Predicting Acute Mountain Sickness Using Regional Sea-Level Cerebral Blood Flow

Area of Science:

• Neurology
• Radiology
• Altitude Medicine

Background:

• Acute mountain sickness (AMS) is a common condition at high altitudes.
• Predicting AMS susceptibility remains challenging.
• Cerebral blood flow (CBF) regulation is critical for acclimatization.

Purpose of the Study:

• To investigate the predictive role of sea-level CBF for AMS.
• To utilize three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL) for non-invasive CBF measurement.
• To compare CBF parameters between AMS and non-AMS groups.

Main Methods:

• Forty-eight healthy volunteers underwent 3D-pCASL MRI at sea level before ascending to 3,650 m.
• CBF in specific arterial territories (ACA, MCA, PCA, PICA) and laterality index (LI) were analyzed.
• Statistical analysis and ROC curves assessed predictive performance for AMS.

Main Results:

• Mean cortical CBF was higher in women than men.
• In men, higher CBF in ACA, PCA, PICA, and right MCA at sea level correlated with AMS development.
• Right PCA CBF showed the highest predictive value (AUC=0.818) in men; ACA LI predicted AMS in women (AUC=0.753).

Conclusions:

• Sea-level CBF, especially in the posterior circulation, may predict AMS in male volunteers.
• Non-invasive 3D-pCASL is a promising tool for assessing AMS risk.
• CBF laterality may also play a role in AMS prediction, particularly in women.