Breath-Hold Blood Oxygen Level–Dependent MRI: A Tool for the Assessment of Cerebrovascular Reserve in Children with Moyamoya Disease

Dlamini, Nomazulu; Shah-Basak, Priyanka P.; Leung, Jackie; Kirkham, Fenella J.; Shroff, Manohar; Kassner, Andrea; Robertson, Amanda; Dirks, Peter B.; Westmacott, Robyn; deVeber, Gabrielle; Logan, William J.

doi:10.3174/ajnr.a5739

Cited by 63 publications

(54 citation statements)

References 36 publications

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“…Note, the analysis run for this subject was the same as previously presented, however the lag values that are included in these maps are not relative to GM median, due to the clear bilateral vascular pathology, and this case being interpreted separately from the other subjects. When lag is not considered, the CVR maps (No-Opt) show dominant negative CVR in this vascular territory, similar to what has been reported in previous CVR mapping studies with Moyamoya [88]- [90]. However, when correcting the CVR maps for lag (Lag-Opt) there is a striking change -the CVR within GM mostly normalizes, without a clear pathology.…”

Section: Clinical Utilitysupporting

confidence: 85%

A practical modification to a resting state fMRI protocol for improved characterization of cerebrovascular function

Stickland

Zvolanek

Moia

et al. 2021

Preprint

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Cerebrovascular reactivity (CVR), defined here as the Blood Oxygenation Level Dependent (BOLD) response to a CO2 pressure change, is a useful metric of cerebrovascular function. Both the amplitude and the timing (hemodynamic lag) of the CVR response can bring insight into the nature of a cerebrovascular pathology and aid in understanding noise confounds when using functional Magnetic Resonance Imaging (fMRI) to study neural activity. This research assessed a practical modification to a typical resting state fMRI protocol, to improve the characterization of cerebrovascular function. In 9 healthy subjects, we modelled CVR and lag in three resting state data segments, and in data segments which added a 2 to 3 minute breathing task to the start of a resting state segment. Two different breathing tasks were used to induce fluctuations in arterial CO2 pressure: a breath hold task to induce hypercapnia (CO2 increase) and a cued deep breathing task to induce hypocapnia (CO2 decrease). Our analysis produced voxelwise estimates of the amplitude (CVR) and timing (lag) of the BOLD fMRI response to CO2 by systematically shifting the CO2 regressor in time to optimize the model fit. This optimization inherently increases grey matter CVR values and fit statistics. The inclusion of a simple breathing task, compared to a resting state scan only, increases the number of voxels in the brain that have a significant relationship between CO2 and BOLD fMRI signals, and improves our confidence in the plausibility of voxelwise CVR and hemodynamic lag estimates. We demonstrate the clinical utility and feasibility of this protocol in an incidental finding of Moyamoya disease, and explore the possibilities and challenges of using this protocol in younger populations. This hybrid protocol has direct applications for CVR mapping in both research and clinical settings and wider applications for fMRI denoising and interpretation.

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Section: Clinical Utilitysupporting

confidence: 85%

A practical modification to a resting state fMRI protocol for improved characterization of cerebrovascular function

Stickland

Zvolanek

Moia

et al. 2021

Preprint

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“…Therefore, results might be influenced by variable arterial circulation times and collaboration of these patients. However, adequate collaboration of patients is controlled by replicable changes of cerebellar BOLD MRI signal change, making this approach reliable for clinical use, as also shown in other studies (Bright and Murphy, 2013; Dlamini et al, 2018). Further we did not use absolute quantification of CBF by PET, but a simplified approximation of CPR and intra-individual normalized values for comparison with MRI.…”

Section: Discussionmentioning

confidence: 63%

“…However, patients with such limited compliance might also not be able to remain without relevant head movement for the time of scanning without sedation and might therefore be generally inappropriate for this examination. A recent study proved that also children with a mean age of 12 years were able to collaborate in repeated breath-hold MR examination with good correlation (Dlamini et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Hypercapnic BOLD MRI compared to H215O PET/CT for the hemodynamic evaluation of patients with Moyamoya Disease

