prepared rapid gradient-echo (3D-MERGE) was acquired for characterizing the wall thickness and longitudinal extent of the lesions in petrous ICA and the distance from proximal lesion to the petrous ICA. The stenosis degree in proximal ICA was measured on the time-of-flight (TOF) images. RESULTS In total, 166 carotid arteries from 125 patients (mean age 61.0 ± 10.5 years, 99 males) were eligible for final analysis and 64 showed DWT in petrous ICAs. The prevalence of severe DWT in petrous ICA was 1.4%, 5.3%, 5.9%, and 80.4% in ipsilateral proximal ICAs with stenosis category of 1%-49%, 50%-69%, 70%-99%, and total occlusion, respectively. Proximal ICA stenosis was significantly correlated with the wall thickness in petrous ICA (r = 0.767, P < 0.001). Logistic regression analysis showed that proximal ICA stenosis was independently associated with DWT in ipsilateral petrous ICA (odds ratio (OR) = 2.459, 95% confidence interval (CI) 1.896-3.189, P < 0.001]. CONCLUSION Proximal ICA steno-occlusive disease is independently associated with DWT in ipsilateral petrous ICA.
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Affiliation(s)
- Xiaoyi Chen
- Center for Brain Disorders Research, Capital Medical University and Beijing Institute for Brain Disorders, Beijing, China.,Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhensen Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Yuanyuan Cui
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Dongye Li
- Center for Brain Disorders Research, Capital Medical University and Beijing Institute for Brain Disorders, Beijing, China.,Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Zechen Zhou
- Healthcare Department, Philips Research China, Beijing, China
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China.,Department of Radiology, University of Washington, Seattle, WA, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China. .,Center for Stroke, Beijing Institute for Brain Disorders, Beijing, China.
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50
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Thompson CK, Walenski M, Chen Y, Caplan D, Kiran S, Rapp B, Grunewald K, Nunez M, Zinbarg R, Parrish TB. Intrahemispheric Perfusion in Chronic Stroke-Induced Aphasia. Neural Plast 2017; 2017:2361691. [PMID: 28357141 PMCID: PMC5357554 DOI: 10.1155/2017/2361691] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/17/2017] [Accepted: 01/26/2017] [Indexed: 01/12/2023] Open
Abstract
Stroke-induced alterations in cerebral blood flow (perfusion) may contribute to functional language impairments and recovery in chronic aphasia. Using MRI, we examined perfusion in the right and left hemispheres of 35 aphasic and 16 healthy control participants. Across 76 regions (38 per hemisphere), no significant between-subjects differences were found in the left, whereas blood flow in the right was increased in the aphasic compared to the control participants. Region-of-interest (ROI) analyses showed a varied pattern of hypo- and hyperperfused regions across hemispheres in the aphasic participants; however, there were no significant correlations between perfusion values and language abilities in these regions. These patterns may reflect autoregulatory changes in blood flow following stroke and/or increases in general cognitive effort, rather than maladaptive language processing. We also examined blood flow in perilesional tissue, finding the greatest hypoperfusion close to the lesion (within 0-6 mm), with greater hypoperfusion in this region compared to more distal regions. In addition, hypoperfusion in this region was significantly correlated with language impairment. These findings underscore the need to consider cerebral perfusion as a factor contributing to language deficits in chronic aphasia as well as recovery of language function.
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Affiliation(s)
- Cynthia K. Thompson
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Matthew Walenski
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - YuFen Chen
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - David Caplan
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Swathi Kiran
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Speech, Language, and Hearing, College of Health & Rehabilitation, Boston University, Boston, MA, USA
| | - Brenda Rapp
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Cognitive Science, Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Kristin Grunewald
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, USA
| | - Mia Nunez
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, USA
| | - Richard Zinbarg
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, USA
| | - Todd B. Parrish
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
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