Cerebrovascular reactivity and its correlation with age in patients with multiple sclerosis

Pelizzari, Laura; Laganà, Maria Marcella; Baglio, Francesca; Bergsland, Niels; Cecconi, Pietro; Viotti, Stefano; Pugnetti, Luigi; Nemni, Raffaello; Baselli, Giuseppe; Clerici, Mario; Mendozzi, Laura

doi:10.1007/s11682-019-00132-5

Cited by 10 publications

(8 citation statements)

References 41 publications

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“…Recent relapse was not an exclusion criterion. A more recent study by Pelizzari et al ( 83 ) that also used ASL MRI found no significant differences in CVR between MS patients and HC from inhalation of air with 5% CO 2 . This cohort had a mean EDSS of 1.5 and predominantly received no treatment or first-line treatment.…”

Section: Discussionmentioning

confidence: 90%

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Cerebrovascular Reactivity and Neurovascular Coupling in Multiple Sclerosis—A Systematic Review

et al. 2022

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The inflammatory processes observed in the central nervous system in multiple sclerosis (MS) could damage the endothelium of the cerebral vessels and lead to a dysfunctional regulation of vessel tonus and recruitment, potentially impairing cerebrovascular reactivity (CVR) and neurovascular coupling (NVC). Impaired CVR or NVC correlates with declining brain health and potentially plays a causal role in the development of neurodegenerative disease. Therefore, we examined studies on CVR or NVC in MS patients to evaluate the evidence for impaired cerebrovascular function as a contributing disease mechanism in MS. Twenty-three studies were included (12 examined CVR and 11 examined NVC). Six studies found no difference in CVR response between MS patients and healthy controls. Five studies observed reduced CVR in patients. This discrepancy can be because CVR is mainly affected after a long disease duration and therefore is not observed in all patients. All studies used CO2 as a vasodilating stimulus. The studies on NVC demonstrated diverse results; hence a conclusion that describes all the published observations is difficult to find. Future studies using quantitative techniques and larger study samples are needed to elucidate the discrepancies in the reported results.

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Section: Discussionmentioning

confidence: 90%

“…Patients were excluded from the study if they had experienced a recent relapse. The authors speculate that the low degree of inflammation in their MS cohort may explain the lack of difference between patients and HC ( 83 ).…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular Reactivity and Neurovascular Coupling in Multiple Sclerosis—A Systematic Review

et al. 2022

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“…Therefore, other non-invasive stimuli (e.g., low body negative pressure) could be conceived to perform autonomic modulation during MRI scans. For instance, alternative non-invasive provocations could be chemoreceptive stimuli, such as hypercapnia, whose MRI-compatibility has already been tested and proved in previous studies including other kind of MRI sequences [ 43 , 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Real-Time Phase-Contrast MRI to Monitor Cervical Blood and Cerebrospinal Fluid Flow Beat-by-Beat Variability

et al. 2022

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Beat-by-beat variability (BBV) rhythms are observed in both cardiovascular (CV) and intracranial (IC) compartments, yet interactions between the two are not fully understood. Real-Time Phase-Contrast (RT-PC) MRI sequence was acquired for 30 healthy volunteers at 1st cervical level on a 3T scanner. The arterial (AF), venous (VF), and cerebrospinal fluid (CSF) flow (CSFF) were computed as velocity integrals over the internal carotid artery, internal jugular vein, and CSF. AF, VF, and CSFF signals were segmented in inspiration and expiration beats, to assess the respiration influence. Systolic and diastolic BBV, and heart period series underwent autoregressive power spectral density analysis, to evaluate the low-frequency (LF, Mayer waves) and high frequency (HF, respiratory waves) components. The diastolic VF had the largest BBV. LF power was high in the diastolic AF series, poor in all CSFF series. The pulse wave analyses revealed higher mean amplitude during inspiration. Findings suggests a possible role of LF modulation of IC resistances and propagation of HF waves from VF to AF and CCSF. PC-RT-MRI could provide new insight into the interaction between CV and IC regulation and pave the way for a detailed analysis of the cerebrovascular effects of varied respiration patterns due to exercise and rehabilitation.

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“…Moreover, a decrease or loss in cerebrovascular reactivity function will result in the inability to adjust during changes in systemic arterial pressure and allow direct propagation of the pressure pulse into the CSF. This inability to dampen the pressure wave may contribute to greater CSF fluid velocities and oscillations [24,25]. MS patients may also display increased age-and atherosclerosis-driven arterial stiffening, which can further contribute towards extending the systolic pulse wave into the cerebral arterial vasculature [26].…”

Section: Discussionmentioning

confidence: 99%

Longitudinal analysis of cerebral aqueduct flow measures: multiple sclerosis flow changes driven by brain atrophy

Jakimovski

Zivadinov

Weinstock‐Guttman

et al. 2020

Fluids Barriers CNS

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Background: Several small cross-sectional studies have investigated cerebrospinal fluid (CSF) flow dynamics in multiple sclerosis (MS) patients and have reported mixed results. Currently, there are no longitudinal studies that investigate CSF dynamics in MS patients. Objective: To determine longitudinal changes in CSF dynamics measured at the level of aqueduct of Sylvius (AoS) in MS patients and matched healthy controls (HCs). Materials and methods: Forty (40) MS patients and 20 HCs underwent 3T MRI cine phase contrast imaging with velocity-encoded pulse-gated sequence at baseline and 5-year follow-up. For atrophy determination, MS patients underwent additional high-resolution 3D T1-weighted imaging. Measures of AoS cross-sectional area (CSA), average systolic and diastolic velocity peaks, maximal systolic and diastolic velocity peaks and average CSF flow rates were determined. Brain atrophy and ventricular CSF (vCSF) expansion rates were determined. Cross-sectional and longitudinal changes were derived by analysis of covariance (ANCOVA) and paired repeated tests. Confirmatory general linear models were also performed. False discovery rate (FDR)-corrected p-values lower than 0.05 were considered significant. Results: The MS population demonstrated significant increase in maximal diastolic peak (from 7.23 to 7.86 cm/s, non-adjusted p = 0.037), diastolic peak flow rate (7.76 ml/min to 9.33 ml/min, non-adjusted p = 0.023) and AoS CSA (from 3.12 to 3.69 mm 2 , adjusted p = 0.001). The only differentiator between MS patients and HCs was the greater AoS CSA (3.58 mm 2 vs. 2.57 mm 2 , age-and sex-adjusted ANCOVA, p = 0.045). The AoS CSA change was associated with vCSF expansion rate (age-and sex-adjusted Spearman's correlation r = 0.496, p = 0.019) and not with baseline nor change in maximal velocity. The expansion rate of the vCSF space explained an additional 23.8% of variance in change of AoS CSA variance when compared to age and sex alone (R 2 = 0.273, t = 2.557, standardized β = 0.51, and p = 0.019). Conclusion: MS patients present with significant longitudinal AoS enlargement, potentially due to regional atrophy changes and ex-vacuo expansion of the aqueduct.

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Cerebrovascular reactivity and its correlation with age in patients with multiple sclerosis

Cited by 10 publications

References 41 publications

Cerebrovascular Reactivity and Neurovascular Coupling in Multiple Sclerosis—A Systematic Review

Cerebrovascular Reactivity and Neurovascular Coupling in Multiple Sclerosis—A Systematic Review

Real-Time Phase-Contrast MRI to Monitor Cervical Blood and Cerebrospinal Fluid Flow Beat-by-Beat Variability

Longitudinal analysis of cerebral aqueduct flow measures: multiple sclerosis flow changes driven by brain atrophy

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