Header

UZH-Logo

Maintenance Infos

Staging hemodynamic failure with blood oxygen-level-dependent functional magnetic resonance imaging cerebrovascular reactivity: a comparison versus gold standard (15O-)H2O-positron emission tomography


Fierstra, Jorn; van Niftrik, Christiaan; Warnock, Geoffrey; Wegener, Susanne; Piccirelli, Marco; Pangalu, Athina; Esposito, Giuseppe; Valavanis, Antonios; Buck, Alfred; Luft, Andreas; Bozinov, Oliver; Regli, Luca (2018). Staging hemodynamic failure with blood oxygen-level-dependent functional magnetic resonance imaging cerebrovascular reactivity: a comparison versus gold standard (15O-)H2O-positron emission tomography. Stroke, 49(3):621-629.

Abstract

BACKGROUND AND PURPOSE: Increased stroke risk correlates with hemodynamic failure, which can be assessed with (15O-)H2O positron emission tomography (PET) cerebral blood flow (CBF) measurements. This gold standard technique, however, is not established for routine clinical imaging. Standardized blood oxygen-level-dependent (BOLD) functional magnetic resonance imaging+CO2 is a noninvasive and potentially widely applicable tool to assess whole-brain quantitative cerebrovascular reactivity (CVR). We examined the agreement between the 2 imaging modalities and hypothesized that quantitative CVR can be a surrogate imaging marker to assess hemodynamic failure.
METHODS: Nineteen data sets of subjects with chronic cerebrovascular steno-occlusive disease (age, 60±11 years; 4 women) and unilaterally impaired perfusion reserve on Diamox-challenged (15O-)H2O PET were studied and compared with a standardized BOLD functional magnetic resonance imaging+CO2 examination within 6 weeks (8±19 days). Agreement between quantitative CBF- and CVR-based perfusion reserve was assessed. Hemodynamic failure was staged according to PET findings: stage 0: normal CBF, normal perfusion reserve; stage I: normal CBF, decreased perfusion reserve; and stage II: decreased CBF, decreased perfusion reserve. The BOLD CVR data set of the same subjects was then matched to the corresponding stage of hemodynamic failure.
RESULTS: PET-based stage I versus stage II could also be clearly separated with BOLD CVR measurements (CVR for stage I 0.11 versus CVR for stage II -0.03; P<0.01). Hemispheric and middle cerebral artery territory difference analyses (ie, affected versus unaffected side) showed a significant correlation for CVR impairment in the affected hemisphere and middle cerebral artery territory (P<0.01, R2=0.47 and P=0.02, R2= 0.25, respectively).
CONCLUSIONS: BOLD CVR corresponded well to CBF perfusion reserve measurements obtained with (15O-)H2O-PET, especially for detecting hemodynamic failure in the affected hemisphere and middle cerebral artery territory and for identifying hemodynamic failure stage II. BOLD CVR may, therefore, be considered for prospective studies assessing stroke risk in patients with chronic cerebrovascular steno-occlusive disease, in particular because it can potentially be implemented in routine clinical imaging.

Abstract

BACKGROUND AND PURPOSE: Increased stroke risk correlates with hemodynamic failure, which can be assessed with (15O-)H2O positron emission tomography (PET) cerebral blood flow (CBF) measurements. This gold standard technique, however, is not established for routine clinical imaging. Standardized blood oxygen-level-dependent (BOLD) functional magnetic resonance imaging+CO2 is a noninvasive and potentially widely applicable tool to assess whole-brain quantitative cerebrovascular reactivity (CVR). We examined the agreement between the 2 imaging modalities and hypothesized that quantitative CVR can be a surrogate imaging marker to assess hemodynamic failure.
METHODS: Nineteen data sets of subjects with chronic cerebrovascular steno-occlusive disease (age, 60±11 years; 4 women) and unilaterally impaired perfusion reserve on Diamox-challenged (15O-)H2O PET were studied and compared with a standardized BOLD functional magnetic resonance imaging+CO2 examination within 6 weeks (8±19 days). Agreement between quantitative CBF- and CVR-based perfusion reserve was assessed. Hemodynamic failure was staged according to PET findings: stage 0: normal CBF, normal perfusion reserve; stage I: normal CBF, decreased perfusion reserve; and stage II: decreased CBF, decreased perfusion reserve. The BOLD CVR data set of the same subjects was then matched to the corresponding stage of hemodynamic failure.
RESULTS: PET-based stage I versus stage II could also be clearly separated with BOLD CVR measurements (CVR for stage I 0.11 versus CVR for stage II -0.03; P<0.01). Hemispheric and middle cerebral artery territory difference analyses (ie, affected versus unaffected side) showed a significant correlation for CVR impairment in the affected hemisphere and middle cerebral artery territory (P<0.01, R2=0.47 and P=0.02, R2= 0.25, respectively).
CONCLUSIONS: BOLD CVR corresponded well to CBF perfusion reserve measurements obtained with (15O-)H2O-PET, especially for detecting hemodynamic failure in the affected hemisphere and middle cerebral artery territory and for identifying hemodynamic failure stage II. BOLD CVR may, therefore, be considered for prospective studies assessing stroke risk in patients with chronic cerebrovascular steno-occlusive disease, in particular because it can potentially be implemented in routine clinical imaging.

Statistics

Citations

Dimensions.ai Metrics
2 citations in Web of Science®
2 citations in Scopus®
1 citation in Microsoft Academic
Google Scholar™

Altmetrics

Downloads

8 downloads since deposited on 08 Mar 2018
8 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:25 January 2018
Deposited On:08 Mar 2018 18:39
Last Modified:20 Sep 2018 04:29
Publisher:American Heart Association
ISSN:0039-2499
OA Status:Green
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1161/STROKEAHA.117.020010
PubMed ID:29371433

Download

Download PDF  'Staging hemodynamic failure with blood oxygen-level-dependent functional magnetic resonance imaging cerebrovascular reactivity: a comparison versus gold standard (15O-)H2O-positron emission tomography'.
Preview
Content: Accepted Version
Filetype: PDF
Size: 1MB
View at publisher