Measurement of volume of cerebral blood flow in healthy preterm and term neonates with ultrasound

Kehrer, Martin; Goelz, Rangmar; Krägeloh‐Mann, Ingeborg; Schöning, M.

doi:10.1016/s0140-6736(02)11720-x

Cited by 44 publications

(44 citation statements)

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“…This study showed a rather strong correlation between PC-MRA measured global CBF and postconceptional age and actual body weight, which is in accordance with previous data observed in an ultrasound study reporting an increase of global CBF of 6 mL/min per postmenstrual week (19). However, the PC-MRA measured CBF per kilogram actual body weight seemed to be remarkable stable over a wide range of postconceptional ages.…”

Section: Discussionsupporting

confidence: 91%

“…This means that mean CBF in this study can be estimated to ϳ20 mL/100 g/min. This is a bit higher than existing estimates using extracranial Doppler, Xenon, and arterial spin labeling MRI (ASL) (8,12,19).…”

Section: Discussionmentioning

confidence: 73%

“…It is known from Doppler ultrasound studies that the flow in the ICAs and BA is related to GA (19). With the more widespread use of MRI in neonates admitted to NICUs, this relatively simple and fast PC-MRA measurement may add to a better understanding of the pathophysiology of the neonatal cerebral perfusion as has been the case in adults (20 -22).…”

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confidence: 96%

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Phase-Contrast Magnetic Resonance Angiography Measurements of Global Cerebral Blood Flow in the Neonate

et al. 2011

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Cerebral blood flow (CBF) alterations are important in pathogenesis of neonatal ischemic/hemorrhagic brain damage. In clinical practice, estimation of neonatal CBF is mostly based on Doppler-measured blood flow velocities in major intracranial arteries. Using phase-contrast magnetic resonance angiography (PC-MRA), global CBF can be estimated, but there is limited neonatal experience. The objective of this study was to gain experience with PC-MRA for the determination of global CBF in neonates. In infants eligible for MRI, PC-MRA global CBF was determined by measuring volume blood flow in both internal carotid arteries (ICAs) and basilar artery (BA). Thirty newborns (GA, 25.7-42.1 wk; weight, 1050 -5858 g; postconceptional age, 225-369 d) were investigated. Total PC-MRA CBF ranged from 27 to 186 mL/min. Significant correlations between PC-MRA CBF and postconceptional age and weight were detected. When calculating PC-MRA measured CBF per kilogram body weight, brain perfusion was about stable over the range of postconceptional ages and ranged between 11 and 48 mL/min/kg (median, 25 mL/min/kg). In conclusion, neonatal PC-MRA CBF seems to be a useful technique to estimate noninvasive CBF. (Pediatr Res 69: 544-547, 2011) P revious studies of (changes in) neonatal cerebral blood flow (CBF) have been performed using different methods, such as the venous occlusion plethysmography (1), positron emission tomography (2), the nitrous oxide technique (3), and the 133 Xenon clearance method (4). In addition, Xenon computed tomography (5) and more recently MRI with contrast (6) have been used to measure neonatal CBF. Furthermore, the use of near-infrared spectroscopy (NIRS) with indocyanine green has been repeatedly reported, but it uses an i.v. injection with the dye indocyanine green (7). Ionizing radiation is involved in these techniques or they are invasive or need special requirements, which limit their use. Arterial spinlabeled perfusion MRI (8) and sophisticated NIRS techniques such as optical diffuse correlation spectroscopy are developed at this moment to evaluate neonatal CBF (9); however, improvements are necessary before these devices can reliably be used. It may be clear that the above-mentioned methods are not (yet) available for clinical use in the vulnerable and unstable (preterm) neonate.Noninvasive approaches for estimating changes in global CBF in the often unstable neonate are performed using NIRS and Doppler-derived blood flow velocity measurements in the major intracranial arteries (10 -14). NIRS as such has not yet become a routine application in the NICUs, whereas measurements of blood flow velocity in intracranial arteries cannot measure volume flow due to the small diameter of the feeding intracranial arteries in newborn infants (5,12).MRI is increasingly used in neonates both in preterm as well as in full term infants, mainly for depicting the various brain regions to detect subtle differences or early ischemic and/or hemorrhagic changes due to perinatal complications (15,16). Recently, usin...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 73%

