CO<sub>2</sub>Blood Oxygen Level–dependent MR Mapping of Cerebrovascular Reserve in a Clinical Population: Safety, Tolerability, and Technical Feasibility

Spano, Vincent R.; Mandell, Daniel M.; Poublanc, Julien; Sam, Kevin; Battisti‐Charbonney, Anne; Pucci, Olivia; Han, Jay; Crawley, Adrian; Fisher, Joseph A.; Mikulis, David J.

doi:10.1148/radiol.12112795

Cited by 129 publications

(113 citation statements)

References 34 publications

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“…Finally, our study did not measure cerebrovascular reactivity because of technical limitations. Combining CO 2 stimulation with blood oxygen level-dependent MR mapping is a proven potential tool for detecting cerebrovascular reactivity changes (40) and may further assist our understanding of the cognitive changes that occur in diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Altered Spontaneous Brain Activity in Type 2 Diabetes: A Resting-State Functional MRI Study

et al. 2014

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Previous research has shown that type 2 diabetes mellitus (T2DM) is associated with an increased risk of cognitive impairment. Patients with impaired cognition often show decreased spontaneous brain activity on resting-state functional magnetic resonance imaging (rs-fMRI). This study used rs-fMRI to investigate changes in spontaneous brain activity among patients with T2DM and to determine the relationship of these changes with cognitive impairment. T2DM patients (n = 29) and age-, sex-, and education-matched healthy control subjects (n = 27) were included in this study. Amplitude of lowfrequency fluctuation (ALFF) and regional homogeneity (ReHo) values were calculated to represent spontaneous brain activity. Brain volume and cognition were also evaluated among these participants. Compared with healthy control subjects, patients with T2DM had significantly decreased ALFF and ReHo values in the occipital lobe and postcentral gyrus. Patients performed worse on several cognitive tests; this impaired cognitive performance was correlated with decreased activity in the cuneus and lingual gyrus in the occipital lobe. Brain volume did not differ between the two groups. The abnormalities of spontaneous brain activity reflected by ALFF and ReHo measurements in the absence of structural changes in T2DM patients may provide insights into the neurological pathophysiology underlying diabetes-associated cognitive decline.

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Section: Discussionmentioning

confidence: 99%

Altered Spontaneous Brain Activity in Type 2 Diabetes: A Resting-State Functional MRI Study

et al. 2014

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“…Less commonly reported symptoms were headache, dizziness and light-headedness, conjunctival erythema, tremor, paraesthesia, hand weakness and chest tightness. 29 …”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging for assessment of cerebrovascular reactivity in cerebral small vessel disease: A systematic review

Blair

Doubal

Thrippleton

et al. 2016

J Cereb Blood Flow Metab

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Cerebral small vessel disease (SVD) pathophysiology is poorly understood. Cerebrovascular reactivity (CVR) impairment may play a role, but evidence to date is mainly indirect. Magnetic resonance imaging (MRI) allows investigation of CVR directly in the tissues affected by SVD. We systematically reviewed the use of MRI to measure CVR in subjects with SVD. Five studies (total n ¼ 155 SVD subjects, 84 controls) provided relevant data. The studies included different types of patients. Each study used blood oxygen level dependent (BOLD) MRI to assess CVR but a different vasoactive stimulus and method of calculating CVR. CVR decreased with increasing white matter hyperintensities in two studies (n ¼ 17, 11%) and in the presence of microbleeds in another. Three studies (n ¼ 138, 89%) found no association of CVR with white matter hyperintensities. No studies provided tissue-specific CVR values. CVR decreased with age in three studies, and with female gender and increasing diastolic blood pressure in one study. Safety and tolerability data were limited. Larger studies using CVR appear to be feasible and are needed, preferably with more standardized methods, to determine if specific clinical or radiological features of SVD are more or less associated with impaired CVR.

