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Obdeijn IV, Wiegers EC, Alic L, Plasschaert SLA, Kranendonk MEG, Hoogduin HM, Klomp DWJ, Wijnen JP, Lequin MH. Amide proton transfer weighted imaging in pediatric neuro-oncology: initial experience. NMR Biomed 2024; 37:e5122. [PMID: 38369653 DOI: 10.1002/nbm.5122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/22/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
Amide proton transfer weighted (APTw) imaging enables in vivo assessment of tissue-bound mobile proteins and peptides through the detection of chemical exchange saturation transfer. Promising applications of APTw imaging have been shown in adult brain tumors. As pediatric brain tumors differ from their adult counterparts, we investigate the radiological appearance of pediatric brain tumors on APTw imaging. APTw imaging was conducted at 3 T. APTw maps were calculated using magnetization transfer ratio asymmetry at 3.5 ppm. First, the repeatability of APTw imaging was assessed in a phantom and in five healthy volunteers by calculating the within-subject coefficient of variation (wCV). APTw images of pediatric brain tumor patients were analyzed retrospectively. APTw levels were compared between solid tumor tissue and normal-appearing white matter (NAWM) and between pediatric high-grade glioma (pHGG) and pediatric low-grade glioma (pLGG) using t-tests. APTw maps were repeatable in supratentorial and infratentorial brain regions (wCV ranged from 11% to 39%), except those from the pontine region (wCV between 39% and 50%). APTw images of 23 children with brain tumor were analyzed (mean age 12 years ± 5, 12 male). Significantly higher APTw values are present in tumor compared with NAWM for both pHGG and pLGG (p < 0.05). APTw values were higher in pLGG subtype pilocytic astrocytoma compared with other pLGG subtypes (p < 0.05). Non-invasive characterization of pediatric brain tumor biology with APTw imaging could aid the radiologist in clinical decision-making.
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Affiliation(s)
- Iris V Obdeijn
- Center for Image Sciences, High Field MR Research Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evita C Wiegers
- Center for Image Sciences, High Field MR Research Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lejla Alic
- Magnetic Detection and Imaging Group, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Sabine L A Plasschaert
- Department of Pediatric Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Mariëtte E G Kranendonk
- Department of Diagnostic Laboratory, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Hans M Hoogduin
- Center for Image Sciences, High Field MR Research Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis W J Klomp
- Center for Image Sciences, High Field MR Research Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jannie P Wijnen
- Center for Image Sciences, High Field MR Research Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten H Lequin
- Department of Pediatric Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Radiology and Nuclear Medicine, University of Medical Center Utrecht, Utrecht, The Netherlands
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Shams Z, Klomp DWJ, Boer VO, Wijnen JP, Wiegers EC. Identifying the source of spurious signals caused by B 0 inhomogeneities in single-voxel 1 H MRS. Magn Reson Med 2022; 88:71-82. [PMID: 35344600 PMCID: PMC9311141 DOI: 10.1002/mrm.29222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/04/2022] [Accepted: 02/19/2022] [Indexed: 12/04/2022]
Abstract
Purpose Single‐voxel MRS (SV MRS) requires robust volume localization as well as optimized crusher and phase‐cycling schemes to reduce artifacts arising from signal outside the volume of interest. However, due to local magnetic field gradients (B0 inhomogeneities), signal that was dephased by the crusher gradients during acquisition might rephase, leading to artifacts in the spectrum. Here, we analyzed this mechanism, aiming to identify the source of signals arising from unwanted coherence pathways (spurious signals) in SV MRS from a B0 map. Methods We investigated all possible coherence pathways associated with imperfect localization in a semi‐localized by adiabatic selective refocusing (semi‐LASER) sequence for potential rephasing of signals arising from unwanted coherence pathways by a local magnetic field gradient. We searched for locations in the B0 map where the signal dephasing due to external (crusher) and internal (B0) field gradients canceled out. To confirm the mechanism, SV‐MR spectra (TE = 31 ms) and 3D‐CSI data with the same volume localization as the SV experiments were acquired from a phantom and 2 healthy volunteers. Results Our analysis revealed that potential sources of spurious signals were scattered over multiple locations throughout the brain. This was confirmed by 3D‐CSI data. Moreover, we showed that the number of potential locations where spurious signals could originate from monotonically decreases with crusher strength. Conclusion We proposed a method to identify the source of spurious signals in SV 1H MRS using a B0 map. This can facilitate MRS sequence design to be less sensitive to experimental artifacts.
