Assessment of cerebrovascular reactivity using real-time BOLD fMRI in children with moyamoya disease: a pilot study

Logan, William J.; Donner, Elizabeth; Shroff, Manohar

doi:10.1007/s00381-012-1952-0

Cited by 12 publications

(9 citation statements)

References 12 publications

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“…The difficulty in administering CO 2 challenges and concerns regarding the repeatability of CO 2 paradigms may be responsible for the limited implementation in clinical scenarios. Breath-hold paradigms have been administered successfully to paediatric patients with moyamoya disease (Thomas et al, 2013), suggesting that even patient groups that are notoriously difficult to scan can successfully complete breath-hold challenges in the MR scanning environment. The results presented in the current study indicate that poor performance of breath-hold challenges is not necessarily a limiting factor in robust mapping of CVR in patients; the End-tidal CO 2 analysis method compensates for ability and consistency factors and provides repeatable CVR values despite these performance variations.…”

Section: Discussionmentioning

confidence: 99%

Reliable quantification of BOLD fMRI cerebrovascular reactivity despite poor breath-hold performance

2013

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Cerebrovascular reactivity (CVR) can be mapped using BOLD fMRI to provide a clinical insight into vascular health that can be used to diagnose cerebrovascular disease. Breath-holds are a readily accessible method for producing the required arterial CO2 increases but their implementation into clinical studies is limited by concerns that patients will demonstrate highly variable performance of breath-hold challenges. This study assesses the repeatability of CVR measurements despite poor task performance, to determine if and how robust results could be achieved with breath-holds in patients. Twelve healthy volunteers were scanned at 3T. Six functional scans were acquired, each consisting of 6 breath-hold challenges (10, 15, or 20 s duration) interleaved with periods of paced breathing. These scans simulated the varying breath-hold consistency and ability levels that may occur in patient data. Uniform ramps, time-scaled ramps, and end-tidal CO2 data were used as regressors in a general linear model in order to measure CVR at the grey matter, regional, and voxelwise level. The intraclass correlation coefficient (ICC) quantified the repeatability of the CVR measurement for each breath-hold regressor type and scale of interest across the variable task performances. The ramp regressors did not fully account for variability in breath-hold performance and did not achieve acceptable repeatability (ICC < 0.4) in several regions analysed. In contrast, the end-tidal CO2 regressors resulted in “excellent” repeatability (ICC = 0.82) in the average grey matter data, and resulted in acceptable repeatability in all smaller regions tested (ICC > 0.4). Further analysis of intra-subject CVR variability across the brain (ICCspatial and voxelwise correlation) supported the use of end-tidal CO2 data to extract robust whole-brain CVR maps, despite variability in breath-hold performance. We conclude that the incorporation of end-tidal CO2 monitoring into scanning enables robust, repeatable measurement of CVR that makes breath-hold challenges suitable for routine clinical practice.

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Section: Discussionmentioning

confidence: 99%

Reliable quantification of BOLD fMRI cerebrovascular reactivity despite poor breath-hold performance

2013

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“…Other studies showed that the increased MTT correlated well with the decreased CVR in patients with occlusive cerebrovascular disease[41,42]. According to these studies, MMT and TTP should be predictive parameters of PWI for assessing reduced CVR, which have been evaluated based on the principle of BOLD signal fluctuations in patients with MMD[35,36,37,38,39]. In the present study, there was no correlation between frontal lobe ALFF and CBV or CBF.…”

Section: Discussionmentioning

confidence: 98%

“…[34] As the disease progresses, more blood flows towards areas of the brain capable of decreasing vascular resistance in response to a vasodilatory stimulus (the steal phenomenon), which could in turn cause a decrease in BOLD signals in the areas of the brain where vascular resistance was already minimized. [35,36,37,38,39] Compared with the NC group, the CVR in the bilateral hemispheres of patients were impaired to varying degrees, which may have reduced the resting-state BOLD responses. Therefore, we speculate that the reduced frontal lobe ALFF may be related to the abnormal cerebral perfusion in patients with MMD.…”

Section: Discussionmentioning

confidence: 99%

Impact of aberrant cerebral perfusion on resting-state functional MRI: A preliminary investigation of Moyamoya disease

