BOLD cerebrovascular reactivity as a novel marker for crossed cerebellar diaschisis

Sebök, Martina; Niftrik, Christiaan Hendrik Bas van; Piccirelli, Marco; Bozinov, Oliver; Wegener, Susanne; Esposito, Giuseppe; Pangalu, Athina; Valavanis, A; Buck, Alfred; Luft, Andreas R.; Regli, Luca; Fierstra, Jorn

doi:10.1212/wnl.0000000000006287

Cited by 42 publications

(64 citation statements)

References 39 publications

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“…This has also been confirmed by others in a similar patient cohort. 4,13 Perhaps surprisingly, this finding is crucial for the capability of BOLD-CVR to detect ipsilateral thalamic diaschisis. Generally, BOLD-CVR and PET-derived cerebral blood flow reactivity has shown a good hemispheric correlation.…”

Section: Discussionmentioning

confidence: 98%

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Characterizing ipsilateral thalamic diaschisis in symptomatic cerebrovascular steno-occlusive patients

Niftrik

Sebök

Muscas

et al. 2019

J Cereb Blood Flow Metab

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The clinical significance of ipsilateral thalamic diaschisis (ITD) occurring after stroke is unknown. To characterize ITD, we investigate its hemodynamic, structural, and clinical implications. A single-institution prospective cross-sectional study was conducted using 28 symptomatic cerebrovascular steno-occlusive patients undergoing both BOLD-CVR and Diamox-challenged 15(O)-H2O-PET. Follow-up was at least three months. In addition, 15 age-matched healthy subjects were included. ITD was diagnosed based on a BOLD-CVR thalamic asymmetry index (TAI) > +2 standard deviations from healthy subjects. Cerebral blood flow differences were assessed using a PET-based TAI before and after Diamox challenge. Thalamic volume masks were determined using Freesurfer. Neurological status at symptom onset and after three months was determined with NIHSS and mRS scores. ITD was diagnosed in 15 of 28 (57%) patients. PET-TAI before and after Diamox challenge were increased in patients with ITD, indicating an ipsilateral thalamic blood flow decrease. Patients with ITD exhibited a marked ipsilateral thalamic volume decrease as compared to patients without ITD and healthy subjects. Furthermore, patients with ITD had worse NIHSS and mRS at symptom onset and after three months follow-up, even after adjustment for stroke volume. The presence of ITD is characterized by thalamic volume reduction, reduced thalamic blood flow, and worse neurological performance unrelated to stroke volume.

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Section: Discussionmentioning

confidence: 98%

“…Further advancements in multimodal diaschisis imaging include MRI-based methods such as arterial spin labeling and blood oxygenation level–dependent MRI cerebrovascular reactivity (BOLD-CVR). 10–13…”

Section: Introductionmentioning

confidence: 99%

Characterizing ipsilateral thalamic diaschisis in symptomatic cerebrovascular steno-occlusive patients

Niftrik

Sebök

Muscas

et al. 2019

J Cereb Blood Flow Metab

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“…cerebral blood volume, oxygen extraction fraction, and cerebral metabolic rate of oxygen). [2, 29] Two papers directly comparing BOLD-CVR with both ASL and ( 15 O)-H 2 O Positron Emission Tomography derived CBF perfusion reserve in patients with cerebrovascular steno-occlusive disease, show a good agreement. [7, 30] Findings by Halani et al elaborated on these findings in healthy subjects.…”

Section: Discussionmentioning

confidence: 99%

The voxel-wise analysis of false negative fMRI activation in regions of provoked impaired cerebrovascular reactivity