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Affiliation(s)
- Zahra Shams
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis W J Klomp
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vincent O Boer
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jannie P Wijnen
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evita C Wiegers
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
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Henriksen OM, del Mar Álvarez-Torres M, Figueiredo P, Hangel G, Keil VC, Nechifor RE, Riemer F, Schmainda KM, Warnert EAH, Wiegers EC, Booth TC. High-Grade Glioma Treatment Response Monitoring Biomarkers: A Position Statement on the Evidence Supporting the Use of Advanced MRI Techniques in the Clinic, and the Latest Bench-to-Bedside Developments. Part 1: Perfusion and Diffusion Techniques. Front Oncol 2022; 12:810263. [PMID: 35359414 PMCID: PMC8961422 DOI: 10.3389/fonc.2022.810263] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/05/2022] [Indexed: 01/16/2023] Open
Abstract
Objective Summarize evidence for use of advanced MRI techniques as monitoring biomarkers in the clinic, and highlight the latest bench-to-bedside developments. Methods Experts in advanced MRI techniques applied to high-grade glioma treatment response assessment convened through a European framework. Current evidence regarding the potential for monitoring biomarkers in adult high-grade glioma is reviewed, and individual modalities of perfusion, permeability, and microstructure imaging are discussed (in Part 1 of two). In Part 2, we discuss modalities related to metabolism and/or chemical composition, appraise the clinic readiness of the individual modalities, and consider post-processing methodologies involving the combination of MRI approaches (multiparametric imaging) or machine learning (radiomics). Results High-grade glioma vasculature exhibits increased perfusion, blood volume, and permeability compared with normal brain tissue. Measures of cerebral blood volume derived from dynamic susceptibility contrast-enhanced MRI have consistently provided information about brain tumor growth and response to treatment; it is the most clinically validated advanced technique. Clinical studies have proven the potential of dynamic contrast-enhanced MRI for distinguishing post-treatment related effects from recurrence, but the optimal acquisition protocol, mode of analysis, parameter of highest diagnostic value, and optimal cut-off points remain to be established. Arterial spin labeling techniques do not require the injection of a contrast agent, and repeated measurements of cerebral blood flow can be performed. The absence of potential gadolinium deposition effects allows widespread use in pediatric patients and those with impaired renal function. More data are necessary to establish clinical validity as monitoring biomarkers. Diffusion-weighted imaging, apparent diffusion coefficient analysis, diffusion tensor or kurtosis imaging, intravoxel incoherent motion, and other microstructural modeling approaches also allow treatment response assessment; more robust data are required to validate these alone or when applied to post-processing methodologies. Conclusion Considerable progress has been made in the development of these monitoring biomarkers. Many techniques are in their infancy, whereas others have generated a larger body of evidence for clinical application.
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Affiliation(s)
- Otto M. Henriksen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Patricia Figueiredo
- Department of Bioengineering and Institute for Systems and Robotics-Lisboa, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Gilbert Hangel
- Department of Neurosurgery, Medical University, Vienna, Austria
- High-Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University, Vienna, Austria
| | - Vera C. Keil
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Ruben E. Nechifor
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Kathleen M. Schmainda
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Evita C. Wiegers
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Thomas C. Booth
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School of Biomedical Engineering and Imaging Sciences, St. Thomas’ Hospital, King’s College London, London, United Kingdom
- Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
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van Meijel LA, van Asten JJA, Grandjean J, Heerschap A, Tack CJ, van der Graaf M, Wiegers EC, de Galan BE. Effect of lactate administration on cerebral blood flow during hypoglycemia in people with type 1 diabetes. BMJ Open Diabetes Res Care 2022; 10:10/2/e002401. [PMID: 35321886 PMCID: PMC8943734 DOI: 10.1136/bmjdrc-2021-002401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 02/22/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Impaired awareness of hypoglycemia, clinically reflected by the inability to timely detect hypoglycemia, affects approximately 25% of the people with type 1 diabetes. Both altered brain lactate handling and increased cerebral blood flow (CBF) during hypoglycemia appear to be involved in the pathogenesis of impaired awareness of hypoglycemia. Here we examine the effect of lactate on CBF during hypoglycemia. RESEARCH DESIGN AND METHODS Nine people with type 1 diabetes and normal awareness of hypoglycemia underwent two hyperinsulinemic euglycemic-hypoglycemic (3.0 mmol/L) glucose clamps in a 3T MR system, once with sodium lactate infusion and once with sodium chloride infusion. Global and regional changes in CBF were determined using pseudocontinuous arterial spin labeling. RESULTS Lactate (3.3±0.6 vs 0.9±0.2 mmol/L during lactate infusion vs placebo infusion, respectively) suppressed the counter-regulatory hormone responses to hypoglycemia. Global CBF increased considerably in response to intravenous lactate infusion but did not further increase during hypoglycemia. Lactate also blunted the hypoglycemia-induced regional redistribution of CBF towards the thalamus. CONCLUSIONS Elevated lactate levels enhance global CBF and blunt the thalamic CBF response during hypoglycemia in patients with type 1 diabetes, mimicking observations of impaired awareness of hypoglycemia. These findings suggest that alteration of CBF associated with lactate may play a role in some aspects of the development of impaired awareness of hypoglycemia. TRIAL REGISTRATION NUMBER NCT03730909.