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“…Physiologically, the change in PaCO 2 we administered is within the range of everyday experience. A previous study on more than 400 consecutive hypercapnic tests for brain vascular reactivity (29) in patients ranging in age from 9 to 88 y with many nonlife-threatening comorbidities reported transient symptoms, such as shortness of breath, headache, and dizziness, to be evident in 11.1% of subjects. Since then, the group has performed more than 1,200 such studies on patients with cerebrovascular disease and accompanying comorbidities (Joseph A. Fisher, oral communication, December 2016).…”

Section: Translational Importance Of Arterial Co 2 Tension As Potent mentioning

confidence: 99%

Arterial CO₂ as a Potent Coronary Vasodilator: A Preclinical PET/MR Validation Study with Implications for Cardiac Stress Testing

et al. 2017

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Myocardial blood flow (MBF) is the critical determinant of cardiac function. However, its response to increases in partial pressure of arterial CO 2 (PaCO 2 ), particularly with respect to adenosine, is not well characterized because of challenges in blood gas control and limited availability of validated approaches to ascertain MBF in vivo. Methods: By prospectively and independently controlling PaCO 2 and combining it with 13 N-ammonia PET measurements, we investigated whether a physiologically tolerable hypercapnic stimulus (;25 mm Hg increase in PaCO 2 ) can increase MBF to that observed with adenosine in 3 groups of canines: without coronary stenosis, subjected to non-flow-limiting coronary stenosis, and after preadministration of caffeine. The extent of effect on MBF due to hypercapnia was compared with adenosine. Results: In the absence of stenosis, mean MBF under hypercapnia was 2.1 6 0.9 mL/min/g and adenosine was 2.2 6 1.1 mL/min/g; these were significantly higher than at rest (0.9 6 0.5 mL/min/g, P , 0.05) and were not different from each other (P 5 0.30). Under left-anterior descending coronary stenosis, MBF increased in response to hypercapnia and adenosine (P , 0.05, all territories), but the effect was significantly lower than in the left-anterior descending coronary territory (with hypercapnia and adenosine; both P , 0.05). Mean perfusion defect volumes measured with adenosine and hypercapnia were significantly correlated (R 5 0.85) and were not different (P 5 0.12). After preadministration of caffeine, a known inhibitor of adenosine, resting MBF decreased; and hypercapnia increased MBF but not adenosine (P , 0.05). Conclusion: Arterial blood CO 2 tension when increased by 25 mm Hg can induce MBF to the same level as a standard dose of adenosine. Prospectively targeted arterial CO 2 has the capability to evolve as an alternative to current pharmacologic vasodilators used for cardiac stress testing.

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CO₂Blood Oxygen Level–dependent MR Mapping of Cerebrovascular Reserve in a Clinical Population: Safety, Tolerability, and Technical Feasibility

Abstract: CVR mapping by using a prospectively targeted CO(2) stimulus and BOLD MR imaging is safe, well tolerated, and technically feasible in a clinical patient population.

Cited by 129 publications

References 34 publications

Altered Spontaneous Brain Activity in Type 2 Diabetes: A Resting-State Functional MRI Study

Altered Spontaneous Brain Activity in Type 2 Diabetes: A Resting-State Functional MRI Study

Magnetic resonance imaging for assessment of cerebrovascular reactivity in cerebral small vessel disease: A systematic review

Arterial CO₂ as a Potent Coronary Vasodilator: A Preclinical PET/MR Validation Study with Implications for Cardiac Stress Testing

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CO2Blood Oxygen Level–dependent MR Mapping of Cerebrovascular Reserve in a Clinical Population: Safety, Tolerability, and Technical Feasibility

Abstract: CVR mapping by using a prospectively targeted CO(2) stimulus and BOLD MR imaging is safe, well tolerated, and technically feasible in a clinical patient population.

Cited by 129 publications

References 34 publications

Altered Spontaneous Brain Activity in Type 2 Diabetes: A Resting-State Functional MRI Study

Altered Spontaneous Brain Activity in Type 2 Diabetes: A Resting-State Functional MRI Study

Magnetic resonance imaging for assessment of cerebrovascular reactivity in cerebral small vessel disease: A systematic review

Arterial CO2 as a Potent Coronary Vasodilator: A Preclinical PET/MR Validation Study with Implications for Cardiac Stress Testing

Contact Info

Product

Resources

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CO₂Blood Oxygen Level–dependent MR Mapping of Cerebrovascular Reserve in a Clinical Population: Safety, Tolerability, and Technical Feasibility

Arterial CO₂ as a Potent Coronary Vasodilator: A Preclinical PET/MR Validation Study with Implications for Cardiac Stress Testing