et al. 2019

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Task-evoked Blood-oxygenation-level-dependent (BOLD-fMRI) signal activation is widely used to interrogate eloquence of brain areas. However, data interpretation can be improved, especially in regions with absent BOLD-fMRI signal activation. Absent BOLD-fMRI signal activation may actually represent false-negative activation due to impaired cerebrovascular reactivity (BOLD-CVR) of the vascular bed. The relationship between impaired BOLD-CVR and BOLD-fMRI signal activation may be better studied in healthy subjects where neurovascular coupling is known to be intact. Using a model-based prospective end-tidal carbon dioxide (CO 2 ) targeting algorithm, we performed two controlled 3 tesla BOLD-CVR studies on 17 healthy subjects: 1: at the subjects’ individual resting end-tidal CO 2 baseline. 2: Around +6.0 mmHg CO 2 above the subjects’ individual resting baseline. Two BOLD-fMRI finger-tapping experiments were performed at similar normo- and hypercapnic levels. Relative BOLD fMRI signal activation and t-values were calculated for BOLD-CVR and BOLD-fMRI data. For each component of the cerebral motor-network (precentral gyrus, postcentral gyrus, supplementary motor area, cerebellum und fronto-operculum), the correlation between BOLD-CVR and BOLD-fMRI signal changes and t-values was investigated. Finally, a voxel-wise quantitative analysis of the impact of BOLD-CVR on BOLD-fMRI was performed. For the motor-network, the linear correlation coefficient between BOLD-CVR and BOLD-fMRI t-values were significant (p<0.01) and in the range 0.33–0.55, similar to the correlations between the CVR and fMRI Δ%signal (p<0.05; range 0.34–0.60). The linear relationship between CVR and fMRI is challenged by our voxel-wise analysis of Δ%signal and t-value change between normo- and hypercapnia. Our main finding is that BOLD fMRI signal activation maps are markedly dampened in the presence of impaired BOLD-CVR and highlights the importance of a complementary BOLD-CVR assessment in addition to a task-evoked BOLD fMRI to identify brain areas at risk for false-negative BOLD-fMRI signal activation.

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“…TCD is relatively inexpensive and widely available, while it does not provide additional information about brain parenchyma and is technically impossible in some cases due to lack of acoustic windows. In the present study, we accurately evaluated CVR for ischemic-stroke patients by multimodal imaging methods (MRI, CT, or SPECT), and explored the recurrence of ischemic stroke after treatment; thus, we can develop a new method for accurate diagnosis and treatment of ischemic stroke [9,19,20]. Our approach possesses a number of novel features compared with other relevant trials.…”

Section: Discussionmentioning

confidence: 99%

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

Xiao

Wan

et al. 2020

Trials

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Background: Cerebrovascular reactivity (CVR) is the change in cerebral blood flow in response to a vaso-active stimulus, and may assist the treatment strategy of ischemic stroke. However, previous studies reported that a therapeutic strategy for stroke mainly depends on the degree of vascular stenosis with steady-state vascular parameters (e.g., cerebral blood flow and CVR). Hence, measurement of CVR by multimodal imaging techniques may improve the treatment of ischemic stroke. Methods/design: This is a prospective, randomized, controlled clinical trial that aimed to examine the capability of multimodal imaging techniques for the evaluation of CVR to improve treatment of patients with ischemic stroke. A total of 66 eligible patients will be recruited from Renji Hospital, Shanghai Jiaotong University School of Medicine. The patients will be categorized based on CVR into two subgroups as follows: CVR > 10% group and CVR < 10% group. The patients will be randomly assigned to medical management, percutaneous transluminal angioplasty and stenting, and intracranial and extra-cranial bypass groups in a 1:1:1 ratio. The primary endpoint is all adverse events and ipsilateral stroke recurrence at 6, 12, and 24 months after management. The secondary outcomes include the CVR, the National Institute of Health stroke scale and the Modified Rankin Scale at 6, 12, and 24 months. Discussion: Measurement of cerebrovascular reserve by multimodal image is recommended by most recent studies to guide the treatment of ischemic stroke, and thus its efficacy and evaluation accuracy need to be established in randomized controlled settings. This prospective, parallel, randomized, controlled registry study, together with other ongoing studies, should present more evidence for optimal individualized accurate treatment of ischemic stroke.

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BOLD cerebrovascular reactivity as a novel marker for crossed cerebellar diaschisis

Abstract: This study provides Class II evidence that BOLD-CVR identifies CCD in patients with symptomatic unilateral cerebrovascular steno-occlusive disease.

Cited by 42 publications

References 39 publications

Characterizing ipsilateral thalamic diaschisis in symptomatic cerebrovascular steno-occlusive patients

Characterizing ipsilateral thalamic diaschisis in symptomatic cerebrovascular steno-occlusive patients

The voxel-wise analysis of false negative fMRI activation in regions of provoked impaired cerebrovascular reactivity

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

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