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Affiliation(s)
- Lian A van Meijel
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
- Department of Internal Medicine, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Jack J A van Asten
- Department of Medical Imaging/Radiology, Radboudumc, Nijmegen, The Netherlands
| | - Joanes Grandjean
- Department of Medical Imaging/Radiology, Radboudumc, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboudumc, Nijmegen, The Netherlands
| | - Arend Heerschap
- Department of Medical Imaging/Radiology, Radboudumc, Nijmegen, The Netherlands
| | - Cornelis J Tack
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Marinette van der Graaf
- Department of Medical Imaging/Radiology, Radboudumc, Nijmegen, The Netherlands
- Department of Pediatrics, Radboudumc, Nijmegen, The Netherlands
| | - Evita C Wiegers
- Department of Medical Imaging/Radiology, Radboudumc, Nijmegen, The Netherlands
- High Field MR Research Group, Department of Radiology, University Medical Center Utrecht Imaging Division, Utrecht, The Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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Booth TC, Wiegers EC, Warnert EAH, Schmainda KM, Riemer F, Nechifor RE, Keil VC, Hangel G, Figueiredo P, Álvarez-Torres MDM, Henriksen OM. High-Grade Glioma Treatment Response Monitoring Biomarkers: A Position Statement on the Evidence Supporting the Use of Advanced MRI Techniques in the Clinic, and the Latest Bench-to-Bedside Developments. Part 2: Spectroscopy, Chemical Exchange Saturation, Multiparametric Imaging, and Radiomics. Front Oncol 2022; 11:811425. [PMID: 35340697 PMCID: PMC8948428 DOI: 10.3389/fonc.2021.811425] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/28/2021] [Indexed: 01/16/2023] Open
Abstract
Objective To summarize evidence for use of advanced MRI techniques as monitoring biomarkers in the clinic, and to highlight the latest bench-to-bedside developments. Methods The current evidence regarding the potential for monitoring biomarkers was reviewed and individual modalities of metabolism and/or chemical composition imaging discussed. Perfusion, permeability, and microstructure imaging were similarly analyzed in Part 1 of this two-part review article and are valuable reading as background to this article. We appraise the clinic readiness of all the individual modalities and consider methodologies involving machine learning (radiomics) and the combination of MRI approaches (multiparametric imaging). Results The biochemical composition of high-grade gliomas is markedly different from healthy brain tissue. Magnetic resonance spectroscopy allows the simultaneous acquisition of an array of metabolic alterations, with choline-based ratios appearing to be consistently discriminatory in treatment response assessment, although challenges remain despite this being a mature technique. Promising directions relate to ultra-high field strengths, 2-hydroxyglutarate analysis, and the use of non-proton nuclei. Labile protons on endogenous proteins can be selectively targeted with chemical exchange saturation transfer to give high resolution images. The body of evidence for clinical application of amide proton transfer imaging has been building for a decade, but more evidence is required to confirm chemical exchange saturation transfer use as a monitoring biomarker. Multiparametric methodologies, including the incorporation of nuclear medicine techniques, combine probes measuring different tumor properties. Although potentially synergistic, the limitations of each individual modality also can be compounded, particularly in the absence of standardization. Machine learning requires large datasets with high-quality annotation; there is currently low-level evidence for monitoring biomarker clinical application. Conclusion Advanced MRI techniques show huge promise in treatment response assessment. The clinical readiness analysis highlights that most monitoring biomarkers require standardized international consensus guidelines, with more facilitation regarding technique implementation and reporting in the clinic.