Hauser

Seeger

Bender

et al. 2019

NeuroImage: Clinical

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Background and purposePatients with Moyamoya Disease (MMD) need hemodynamic evaluation of vascular territories at risk of stroke. Today's investigative standards include H215O PET/CT with pharmacological challenges with acetazolamide (ACZ). Recent developments suggest that CO2-triggered blood‑oxygen-level-dependent (BOLD) functional MRI might provide comparable results to current standard methods for evaluation of territorial hemodynamics, while being a more widely available and easily implementable method. This study examines results of a newly developed quantifiable analysis algorithm for CO2-triggered BOLD MRI in Moyamoya patients and correlates the results with H215O PET/CT with ACZ challenge to assess comparability between both modalities.MethodsCO2-triggered BOLD MRI was performed and compared to H215O PET/CT with ACZ challenge in patients with angiographically proven MMD. Images of both modalities were analyzed retrospectively in a blinded, standardized fashion by visual inspection, as well as with a semi-quantitative analysis using stimuli-induced approximated regional perfusion-weighted data and BOLD-signal changes with reference to cerebellum.Results20 consecutive patients fulfilled the inclusion criteria, a total of 160 vascular territories were analyzed retrospectively. Visual analysis (4-step visual rating system) of standardized, color-coded cerebrovascular reserve/reactivity maps showed a very strong correlation (Spearman's rho = 0.9, P < 0.001) between both modalities. Likewise, comparison of approximated regional perfusion changes across vascular territories (normalized to cerebellar change) reveal a highly significant correlation between both methods (Pearson's r = 0.71, P < 0.001).ConclusionsThe present analysis indicates that CO2-triggered BOLD MRI is a very promising tool for the hemodynamic evaluation of MMD patients with results comparable to those seen in H215O PET/CT with ACZ challenge. It therefore holds future potential in becoming a routine examination in the pre- and postoperative evaluation of MMD patients after further prospective evaluation.

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“…Furthermore, a new generation of methods that are simply based on the spontaneous breathing fluctuations occurring during resting-state has also started to emerge. Both strategies have been shown to be well tolerated by populations generally considered less cooperative ( Thomason et al, 2005 ; Handwerker et al, 2007 ; Kannurpatti et al, 2010 ; Raut et al, 2016 ; Dlamini et al, 2018 ) and to yield results comparable to those obtained with external gas manipulation techniques ( Kastrup et al, 2001 ; Kannurpatti and Biswal, 2008 ; Golestani et al, 2016b ; Liu et al, 2017a ). Because of their simplicity and inexpensive implementation, these strategies might offer a new opportunity for the application of CVR mapping as a useful clinical and research tool.…”

Section: Introductionmentioning

confidence: 91%

Cerebrovascular Reactivity Mapping Without Gas Challenges: A Methodological Guide

et al. 2021

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Cerebrovascular reactivity (CVR) is defined as the ability of vessels to alter their caliber in response to vasoactive factors, by means of dilating or constricting, in order to increase or decrease regional cerebral blood flow (CBF). Importantly, CVR may provide a sensitive biomarker for pathologies where vasculature is compromised. Furthermore, the spatiotemporal dynamics of CVR observed in healthy subjects, reflecting regional differences in cerebral vascular tone and response, may also be important in functional MRI studies based on neurovascular coupling mechanisms. Assessment of CVR is usually based on the use of a vasoactive stimulus combined with a CBF measurement technique. Although transcranial Doppler ultrasound has been frequently used to obtain global flow velocity measurements, MRI techniques are being increasingly employed for obtaining CBF maps. For the vasoactive stimulus, vasodilatory hypercapnia is usually induced through the manipulation of respiratory gases, including the inhalation of increased concentrations of carbon dioxide. However, most of these methods require an additional apparatus and complex setups, which not only may not be well-tolerated by some populations but are also not widely available. For these reasons, strategies based on voluntary breathing fluctuations without the need for external gas challenges have been proposed. These include the task-based methodologies of breath holding and paced deep breathing, as well as a new generation of methods based on spontaneous breathing fluctuations during resting-state. Despite the multitude of alternatives to gas challenges, existing literature lacks definitive conclusions regarding the best practices for the vasoactive modulation and associated analysis protocols. In this work, we perform an extensive review of CVR mapping techniques based on MRI and CO2 variations without gas challenges, focusing on the methodological aspects of the breathing protocols and corresponding data analysis. Finally, we outline a set of practical guidelines based on generally accepted practices and available data, extending previous reports and encouraging the wider application of CVR mapping methodologies in both clinical and academic MRI settings.

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Breath-Hold Blood Oxygen Level–Dependent MRI: A Tool for the Assessment of Cerebrovascular Reserve in Children with Moyamoya Disease

Cited by 63 publications

References 36 publications

A practical modification to a resting state fMRI protocol for improved characterization of cerebrovascular function

A practical modification to a resting state fMRI protocol for improved characterization of cerebrovascular function

Hypercapnic BOLD MRI compared to H215O PET/CT for the hemodynamic evaluation of patients with Moyamoya Disease

Cerebrovascular Reactivity Mapping Without Gas Challenges: A Methodological Guide

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