Arterial Spin-Labeling MR Imaging Measurements of Timing Parameters in Patients with a Carotid Artery Occlusion

Bokkers, Reinoud P H; Laar, Peter Jan van; Ven, K.C.C. van de; Kapelle, L.J.; Klijn, Catharina J.M.; Hendrikse, Jeroen

doi:10.3174/ajnr.a1232

Cited by 57 publications

(64 citation statements)

References 42 publications

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“…They observed a significant decrease in CBF in the hemisphere ipsilateral to the occlusion as compared with the CBF in the contralateral hemisphere and in a healthy control group (22). In contrast to our study, Bokkers and Hendrikse et al also described significantly reduced CBF in the hemisphere ipsilateral to the stenosis or occlusion when compared to that of healthy controls (21,22). In contrast to our study, both study groups investigated adult patients.…”

Section: Discussioncontrasting

confidence: 99%

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Cerebral Perfusion After Repair of Congenital Diaphragmatic Hernia with Common Carotid Artery Occlusion After ECMO Therapy

Henzler

Zöllner

Weis

et al. 2017

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Abstract. Aim: To prospectively evaluate cerebral perfusion after repair of congenital diaphragmatic hernia (CDH) and right-common-carotid-artery (rCCA) Congenital diaphragmatic hernia (CDH) occurs in approximately one in 3,000-4,000 live births (1). A defect of the diaphragm leads to herniation of abdominal organs into the thoracic cavity. Lung hypoplasia and secondary pulmonary hypertension are the major causes of death (2). The implementation of new therapeutic strategies has improved the survival rate even in those patients with severe CDH (3). If conservative treatment in newborns with CDH fails, extracorporeal membrane oxygenation (ECMO) therapy is an important alternative for accomplishing sufficient oxygenation of the newborns. The Congenital Diaphragmatic Hernia Study Group showed an improved survival rate in patients with CDH after ECMO therapy, in whom, without ECMO, mortality was predicted to be higher than 80% (4). As a consequence, morbidity plays an increasing role in patients with CDH. Not only pulmonary problems but also neurological disorders have been identified as significant morbidities among CDH survivors (5, 6). In a study by McGahren et al., 8/12 (67%) ECMO survivors showed delayed neurological development compared to only 5/21(24%) of the non-ECMO-treated survivors.In CDH, veno-arterial ECMO is usually performed. Vascular access is usually achieved by insertion of the ECMO cannulas through the right common carotid artery (rCCA) and the right internal jugular vein. At the time of decannulation, ligation or surgical reconstruction of the rCCA can be performed but secondary occlusion of the surgical reconstructed rCCA can occur (7). Büsing et al. investigated 2-year-old children with history of CDH and reconstruction of the rCCA after ECMO therapy. Their study showed that in 72% of the patients, the rCCA was found to be occluded or highly stenotic using contrast-enhanced magnetic resonance angiography (7). Using Doppler ultrasound in 5-year-old patients, Desai et al. reported that most of the reconstructed rCCAs after ECMO therapy were patent and in only 24% of the patients there was significant 557

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Section: Discussioncontrasting

confidence: 99%

“…Bokkers et al used pASL in patients with symptomatic ICA stenoses. They found significantly reduced CBF in the hemisphere ipsilateral to the stenosis compared with the contralateral hemisphere (21). Using pASL, Hendrikse et al investigated CBF in the middle cerebral artery territory in patients with ICA occlusion.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Perfusion After Repair of Congenital Diaphragmatic Hernia with Common Carotid Artery Occlusion After ECMO Therapy

Henzler

Zöllner

Weis

et al. 2017

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“…2 A recent ICA occlusion study highlighted the relevance of AAT in clinical perfusion ASL. 5 The goal in the current study is to demonstrate the clinical utility of a whole-brain 3D-GRASE-PASL implementation with multiple-inflow periods to derive maps of CBF and AAT in patients with minor stroke/TIA. Analogous to hemodynamic timing parameters used in DSC perfusion for acute stroke diagnosis, AAT maps, hypothetically, can be used to characterize the extent of perfusion abnormalities.…”

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confidence: 99%

Multiple Inflow Pulsed Arterial Spin-Labeling Reveals Delays in the Arterial Arrival Time in Minor Stroke and Transient Ischemic Attack