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Affiliation(s)
- Thomas C. Booth
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
- Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Evita C. Wiegers
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Kathleen M. Schmainda
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ruben E. Nechifor
- Department of Clinical Psychology and Psychotherapy International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Vera C. Keil
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location VUmc, Amsterdam, Netherlands
| | - Gilbert Hangel
- Department of Neurosurgery & High-Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Patrícia Figueiredo
- Department of Bioengineering and Institute for Systems and Robotics - Lisboa, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | | | - Otto M. Henriksen
- Department of Clinical Physiology, Nuclear medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Shams Z, van der Kemp WJM, Emir U, Dankbaar JW, Snijders TJ, de Vos FYF, Klomp DWJ, Wijnen JP, Wiegers EC. Comparison of 2-Hydroxyglutarate Detection With sLASER and MEGA-sLASER at 7T. Front Neurol 2021; 12:718423. [PMID: 34557149 PMCID: PMC8452903 DOI: 10.3389/fneur.2021.718423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/05/2021] [Indexed: 12/15/2022] Open
Abstract
The onco-metabolite 2-hydroxyglutarate (2HG), a biomarker of IDH-mutant gliomas, can be detected with 1H MR spectroscopy (1H-MRS). Recent studies showed measurements of 2HG at 7T with substantial gain in signal to noise ratio (SNR) and spectral resolution, offering higher specificity and sensitivity for 2HG detection. In this study, we assessed the sensitivity of semi-localized by adiabatic selective refocusing (sLASER) and J-difference MEsher-GArwood-semi-LASER (MEGA-sLASER) for 2HG detection at 7T. We performed spectral editing at long TE using a TE-optimized sLASER sequence (110 ms) and J-difference spectroscopy using MEGA-sLASER (TE = 74ms) in phantoms with different 2HG concentrations to assess the sensitivity of 2HG detection. The robustness of the methods against B0 inhomogeneity was investigated. Moreover, the performance of these two techniques was evaluated in four patients with IDH1-mutated glioma. In contrary to MEGA-sLASER, sLASER was able to detect 2HG concentration as low as 0.5 mM. In case of a composite phantom containing 2HG with overlapping metabolites, MEGA-sLASER provided a clean 2HG signal with higher fitting reliability (lower %CRLB). The results demonstrate that sLASER is more robust against field inhomogeneities and experimental or motion-related artifacts which promotes to adopt sLASER in clinical implementations.
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Affiliation(s)
- Zahra Shams
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Uzay Emir
- School of Health Sciences, Purdue University, West Lafayette, IN, United States
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tom J Snijders
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/UMC Utrecht Brain Center, Utrecht, Netherlands
| | - Filip Y F de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dennis W J Klomp
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jannie P Wijnen
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Evita C Wiegers
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
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7
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Schmitz-Abecassis B, Vinogradov E, Wijnen JP, van Harten T, Wiegers EC, Hoogduin H, van Osch MJP, Ercan E. The use of variable delay multipulse chemical exchange saturation transfer for separately assessing different CEST pools in the human brain at 7T. Magn Reson Med 2021; 87:872-883. [PMID: 34520077 PMCID: PMC9290048 DOI: 10.1002/mrm.29005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Current challenges of in vivo CEST imaging include overlapping signals from different pools. The overlap arises from closely resonating pools and/or the broad magnetization transfer contrast (MTC) from macromolecules. This study aimed to evaluate the feasibility of variable delay multipulse (VDMP) CEST to separately assess solute pools with different chemical exchange rates in the human brain in vivo, while mitigating the MTC. METHODS VDMP saturation buildup curves were simulated for amines, amides, and relayed nuclear Overhauser effect. VDMP data were acquired from glutamate and bovine serum albumin phantoms, and from six healthy volunteers at 7T. For the in vivo data, MTC removal was performed via a three-pool Lorentzian fitting. Different B1 amplitudes and mixing times were used to evaluate CEST pools with different exchange rates. RESULTS The results show the importance of removing MTC when applying VDMP in vivo and the influence of B1 for distinguishing different pools. Finally, the optimal B1 and mixing times to effectively saturate slow- and fast-exchanging components are also reported. Slow-exchanging amides and rNOE components could be distinguished when using B1 = 1 μT and tmix = 10 ms and 40 ms, respectively. Fast-exchanging components reached the highest saturation when using a B1 = 2.8 μT and tmix = 0 ms. CONCLUSION VDMP is a powerful CEST-editing tool, exploiting chemical exchange-rate differences. After MTC removal, it allows separate assessment of slow- and fast-exchanging solute pools in in vivo human brain.
