Absolute and regional cerebral perfusion assessment feasibility in head-down position with arterial spin-labeling magnetic resonance. A preliminary report on healthy subjects

Pavilla, Aude; Arrigo, Alessandro; Colombani, Sylvie; Mejdoubi, Mehdi

doi:10.1016/j.neurad.2016.03.003

Cited by 10 publications

(9 citation statements)

References 19 publications

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“…Finally, our study was monocentric, which may limit the external validity of our results restricted to patients with large vessel proximal occlusion. These things being said, we believe our findings support the early benefit of TP and that they could motivate further studies in the aim to both increase "proof of concept" evidence [12] and investigate long-term functional outcomes [29]. In particular, we believe that the appropriate assessment of TP intervention safety is an indispensable prerequisite prior to a long-term evaluation of its effectiveness.…”

Section: Discussionsupporting

confidence: 63%

Trendelenburg Positioning in Large Vessel Ischaemic Stroke: A Pre-Post Observational Study Using Propensity Score Matching

et al. 2018

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Background: Along with pharmacological and mechanical recanalization, improving cerebral perfusion through the recruitment of collateral vessels during the acute phase of ischaemic stroke (IS) is a clinical challenge. Our objective was to assess the effectiveness and safety of Trendelenburg positioning (TP), a procedure intended to increase cerebral blood flow, on the outcome of IS. Methods: Two cohorts of patients with an acute supratentorial IS related to a large artery occlusion were compared. In the first cohort (n = 119), we used standard positioning (0 to +30°); in the second cohort (n = 90), we used TP (0 to –15°). The primary outcome measure was the improvement of National Institutes of Health Stroke Scale (NIHSS) score between admission and day 2. Factors associated with an improvement ≥4 points of NIHSS score were assessed using multiple logistic regression and propensity score (PS) matching analyses. Results: TP was significantly associated with a greater improvement of NIHSS score within 48 h following stroke onset (4.0 ± 5.7 vs. 1.8 ± 5.9, p = 0.011) but also at discharge (p = 0.005). Multiple logistic regression analysis suggested that TP was an independent predictor of early neurological improvement (adjusted OR 1.81, 95% CI 1.00–3.27) in a model controlling recanalization and haemoglobin level. In addition, PS matching analysis confirmed the possible effectiveness of TP (unadjusted OR 1.99, 95% CI 1.04–3.82), especially in male subjects. The effect of TP was more pronounced in patients with admission mean arterial blood pressure ≥100 mm Hg, those exhibiting a good collateral vessel network on admission CT-angiography or experiencing an effective recanalization. Furthermore, TP was not associated with life-threatening complications. Conclusion: TP could be an effective and safe strategy in patients with large IS resulting from the proximal occlusion of a large vessel.

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Section: Discussionsupporting

confidence: 63%

Trendelenburg Positioning in Large Vessel Ischaemic Stroke: A Pre-Post Observational Study Using Propensity Score Matching

et al. 2018

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“…Very few studies have focused on HD positioning and they used NIRS or TCD, which provides only an indirect assessment of CBF or cerebral blood volume (CBV). Some studies assume that HD positioning or flat positioning increases CBF, while recent MR studies, measuring CBF indirectly through the phase‐contrast technique or through ASL, found a decrease. Two MRI technological advances enabled the design of our study.…”

Section: Discussionmentioning

confidence: 99%

“…Arterial spin‐labeling (ASL) is an MR perfusion technique providing images of regional CBF without contrast agent injection. In a previous study, the feasibility of using MR to directly assess CBF in the HD position was described …”

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confidence: 99%

Impact of Head‐Down Position on Cerebral Blood Flow in Healthy Subjects: An Arterial Spin‐Labeling MR Perfusion Study

Mejdoubi

Pavilla

Colombani

et al. 2019

Magnetic Resonance Imaging

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Background: A head-down (HD) position is used in some stroke centers to maintain cerebral perfusion (CP) in stroke patients. Purpose: To assess CP in healthy volunteers in the supine and HD (-15 ) positions. Study Type: Prospective. Population: Eighteen healthy subjects of 53 (AE8) years old. Field Strength/Sequence: 1.5T / arterial spin-labeling (ASL) in the supine position and after 4 minutes of HD position. Assessment: Regions of interest from reconstructed cerebral blood-flow (CBF) maps: subcortical nuclear gray matter (accumbens, amygdala, caudate, hippocampus, pallidum, putamen, thalamus), cortical gray matter (cGM), and white matter (WM). We also monitored hemodynamic parameters. Statistical Tests: Shapiro-Wilk test, analysis of variance (ANOVA) tests, Student's t-tests, and Pearson correlation analysis. Results: CBF was higher in women compared to men, whatever the position (mean difference of 17% in supine, and 13% in HD position). From supine to HD position, CBF was decreased in all regions (mean decrease of -7%). Simultaneously, mean arterial pressure and systolic blood pressure increased (respectively P = 0.004 and P < 0.001). Data Conclusion: The CBF decrease, despite increased hemodynamic parameters, may indicate efficient cerebral autoregulation. Our results seem to reflect only early cerebral autoregulation stages but may open the way towards a more precise understanding of CP. Level of Evidence: 1 Technical Efficacy: Stage 2

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“…There are many reports on the CBF and blood flow velocity in the HDT; however, the results of posture‐related blood flow analyses are inconsistent. It is difficult to interpret these previous reports due to diverse bias factors, eg, measured vessel location, procedure, tilt angle, and duration in the HDT . On the basis of our results, we speculate that the ICAs have a higher reactivity to posture changes than the VAs.…”

Section: Discussionmentioning

confidence: 99%

“…It is difficult to interpret these previous reports due to diverse bias factors, eg, measured vessel location, procedure, tilt angle, and duration in the HDT. 13,[24][25][26] On the basis of our results, we speculate that the ICAs have a higher reactivity to posture changes than the VAs. Despite the significant increase in mean blood flow velocity of the ICAs, the tCBF was not significantly affected.…”

Section: Discussionmentioning

confidence: 99%

MRI‐based assessment of acute effect of head‐down tilt position on intracranial hemodynamics and hydrodynamics

Ishida

Miyati

Ohno

et al. 2017

Magnetic Resonance Imaging

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Absolute and regional cerebral perfusion assessment feasibility in head-down position with arterial spin-labeling magnetic resonance. A preliminary report on healthy subjects

Cited by 10 publications

References 19 publications

Trendelenburg Positioning in Large Vessel Ischaemic Stroke: A Pre-Post Observational Study Using Propensity Score Matching

Trendelenburg Positioning in Large Vessel Ischaemic Stroke: A Pre-Post Observational Study Using Propensity Score Matching

Impact of Head‐Down Position on Cerebral Blood Flow in Healthy Subjects: An Arterial Spin‐Labeling MR Perfusion Study

MRI‐based assessment of acute effect of head‐down tilt position on intracranial hemodynamics and hydrodynamics

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