MRI-Based Classification of Cerebral Hemodynamic Failure With Resting Perfusion Metrics and Cerebrovascular Reactivity.

IF 8.9 1区医学 Q1 CLINICAL NEUROLOGY

Stroke Pub Date : 2025-10-01 Epub Date: 2025-08-07 DOI:10.1161/STROKEAHA.125.050978

Ece Su Sayin, James Duffin, Julien Poublanc, Joseph A Fisher, David J Mikulis, Olivia Sobczyk

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引用次数: 0

Abstract

Background: The inability to augment regional cerebral blood flow (CBF) in the setting of steno-occlusive disease involving large brain-supplying arteries is a risk factor for stroke. The gold standard for detecting such hemodynamic impairment requires the application of a vasodilatory stimulus while measuring changes in CBF. Resting blood flow metrics derived from computed tomography or magnetic resonance imaging (MRI) perfusion methods have been applied as surrogates for assessing hemodynamic insufficiency including relative CBF, relative cerebral blood volume, and mean transit time (MTT). The purpose of this study, therefore, was to compare the sensitivity and specificity of MRI resting perfusion metrics with cerebrovascular reactivity (CVR). MRI CVR mapping was used as a reference standard for comparing MRI perfusion-derived CBF, CBV, and MTT.

Methods: MRI resting perfusion metrics were measured using a recently reported noninvasive method that induces a bolus of hypoxia-induced deoxyhemoglobin as the dynamic susceptibility contrast in place of the gadolinium-based contrast agents. CVR was measured using a standardized hypercapnic vasoactive stimulus during blood oxygen level-dependent MRI as a surrogate for CBF.

Results: Twenty-two patients with large artery steno-occlusive disease (mean age±SD, 46±17.8 years; 60% female), 24 healthy participants for the CVR atlas (35.1±13.8 years; 33% female), and 25 for the perfusion atlas (38.4±17.6 years; 24% female) were recruited. Significant differences in mean hemispheric middle cerebral artery perfusion (MTT, relative CBF) and CVR metrics in gray matter (P<0.05) were observed between patients and healthy participants. Comparisons between affected and unaffected hemispheres in patients showed significant differences only for MTT and CVR in gray matter (P<0.05). Receiver-operating characteristic curves identified CVR as the most sensitive predictor for hemodynamic impairment followed by MTT.

Conclusions: CVR remains a more accurate test for assessing hemodynamic impairment compared to resting blood flow metrics.

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基于静息灌注指标和脑血管反应性的脑血流动力学衰竭mri分类。

背景：在涉及大脑供血动脉的狭窄闭塞性疾病中，无法增加区域脑血流量（CBF）是卒中的危险因素。检测此类血流动力学损伤的金标准要求在测量CBF变化时应用血管舒张刺激。通过计算机断层扫描或磁共振成像（MRI）灌注方法获得的静息血流量指标已被用作评估血流动力学功能不全的替代指标，包括相对CBF、相对脑血容量和平均传递时间（MTT）。因此，本研究的目的是比较MRI静息灌注指标与脑血管反应性（CVR）的敏感性和特异性。MRI CVR制图被用作与MRI灌注衍生CBF、CBV和MTT比较的金标准。方法：MRI静息灌注指标使用最近报道的一种无创方法进行测量，该方法诱导大量缺氧诱导的脱氧血红蛋白作为动态敏感性对比剂，代替用于此目的的钆基对比剂。在血氧水平依赖的MRI期间，使用标准化的高碳酸血症血管活性刺激来测量CVR，作为CBF的替代品。结果：大动脉狭窄闭塞性疾病22例(平均年龄±SD， 46±17.8岁；60%为女性)，24名健康参与者(35.1±13.8岁；33%女性)，灌注图谱25例(38.4±17.6岁；（24%为女性）。脑灰质平均半球大脑中动脉灌注（MTT，相对CBF）和CVR指标的显著差异（ppp）结论：与静息血流指标相比，CVR仍然是评估血流动力学损伤的更准确的测试。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.