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Affiliation(s)
- Bárbara Schmitz-Abecassis
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elena Vinogradov
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA.,Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jannie P Wijnen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thijs van Harten
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Evita C Wiegers
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans Hoogduin
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthias J P van Osch
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ece Ercan
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Annink KV, van der Aa NE, Dudink J, Alderliesten T, Groenendaal F, Lequin M, Jansen FE, Rhebergen KS, Luijten P, Hendrikse J, Hoogduin HJM, Huijing ER, Versteeg E, Visser F, Raaijmakers AJE, Wiegers EC, Klomp DWJ, Wijnen JP, Benders MJNL. Introduction of Ultra-High-Field MR Imaging in Infants: Preparations and Feasibility. AJNR Am J Neuroradiol 2020; 41:1532-1537. [PMID: 32732273 DOI: 10.3174/ajnr.a6702] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral MR imaging in infants is usually performed with a field strength of up to 3T. In adults, a growing number of studies have shown added diagnostic value of 7T MR imaging. 7T MR imaging might be of additional value in infants with unexplained seizures, for example. The aim of this study was to investigate the feasibility of 7T MR imaging in infants. We provide information about the safety preparations and show the first MR images of infants at 7T. MATERIALS AND METHODS Specific absorption rate levels during 7T were simulated in Sim4life using infant and adult models. A newly developed acoustic hood was used to guarantee hearing protection. Acoustic noise damping of this hood was measured and compared with the 3T Nordell hood and no hood. In this prospective pilot study, clinically stable infants, between term-equivalent age and the corrected age of 3 months, underwent 7T MR imaging immediately after their standard 3T MR imaging. The 7T scan protocols were developed and optimized while scanning this cohort. RESULTS Global and peak specific absorption rate levels in the infant model in the centered position and 50-mm feet direction did not exceed the levels in the adult model. Hearing protection was guaranteed with the new hood. Twelve infants were scanned. No MR imaging-related adverse events occurred. It was feasible to obtain good-quality imaging at 7T for MRA, MRV, SWI, single-shot T2WI, and MR spectroscopy. T1WI had lower quality at 7T. CONCLUSIONS 7T MR imaging is feasible in infants, and good-quality scans could be obtained.
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Affiliation(s)
- K V Annink
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| | - N E van der Aa
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| | - J Dudink
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| | - T Alderliesten
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| | - F Groenendaal
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| | - M Lequin
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - F E Jansen
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| | - K S Rhebergen
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - P Luijten
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - J Hendrikse
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - H J M Hoogduin
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - E R Huijing
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - E Versteeg
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - F Visser
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - A J E Raaijmakers
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - E C Wiegers
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - D W J Klomp
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - J P Wijnen
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - M J N L Benders
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
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9
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Wiegers EC, Rooijackers HM, Tack CJ, Philips BW, Heerschap A, van der Graaf M, de Galan BE. Effect of lactate administration on brain lactate levels during hypoglycemia in patients with type 1 diabetes. J Cereb Blood Flow Metab 2019; 39:1974-1982. [PMID: 29749805 PMCID: PMC6775588 DOI: 10.1177/0271678x18775884] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Administration of lactate during hypoglycemia suppresses symptoms and counterregulatory responses, as seen in patients with type 1 diabetes and impaired awareness of hypoglycemia (IAH), presumably because lactate can substitute for glucose as a brain fuel. Here, we examined whether lactate administration, in a dose sufficient to impair awareness of hypoglycemia, affects brain lactate levels in patients with normal awareness of hypoglycemia (NAH). Patients with NAH (n = 6) underwent two euglycemic-hypoglycemic clamps (2.8 mmol/L), once with sodium lactate infusion (NAH w|lac) and once with saline infusion (NAH w|placebo). Results were compared to those obtained during lactate administration in patients with IAH (n = 7) (IAH w|lac). Brain lactate levels were determined continuously with J-difference editing 1H-MRS. During lactate infusion, symptom and adrenaline responses to hypoglycemia were considerably suppressed in NAH. Infusion of lactate increased brain lactate levels modestly, but comparably, in both groups (mean increase in NAH w|lac: 0.12 ± 0.05 µmol/g and in IAH w|lac: 0.06 ± 0.04 µmol/g). The modest increase in brain lactate may suggest that the excess of lactate is immediately metabolized by the brain, which in turn may explain the suppressive effects of lactate on awareness of hypoglycemia observed in patients with NAH.
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Affiliation(s)
- Evita C Wiegers
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Hanne M Rooijackers
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Bart Wj Philips
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Arend Heerschap
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Marinette van der Graaf
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands.,Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
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10
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Herpers PCM, Bakker-Huvenaars MJ, Greven CU, Wiegers EC, Nijhof KS, Baanders AN, Buitelaar JK, Rommelse NNJ. Emotional valence detection in adolescents with oppositional defiant disorder/conduct disorder or autism spectrum disorder. Eur Child Adolesc Psychiatry 2019; 28:1011-1022. [PMID: 30680520 DOI: 10.1007/s00787-019-01282-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
Oppositional defiant disorder, conduct disorder (ODD/CD), and autism spectrum disorder (ASD) share poor empathic functioning and have been associated with impaired emotional processing. However, no previous studies directly compared similarities and differences in these processes for the two disorders. A two-choice emotional valence detection task requiring differentiation between positive, negative, and neutral IAPS pictures was administered to 52 adolescents (12-19 years) with ODD/CD, 52 with ASD and 24 typically developing individuals (TDI). Callous-unemotional (CU) traits were assessed by self- and parent reports using the Inventory of callous-unemotional traits. Main findings were that adolescents with ODD/CD or ASD both performed poorer than TDI in terms of accuracy, yet only the TDI-not both clinical groups-had relatively most difficulty in discriminating between positive versus neutral pictures compared to neutral-negative or positive-negative contrasts. Poorer performance was related to a higher level of CU traits. The results of the current study suggest youth with ODD/CD or ASD have a diminished ability to detect emotional valence which is not limited to facial expressions and is related to a higher level of CU traits. More specifically, youth with ODD/CD or ASD seem to have a reduced processing of positive stimuli and/or lack a 'positive perception bias' present in TDI that could either contribute to the symptoms and/or be a result of having the disorder and may contribute to the comorbidity of both disorders.