MacIntosh¹,

Lindsay²,

Kylintireas³

et al. 2010

AJNR Am J Neuroradiol

106

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SUMMARY:Our purpose was to use multiple inflow pulsed ASL to investigate whether hemodynamic AAT information is sensitive to hemispheric asymmetry in acute ischemia. The cohorts included 15 patients with acute minor stroke or TIA and 15 age-matched controls. Patients were scanned by using a stroke MR imaging protocol at a median time of 74 hours. DWI lesion volumes were small and functional impairment was low; however, perfusion abnormalities were evident. Prolonged AAT values were more likely to reside in the affected hemisphere (significant when compared with controls, P Ͻ .048). An advantage of this ASL technique is the ability to use AAT information in addition to CBF to characterize ischemia. ABBREVIATIONS:AAT ϭ arterial arrival time; ASL ϭ arterial spin-labeling; AUH ϭ area under the histogram; CBF ϭ cerebral blood flow; DSC ϭ dynamic susceptibility contrast; DWI ϭ diffusionweighted imaging; FMRIB ϭ Functional MRI of the Brain; GRASE ϭ gradient and spin-echo; ICA ϭ internal carotid artery; MCA ϭ middle cerebral artery; NIHSS ϭ National Institutes of Health Stroke Scale; PASL ϭ pulsed arterial spin-labeling; TIA ϭ transient ischemic attack A SL is a noninvasive MR imaging technique capable of providing perfusion information without the use of gadolinium-based contrast agents. ASL relies on contrast by magnetically labeling blood water and detecting the signal intensity as a tracer bolus; it has shown promise in clinical studies involving acute stroke 1,2 and ICA occlusion. 3,4 The shortcomings of the ASL techniques include the following: 1) limited brain coverage, 2) low signal intensity-to-noise ratio, and 3) accounting for delays in AAT (the time duration for blood to move from tagging to imaging locations). The current study attempts to address each of these issues.An acute cerebrovascular event may increase the AAT by the following mechanisms: Labeled blood must travel via either collateral pathways of the circle of Willis or secondary collateral pathways, such as those that are provided by leptomeningeal vessels. Labeled blood that remains in the largevessel intravascular space at the time of imaging, due to an insufficient postlabel delay as in continuous ASL or an insufficient TI as in pulsed ASL, will affect the CBF image.2 A recent ICA occlusion study highlighted the relevance of AAT in clinical perfusion ASL. 5 The goal in the current study is to demonstrate the clinical utility of a whole-brain 3D-GRASE-PASL implementation with multiple-inflow periods to derive maps of CBF and AAT in patients with minor stroke/TIA. Analogous to hemodynamic timing parameters used in DSC perfusion for acute stroke diagnosis, AAT maps, hypothetically, can be used to characterize the extent of perfusion abnormalities. TechniqueMR imaging data were collected on a 3T scanner (Tim Trio; Siemens, Erlangen, Germany) with a 12-channel head receive coil in a 2-cohort study: 1) 15 patients with acute minor stroke or TIA, and 2) 15 agematched controls. Carotid Doppler sonography was performed on patients only. Relevant sequen...

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“…O-PET in patient populations and in healthy controls (Bokkers et al 2008(Bokkers et al , 2010Ye et al 2000). It allows for repeated acquisitions since no exposure to radioactivity is required and it provides a temporal resolution in the range of a few seconds.…”

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confidence: 99%

Quantification of Network Perfusion in ASL Cerebral Blood Flow Data with Seed Based and ICA Approaches

et al. 2013

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Independent component analysis (ICA) or seed based approaches (SBA) in functional magnetic resonance imaging blood oxygenation level dependent (BOLD) data became widely applied tools to identify functionally connected, large scale brain networks. Differences between task conditions as well as specific alterations of the networks in patients as compared to healthy controls were reported. However, BOLD lacks the possibility of quantifying absolute network metabolic activity, which is of particular interest in the case of pathological alterations. In contrast, arterial spin labeling (ASL) techniques allow quantifying absolute cerebral blood flow (CBF) in rest and in task-related conditions. In this study, we explored the ability of identifying networks in ASL data using ICA and to quantify network activity in terms of absolute CBF values. Moreover, we compared the results to SBA and performed a test-retest analysis. Twelve healthy young subjects performed a fingertapping block-design experiment. During the task pseudo-continuous ASL was measured. After CBF quantification the individual datasets were concatenated and subjected to the ICA algorithm. ICA proved capable to identify the somato-motor and the default mode network. Moreover, absolute network CBF within the separate networks during either condition could be quantified. We could demonstrate that using ICA and SBA functional connectivity analysis is feasible and robust in ASL-CBF data. CBF functional connectivity is a novel approach that opens a new strategy to evaluate differences of network activity in terms of absolute network CBF and thus allows quantifying inter-individual differences in the resting state and task-related activations and deactivations.

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Arterial Spin-Labeling MR Imaging Measurements of Timing Parameters in Patients with a Carotid Artery Occlusion

Cited by 57 publications

References 42 publications

Cerebral Perfusion After Repair of Congenital Diaphragmatic Hernia with Common Carotid Artery Occlusion After ECMO Therapy

Cerebral Perfusion After Repair of Congenital Diaphragmatic Hernia with Common Carotid Artery Occlusion After ECMO Therapy

Multiple Inflow Pulsed Arterial Spin-Labeling Reveals Delays in the Arterial Arrival Time in Minor Stroke and Transient Ischemic Attack

Quantification of Network Perfusion in ASL Cerebral Blood Flow Data with Seed Based and ICA Approaches

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