Wang¹,

Wang²,

Qiao³

et al. 2017

PLoS ONE

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The impact of chronic cerebral hypoperfusion on resting-state blood oxygen level-dependent signal fluctuations remains unknown. We aimed to determine whether chronic ischemia induces changes in amplitude of low-frequency fluctuations (ALFF) and to investigate the correlation between ALFF and perfusion-weighted magnetic resonance imaging (PWI) parameters in patients with moyamoya disease (MMD). Thirty patients with pre- and postoperative resting-state functional magnetic resonance imaging and PWI were included, and thirty normal controls underwent resting-state functional magnetic resonance imaging. A decrease in preoperative frontal lobe ALFF was observed in patients with MMD. Postoperative frontal lobe ALFF showed moderate improvement but still remained lower than those in normal controls. The values of mean transit time and time-to-peak, but not cerebral blood volume and cerebral blood flow, correlated significantly with frontal lobe ALFF. Moreover, there were significant negative correlations between changes in frontal lobe PWI parameters and changes in frontal lobe ALFF on both operated side and contralateral side after the unilateral revascularization surgery. Our results demonstrate that reduced ALFF are closely related to the abnormal PWI parameters and vary with the alteration of cerebral perfusion in patients with MMD.

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“…An alternative approach for the assessment of CVR is the breath-hold technique[20]. Thomas et al[16] used a breath-hold challenge in eight consecutive pediatric moyamoya patients and found that while all breath-hold challenge during general anesthesia resulted in best quality CVR maps, only 42% of studies without general anesthesia yielded best quality CVR maps. Finally, a previous study Shiino et al[18] validated CO 2 BOLD CVR against acetazolamide SPECT CVR in 17 healthy subjects and 10 patients with severe ICA steno-occlusive disease, including 2 patients with moyamoya disease.…”

Section: Discussionmentioning

confidence: 99%

“…This sample size should however be considered in light of the very low prevalence of moyamoya syndrome of 3/1000000 in European countries[3]. Consequently, the previous related studies discussed above include 8[16], 11[12], 12[13] and 13 pediatric[15] patients with moyamoya. It is also important to note that the vasodilation induced by acetazolamide is stronger than the vasodilation induced by the inhalation of CO 2 via a simple nasal cannula.…”

Section: Discussionmentioning

confidence: 99%

CO₂BOLD assessment of moyamoya syndrome: Validation with single photon emission computed tomography and positron emission tomography imaging

Pellaton¹,

Bijlenga²,

Bouchez³

et al. 2016

WJR

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AIMTo compare the assessment of cerebrovascular reserve (CVR) using CO2BOLD magnetic resonance imaging (MRI) vs positron emission tomography (PET) and single photon emission computed tomography (SPECT) as reference standard.METHODSTen consecutive patients (8 women, mean age of 41 ± 26 years) with moyamoya syndrome underwent 14 pre-surgical evaluations for external-internal carotid artery bypass surgery. CVR was assessed using CO2BOLD and PET (4)/SPECT (11) with a maximum interval of 36 d, and evaluated by two experienced neuroradiologists.RESULTSThe inter-rater agreement was 0.81 for SPECT (excellent), 0.43 for PET (fair) and 0.7 for CO2BOLD (good). In 9/14 cases, there was a correspondence between CO2BOLD and PET/SPECT. In 4/14 cases, CVR was over-estimated in CO2BOLD, while in 1/14 case, CVR was underestimated in CO2BOLD. The sensitivity of CO2BOLD was 86% and a specificity of 43%.CONCLUSIONCO2BOLD can be used for pre-surgical assessment of CVR in patients with moyamoya syndrome and combines the advantages of absent irradiation, high availability of MRI and assessment of brain parenchyma, cerebral vessels and surrogate CVR in one stop.

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Assessment of cerebrovascular reactivity using real-time BOLD fMRI in children with moyamoya disease: a pilot study

Cited by 12 publications

References 12 publications

Reliable quantification of BOLD fMRI cerebrovascular reactivity despite poor breath-hold performance

Reliable quantification of BOLD fMRI cerebrovascular reactivity despite poor breath-hold performance

Impact of aberrant cerebral perfusion on resting-state functional MRI: A preliminary investigation of Moyamoya disease

CO₂BOLD assessment of moyamoya syndrome: Validation with single photon emission computed tomography and positron emission tomography imaging

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Assessment of cerebrovascular reactivity using real-time BOLD fMRI in children with moyamoya disease: a pilot study

Cited by 12 publications

References 12 publications

Reliable quantification of BOLD fMRI cerebrovascular reactivity despite poor breath-hold performance

Reliable quantification of BOLD fMRI cerebrovascular reactivity despite poor breath-hold performance

Impact of aberrant cerebral perfusion on resting-state functional MRI: A preliminary investigation of Moyamoya disease

CO2BOLD assessment of moyamoya syndrome: Validation with single photon emission computed tomography and positron emission tomography imaging

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CO₂BOLD assessment of moyamoya syndrome: Validation with single photon emission computed tomography and positron emission tomography imaging