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Affiliation(s)
- Pierre C M Herpers
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands. .,Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands.
| | - Mireille J Bakker-Huvenaars
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands
| | - Corina U Greven
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands.,Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Evita C Wiegers
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.,Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Karin S Nijhof
- Pluryn, Industrieweg 50, 6541 TW, Nijmegen, The Netherlands.,Behavioural Science Institute, Developmental Psychopathology, Radboud University Nijmegen, Montessorilaan 3, 6500 HE, Nijmegen, The Netherlands
| | - Arianne N Baanders
- Ottho Gerhard Heldring Foundation, Wageningsestraat 104, 6671 DH, Zetten, The Netherlands
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands
| | - Nanda N J Rommelse
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.,Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands
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11
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Wiegers EC, Rooijackers HM, van Asten JJA, Tack CJ, Heerschap A, de Galan BE, van der Graaf M. Elevated brain glutamate levels in type 1 diabetes: correlations with glycaemic control and age of disease onset but not with hypoglycaemia awareness status. Diabetologia 2019; 62:1065-1073. [PMID: 31001674 PMCID: PMC6509078 DOI: 10.1007/s00125-019-4862-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/04/2019] [Indexed: 12/27/2022]
Abstract
AIMS/HYPOTHESIS Chronic hyperglycaemia in type 1 diabetes affects the structure and functioning of the brain, but the impact of recurrent hypoglycaemia is unclear. Changes in the neurochemical profile have been linked to loss of neuronal function. We therefore aimed to investigate the impact of type 1 diabetes and burden of hypoglycaemia on brain metabolite levels, in which we assumed the burden to be high in individuals with impaired awareness of hypoglycaemia (IAH) and low in those with normal awareness of hypoglycaemia (NAH). METHODS We investigated 13 non-diabetic control participants, 18 individuals with type 1 diabetes and NAH and 13 individuals with type 1 diabetes and IAH. Brain metabolite levels were determined by analysing previously obtained 1H magnetic resonance spectroscopy data, measured under hyperinsulinaemic-euglycaemic conditions. RESULTS Brain glutamate levels were higher in participants with diabetes, both with NAH (+15%, p = 0.013) and with IAH (+19%, p = 0.003), compared with control participants. Cerebral glutamate levels correlated with HbA1c levels (r = 0.40; p = 0.03) and correlated inversely (r = -0.36; p = 0.04) with the age at diagnosis of diabetes. Other metabolite levels did not differ between groups, apart from an increase in aspartate in IAH. CONCLUSIONS/INTERPRETATION In conclusion, brain glutamate levels are elevated in people with type 1 diabetes and correlate with glycaemic control and age of disease diagnosis, but not with burden of hypoglycaemia as reflected by IAH. This suggests a potential role for glutamate as an early marker of hyperglycaemia-induced cerebral complications of type 1 diabetes. ClinicalTrials.gov NCT03286816; NCT02146404; NCT02308293.