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Phase-Contrast Magnetic Resonance Angiography Measurements of Global Cerebral Blood Flow in the Neonate

et al. 2011

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“…In a first interobserver reproducibility performed in children and adults, a 10.0% coefficient of variation has been found (6). The result was comparable with that of a reproducibility study in adult men where two subsequent H 2 15 O-PET scans had been done (7). A recent interobserver reproducibility study performed in neonates resulted in a coefficient of variation of only 6.3% (8).…”

Section: Introductionsupporting

confidence: 67%

A Longitudinal Study of Cerebral Blood Flow Over the First 30 Months

Kehrer

Schöning

2009

Pediatr Res

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ABSTRACT:To investigate prospectively the development of cerebral perfusion during infancy, serial quantitative measurements of cerebral blood flow (CBF) volume were performed in two healthy children from birth up to the age of 30 mo. A total of 28 CBF volume measurements were done in either of the children. Absolute flows were measured in the internal carotid and vertebral arteries on both sides. Blood flow was calculated as the product of angle-corrected time-averaged flow velocity and the cross-sectional area of the vessel. Starting from 67 and 80 mL/min, respectively, at birth an almost 10-fold increase of CBF volume was observed in both children during the examination period. Half of this rise occurred during the first 6 mo, probably reflecting the steep metabolic incline during this period of synaptogenesis. The continuous increase in CBF volume after the sixth month of life mainly corresponds to brain growth. Estimated CBF (based on estimated brain weights) increased from 21 and 23 mL 100 g Ϫ1 min Ϫ1 , respectively, after birth to 46 and 53 mL 100 g Ϫ1 min Ϫ1 , respectively, during the first 6 mo of life in both children, remaining stable thereafter. This study is the first to provide longitudinal data of CBF during the first 30 mo after birth. The method is noninvasive and innocuous and therefore suited for serial measurements, which has been shown in adult neurointensive care patients (3,4) and in a longitudinal study in preterm infants (5). The accuracy of the measurement depends on a motionless position of the patient and a strict compliance with a standardized study protocol. In a first interobserver reproducibility performed in children and adults, a 10.0% coefficient of variation has been found (6). The result was comparable with that of a reproducibility study in adult men where two subsequent H 2 15 O-PET scans had been done (7). A recent interobserver reproducibility study performed in neonates resulted in a coefficient of variation of only 6.3% (8).Reference data for CBF volume are available for preterm and term neonates (gestational age, 32-42 wk) (9) and for children from 3 y up to the age of 18 y (10). Although the CBF volume in term neonates is about 70 mL/min (9), it is 10 times higher in 3-y-old children (about 700 mL/min) (10). The dynamics of CBF volume increase, however, from birth up to the age of 3 y is still unclear. The aim of the presented longitudinal study was to describe the development of cerebral perfusion during the first 30 mo of life by serial measurements of CBF volume in two healthy children. METHODSProbands. Two healthy, term born children [1 female ("F"), 1 male ("M")] were involved in a prospective study. Birth weights were 3210 g (M) and 2810 g (F), body lengths at birth were 53 cm (M) and 50 cm (F), and head circumferences at birth were 34.0 cm (M) and 33.0 cm (F). Cerebral B-mode ultrasound examinations performed until the closure of the anterior fontanel were always normal in both children. Neither of them ever presented cardiologic or neurologic abnormalities or ...

