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A Volumetric Method for Quantification of Cerebral Vasospasm in a Murine Model of Subarachnoid Hemorrhage
Published on: July 28, 2018
Intracranial hemodynamic relationships in patients with cerebral small vessel disease
Gordon W Blair1, Michael J Thrippleton1, Yulu Shi1
1From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom.
Insights
Reduced cerebrovascular reactivity (CVR) is linked to white matter hyperintensities and perivascular spaces in stroke patients. These findings highlight dynamic vascular dysfunctions in small vessel disease progression.
Area of Science:
- Neurology
- Radiology
- Vascular Biology
Background:
- Cerebral small vessel disease (SVD) is a major cause of stroke and cognitive decline.
- Understanding the relationship between vascular function and SVD is crucial for developing effective treatments.
Purpose of the Study:
- To investigate cerebrovascular reactivity (CVR), blood flow, and pulsatility in relation to SVD features in minor ischemic stroke patients.
- To identify dynamic vascular dysfunctions underlying SVD progression.
Main Methods:
- Recruited patients with minor ischemic stroke and SVD.
- Assessed CVR using fMRI during hypercapnia, cerebral blood flow (CBF), and vascular/CSF pulsatility using phase-contrast MRI.
- Quantified white matter hyperintensities (WMHs) and perivascular spaces (PVSs) using structural MRI.
Main Results:
- Lower white matter CVR correlated with increased WMH volume, basal ganglia PVS, and higher venous pulsatility.
- CBF was not significantly associated with SVD features.
- Lower cerebrospinal fluid (CSF) stroke volume at the foramen magnum was linked to worse white matter CVR and more severe basal ganglia PVS.
Conclusions:
- Dynamic vascular dysfunctions, including reduced CVR and altered pulsatility, are implicated in PVS dysfunction and WMH development.
- Further research into microvascular dysfunction and CSF dynamics may reveal new therapeutic targets for SVD.
Objective:
To investigate cerebrovascular reactivity (CVR), blood flow, vascular and CSF pulsatility, and their independent relationship with cerebral small vessel disease (SVD) features in patients with minor ischemic stroke and MRI evidence of SVD.
Methods:
We recruited patients with minor ischemic stroke and assessed CVR using blood oxygen level-dependent MRI during a hypercapnic challenge, cerebral blood flow (CBF), vascular and CSF pulsatility using phase-contrast MRI, and structural magnetic resonance brain imaging to quantify white matter hyperintensities (WMHs) and perivascular spaces (PVSs). We used multiple regression to identify parameters associated with SVD features, controlling for patient characteristics.
Results:
Fifty-three of 60 patients completed the study with a full data set (age 68.0% ± 8.8 years, 74% male, 75% hypertensive). After controlling for age, sex, and systolic blood pressure, lower white matter CVR was associated with higher WMH volume (-0.01%/mm Hg per log10 increase in WMH volume, p = 0.02), basal ganglia PVS (-0.01%/mm Hg per point increase in the PVS score, p = 0.02), and higher venous pulsatility (superior sagittal sinus -0.03%/mm Hg, p = 0.02, per unit increase in the pulsatility index) but not with CBF (p = 0.58). Lower foramen magnum CSF stroke volume was associated with worse white matter CVR (0.04%/mm Hg per mL increase in stroke volume, p = 0.04) and more severe basal ganglia PVS (p = 0.09).
Conclusions:
Lower CVR, higher venous pulsatility, and lower foramen magnum CSF stroke volume indicate that dynamic vascular dysfunctions underpin PVS dysfunction and WMH development. Further exploration of microvascular dysfunction and CSF dynamics may uncover new mechanisms and intervention targets to reduce SVD lesion development, cognitive decline, and stroke.
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