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Affiliation(s)
- Evita C Wiegers
- Department of Radiology and Nuclear Medicine (766), Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Hanne M Rooijackers
- Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Jack J A van Asten
- Department of Radiology and Nuclear Medicine (766), Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Arend Heerschap
- Department of Radiology and Nuclear Medicine (766), Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Marinette van der Graaf
- Department of Radiology and Nuclear Medicine (766), Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
- Department of Pediatrics, Radboud university medical center, Nijmegen, the Netherlands
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12
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Wiegers EC, Rooijackers HM, Tack CJ, Groenewoud HJMM, Heerschap A, de Galan BE, van der Graaf M. Effect of Exercise-Induced Lactate Elevation on Brain Lactate Levels During Hypoglycemia in Patients With Type 1 Diabetes and Impaired Awareness of Hypoglycemia. Diabetes 2017; 66:3105-3110. [PMID: 28935628 DOI: 10.2337/db17-0794] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/15/2017] [Indexed: 11/13/2022]
Abstract
Since altered brain lactate handling has been implicated in the development of impaired awareness of hypoglycemia (IAH) in type 1 diabetes, the capacity to transport lactate into the brain during hypoglycemia may be relevant in its pathogenesis. High-intensity interval training (HIIT) increases plasma lactate levels. We compared the effect of HIIT-induced hyperlacticacidemia on brain lactate during hypoglycemia between 1) patients with type 1 diabetes and IAH, 2) patients with type 1 diabetes and normal awareness of hypoglycemia, and 3) healthy participants without diabetes (n = 6 per group). All participants underwent a hypoglycemic (2.8 mmol/L) clamp after performing a bout of HIIT on a cycle ergometer. Before HIIT (baseline) and during hypoglycemia, brain lactate levels were determined continuously with J-difference-editing 1H-MRS, and time curves were analyzed using nonlinear mixed-effects modeling. At the beginning of hypoglycemia (after HIIT), brain lactate levels were elevated in all groups but most pronounced in patients with IAH. During hypoglycemia, brain lactate decreased ∼30% below baseline in patients with IAH but returned to baseline levels and remained there in the other two groups. Our results support the concept of enhanced lactate transport as well as increased lactate oxidation in patients with type 1 diabetes and IAH.
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Affiliation(s)
- Evita C Wiegers
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hanne M Rooijackers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hans J M M Groenewoud
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arend Heerschap
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marinette van der Graaf
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, the Netherlands
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13
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Rooijackers HM, Wiegers EC, van der Graaf M, Thijssen DH, Kessels RPC, Tack CJ, de Galan BE. A Single Bout of High-Intensity Interval Training Reduces Awareness of Subsequent Hypoglycemia in Patients With Type 1 Diabetes. Diabetes 2017; 66:1990-1998. [PMID: 28420673 DOI: 10.2337/db16-1535] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/11/2017] [Indexed: 11/13/2022]
Abstract
High-intensity interval training (HIIT) has gained increasing popularity in patients with diabetes. HIIT acutely increases plasma lactate levels. This may be important, since the administration of lactate during hypoglycemia suppresses symptoms and counterregulation while preserving cognitive function. We tested the hypothesis that, in the short term, HIIT reduces awareness of hypoglycemia and attenuates hypoglycemia-induced cognitive dysfunction. In a randomized crossover trial, patients with type 1 diabetes and normal awareness of hypoglycemia (NAH), patients with impaired awareness of hypoglycemia (IAH), and healthy participants (n = 10 per group) underwent a hyperinsulinemic-hypoglycemic (2.6 mmol/L) clamp, either after a HIIT session or after seated rest. Compared with rest, HIIT reduced symptoms of hypoglycemia in patients with NAH but not in healthy participants or patients with IAH. HIIT attenuated hypoglycemia-induced cognitive dysfunction, which was mainly driven by changes in the NAH subgroup. HIIT suppressed cortisol and growth hormone responses, but not catecholamine responses to hypoglycemia. The present findings demonstrate that a single HIIT session rapidly reduces awareness of subsequent hypoglycemia in patients with type 1 diabetes and NAH, but does not in patients with IAH, and attenuates hypoglycemia-induced cognitive dysfunction. The role of exercise-induced lactate in mediating these effects, potentially serving as an alternative fuel for the brain, should be further explored.
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Affiliation(s)
- Hanne M Rooijackers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Evita C Wiegers
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marinette van der Graaf
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dick H Thijssen
- Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, U.K
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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14
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Wiegers EC, Becker KM, Rooijackers HM, von Samson-Himmelstjerna FC, Tack CJ, Heerschap A, de Galan BE, van der Graaf M. Cerebral blood flow response to hypoglycemia is altered in patients with type 1 diabetes and impaired awareness of hypoglycemia. J Cereb Blood Flow Metab 2017; 37:1994-2001. [PMID: 27389175 PMCID: PMC5464695 DOI: 10.1177/0271678x16658914] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
It is unclear whether cerebral blood flow responses to hypoglycemia are altered in people with type 1 diabetes and impaired awareness of hypoglycemia. The aim of this study was to investigate the effect of hypoglycemia on both global and regional cerebral blood flow in type 1 diabetes patients with impaired awareness of hypoglycemia, type 1 diabetes patients with normal awareness of hypoglycemia and healthy controls ( n = 7 per group). The subjects underwent a hyperinsulinemic euglycemic-hypoglycemic glucose clamp in a 3 T MR system. Global and regional changes in cerebral blood flow were determined by arterial spin labeling magnetic resonance imaging, at the end of both glycemic phases. Hypoglycemia generated typical symptoms in patients with type 1 diabetes and normal awareness of hypoglycemia and healthy controls, but not in patients with impaired awareness of hypoglycemia. Conversely, hypoglycemia increased global cerebral blood flow in patients with impaired awareness of hypoglycemia, which was not observed in the other two groups. Regionally, hypoglycemia caused a redistribution of cerebral blood flow towards the thalamus of both patients with normal awareness of hypoglycemia and healthy controls, consistent with activation of brain regions associated with the autonomic response to hypoglycemia. No such redistribution was found in the patients with impaired awareness of hypoglycemia. An increase in global cerebral blood flow may enhance nutrient supply to the brain, hence suppressing symptomatic awareness of hypoglycemia. Altogether these results suggest that changes in cerebral blood flow during hypoglycemia contribute to impaired awareness of hypoglycemia.