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“…NIRS as a cot-side method for measuring CBF was described in the late 1980s (12) but has not yet become a routine application, probably because methodological limitations are a problem in quantitative NIRS perfusion measurements. However, quantitative measurements of CBF in neonates have recently been performed with sonographic flowmetry of carotid and vertebral arteries (13)(14)(15)(16). From these studies, it is known that global CBF increases with PMA; however, quantitative regional brain perfusion data and the influence of postnatal age beyond the first 2 wk of life (16) are not yet available on healthy neonates.…”

mentioning

confidence: 99%

Noninvasive Measurements of Regional Cerebral Perfusion in Preterm and Term Neonates by Magnetic Resonance Arterial Spin Labeling

2006

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Magnetic resonance arterial spin labeling (ASL) at 3 Tesla has been investigated as a quantitative technique for measuring regional cerebral perfusion (RCP) in newborn infants. RCP values were measured in 49 healthy neonates: 32 preterm infants born before 34 wk of gestation and 17 term-born neonates. Examinations were performed on unsedated infants at postmenstrual age of 39 -40 wk in both groups. Due to motion, reliable data were obtained from 23 preterm and 6 term infants. Perfusion in the basal ganglia (39 and 30 mL/100 g/min for preterm and term neonates, respectively) was significantly higher (p Ͻ 0.0001) than in cortical gray matter (19 and 16 mL/100 g/min) and white matter (15 and 10 mL/100 g/min), both in preterm neonates at term-equivalent age and in term neonates. Perfusion was significantly higher (p ϭ 0.01) in the preterm group than in the term infants, indicating that RCP may be influenced by developmental and postnatal ages. This study demonstrates, for the first time, that noninvasive ASL at 3T may be used to measure RCP in healthy unsedated preterm and term neonates. ASL is, therefore, a viable tool that will allow serial studies of RCP in high-risk neonates. H igh-risk neonates, either infants born prematurely or asphyxiated infants born at term, have a vulnerable cerebral circulation (1). Impaired autoregulation of the CBF and thus cerebral perfusion contributes to some extent to the development of brain damage in those infants (2-4). Other mechanisms, as inflammation-mediated perfusion disturbances might also be implicated in brain damage development (5), however, this point has not yet been demonstrated.Studies of the cerebral circulation have previously been performed using different invasive methods as xenon clearance (1,6), positron emission tomography (PET) (7,8), and SPECT (9). Noninvasive approaches for estimating global CBF, e.g. Doppler ultrasonography and NIRS (10) have been used achieving only a limited use (11). NIRS as a cot-side method for measuring CBF was described in the late 1980s (12) but has not yet become a routine application, probably because methodological limitations are a problem in quantitative NIRS perfusion measurements. However, quantitative measurements of CBF in neonates have recently been performed with sonographic flowmetry of carotid and vertebral arteries (13)(14)(15)(16). From these studies, it is known that global CBF increases with PMA; however, quantitative regional brain perfusion data and the influence of postnatal age beyond the first 2 wk of life (16) are not yet available on healthy neonates.In recent years, a noninvasive magnetic resonance (MR) method for accurately measuring regional brain perfusion has been developed (17). MR-Atrial spin labeling (ASL) is a completely noninvasive MR technique that enables accurate maps of RCP to be acquired in a few minutes. As this MR method is noninvasive and safe, even in very young infants, the measurements may be repeated, e.g. for monitoring changes in perfusion or response to treatment.The basic...

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Measurement of volume of cerebral blood flow in healthy preterm and term neonates with ultrasound

Cited by 44 publications

References 5 publications

Phase-Contrast Magnetic Resonance Angiography Measurements of Global Cerebral Blood Flow in the Neonate

Phase-Contrast Magnetic Resonance Angiography Measurements of Global Cerebral Blood Flow in the Neonate

A Longitudinal Study of Cerebral Blood Flow Over the First 30 Months

Noninvasive Measurements of Regional Cerebral Perfusion in Preterm and Term Neonates by Magnetic Resonance Arterial Spin Labeling

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