Arterial Spin Labeling and Blood Oxygen Level-Dependent MRI Cerebrovascular Reactivity in Cerebrovascular Disease: A Systematic Review and Meta-Analysis

Abstract

Background: The cerebrovascular reactivity (CVR) results of blood oxygen level-dependent (BOLD) and arterial spin labeling (ASL) MRI studies performed in patients with cerebrovascular disease (steno-occlusive vascular disease or stroke) were systematically reviewed. Summary: Thirty-one articles were included. Twenty-three (74.2%) studies used BOLD MRI to evaluate the CVR, 4 (12.9%) studies used ASL MRI and 4 (12.9%) studies used both BOLD and ASL MRI. Thirteen studies (3 significant) found a lower BOLD CVR, 2 studies found a similar CVR and 3 studies found a higher CVR in the ipsilateral compared to the contralateral hemisphere. Nine (5 significant) out of 10 studies found a lower BOLD CVR in the ipsilateral hemispheres of patients compared to controls. Six studies (2 significant) found a lower ASL CVR in the ipsilateral compared to the contralateral hemispheres. Three out of 5 studies found a significant lower ASL CVR in the ipsilateral hemispheres of patients compared to controls. Key Messages: This review brings support for a reduced BOLD and ASL CVR in the ipsilateral hemisphere of patients with cerebrovascular disease. We suggest that future studies will be performed in a uniform way so reference values can be established and could be used to guide treatment decisions in patients with cerebrovascular disease.

Decreased Cerebrovascular Reserve is the Initial Cause of White Matter Hyperintensity Related Cognitive Decline

“…Assessment of CVR by breath-holding index of middle cerebral arteries via transcranial doppler ultrasound has found global CVR decreased as the severity of WMH increased and associated with cognitive performance [34]. Findings from BOLD-based CVR studies remain controversial [16]. Some studies reported whole brain CVR was not related to WMH [42,43], but others showed decreased CVR at baseline can predict the process of WMH lesions [18,44,45].…”

“…Impaired CVR is correlated closely with normal aging [13] and might be a sensitive early predictor of Alzheimer's disease [14]. In addition, it is reported that impaired CVR is the most reliable neuroimaging predictor of impending cerebrovascular disease [15,16], and could be a neuroimaging marker guiding the treatment and prevention of stroke and cerebral small vessel disease (CSVD) [17,18]. Furthermore, increasing evidences have demonstrated that CVR function is associated with subtle perfusion and microstructure changes in normal-appearing white matter (NAWM) [19], and has been involved in the pathophysiology disruption of the brain network connectome in individuals with WMH [20].…”

Acetazolamide-augmented dynamic BOLD (aczBOLD) imaging for assessing cerebrovascular reactivity in chronic steno-occlusive disease of the anterior circulation: An initial experience

“…Further studies are required to investigate whether BOLD and ASL could provide complementary information about ACZ-induced CVR. Simultaneous evaluation of ASL and BOLD, such as with dual-echo ASL (Smeeing et al, 2016), may prove valuable as a synergistic approach for further interrogation. Combining dual-echo ASL imaging and ACZ to characterize CVR is currently underway in our group.…”

Measurement of cerebrovascular reserve by multimodal imaging for cerebral arterial occlusion or stenosis patients: protocol of a prospective, randomized, controlled clinical study

“…The CVR is the ability of cerebral vessels to dilate or constrict in response to challenges or maneuvers [5,6]. In addition, CVR is thought to be an important index of the brain's vascular health, and provides vascular-reserve information that is complementary to steady-state vascular parameters, including CBF and CBV [7,8]. There have been two main approaches to measuring CVR.…”