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Affiliation(s)
- Evita C Wiegers
- 1 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kirsten M Becker
- 1 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hanne M Rooijackers
- 2 Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Federico C von Samson-Himmelstjerna
- 3 Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany.,4 Faculty of Physics and Electronics, University of Bremen, Bremen, Germany
| | - Cees J Tack
- 2 Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arend Heerschap
- 1 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan E de Galan
- 2 Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marinette van der Graaf
- 1 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,5 Department of Pediatrics, Radboud University Medical Center, Nijmegen, the Netherlands
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15
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Wiegers EC, Rooijackers HM, Tack CJ, Heerschap A, de Galan BE, van der Graaf M. Brain Lactate Concentration Falls in Response to Hypoglycemia in Patients With Type 1 Diabetes and Impaired Awareness of Hypoglycemia. Diabetes 2016; 65:1601-5. [PMID: 26993070 DOI: 10.2337/db16-0068] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/09/2016] [Indexed: 11/13/2022]
Abstract
Brain lactate may be involved in the development of impaired awareness of hypoglycemia (IAH), a condition that affects approximately 25% of patients with type 1 diabetes and increases the risk of severe hypoglycemia. The aim of this study was to investigate the effect of acute hypoglycemia on brain lactate concentration in patients with IAH as compared with those with normal awareness of hypoglycemia (NAH) and healthy control subjects (n = 7 per group). After an overnight fast, all subjects underwent a two-step hyperinsulinemic euglycemic (5.0 mmol/L)-hypoglycemic (2.8 mmol/L) glucose clamp. Brain lactate concentrations were measured continuously with (1)H-MRS using a specific lactate detection method. Hypoglycemia generated symptoms in patients with NAH and healthy control subjects but not in patients with IAH. Brain lactate fell significantly by ∼20% in response to hypoglycemia in patients with type 1 diabetes with IAH but remained stable in both healthy control subjects and in patients with NAH. The fall in brain lactate is compatible with increased brain lactate oxidation providing an alternative fuel source during hypoglycemia, which may contribute to the impaired detection of hypoglycemia.
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Affiliation(s)
- Evita C Wiegers
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Hanne M Rooijackers
- Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Arend Heerschap
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Marinette van der Graaf
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, the Netherlands Department of Pediatrics, Radboud university medical center, Nijmegen, the Netherlands
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16
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Rooijackers HMM, Wiegers EC, Tack CJ, van der Graaf M, de Galan BE. Brain glucose metabolism during hypoglycemia in type 1 diabetes: insights from functional and metabolic neuroimaging studies. Cell Mol Life Sci 2015; 73:705-22. [PMID: 26521082 PMCID: PMC4735263 DOI: 10.1007/s00018-015-2079-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/16/2015] [Accepted: 10/20/2015] [Indexed: 12/30/2022]
Abstract
Hypoglycemia is the most frequent complication of insulin therapy in patients with type 1 diabetes. Since the brain is reliant on circulating glucose as its main source of energy, hypoglycemia poses a threat for normal brain function. Paradoxically, although hypoglycemia commonly induces immediate decline in cognitive function, long-lasting changes in brain structure and cognitive function are uncommon in patients with type 1 diabetes. In fact, recurrent hypoglycemia initiates a process of habituation that suppresses hormonal responses to and impairs awareness of subsequent hypoglycemia, which has been attributed to adaptations in the brain. These observations sparked great scientific interest into the brain’s handling of glucose during (recurrent) hypoglycemia. Various neuroimaging techniques have been employed to study brain (glucose) metabolism, including PET, fMRI, MRS and ASL. This review discusses what is currently known about cerebral metabolism during hypoglycemia, and how findings obtained by functional and metabolic neuroimaging techniques contributed to this knowledge.
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Affiliation(s)
- Hanne M M Rooijackers
- Department of Internal Medicine 463, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Evita C Wiegers
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cees J Tack
- Department of Internal Medicine 463, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marinette van der Graaf
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine 463, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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