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Research ArticleBrain

Quantitative Measurement of Cerebrovascular Reactivity by Blood Oxygen Level-Dependent MR Imaging in Patients with Intracranial Stenosis: Preoperative Cerebrovascular Reactivity Predicts the Effect of Extracranial-Intracranial Bypass Surgery

D.M. Mandell, J.S. Han, J. Poublanc, A.P. Crawley, J. Fierstra, M. Tymianski, J.A. Fisher and D.J. Mikulis
American Journal of Neuroradiology April 2011, 32 (4) 721-727; DOI: https://doi.org/10.3174/ajnr.A2365
D.M. Mandell
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J.S. Han
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J. Poublanc
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A.P. Crawley
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J. Fierstra
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M. Tymianski
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J.A. Fisher
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D.J. Mikulis
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Abstract

BACKGROUND AND PURPOSE: CVR is a measure of cerebral hemodynamic impairment. A recently validated technique quantifies CVR by using a precise CO2 vasodilatory stimulus and BOLD MR imaging. Our aim was to determine whether preoperative CO2 BOLD CVR predicts the hemodynamic effect of ECIC bypass surgery in patients with intracranial steno-occlusive disease.

MATERIALS AND METHODS: Twenty-five patients undergoing ECIC bypass surgery for treatment of intracranial stenosis or occlusion were recruited. CVR was measured preoperatively and postoperatively and expressed as %ΔBOLD MR signal intensity per mm Hg ΔPetCO2. Using normative data from healthy subjects, we stratified patients on the basis of preoperative CVR into 3 groups: normal CVR, reduced CVR, and negative (paradoxical) CVR. Wilcoxon 2-sample tests (2-sided, α = 0.05) were used to determine whether the 3 groups differed with respect to change in CVR following bypass surgery.

RESULTS: The group with normal preoperative CVR demonstrated no significant change in CVR following bypass surgery (mean, 0.22% ± 0.05% to 0.22% ± 0.01%; P = .881). The group with reduced preoperative CVR demonstrated a significant improvement following bypass surgery (mean, 0.08% ± 0.05% to 0.21 ± 0.08%; P < .001), and the group with paradoxical preoperative CVR demonstrated the greatest improvement (mean change, −0.04% ± 0.03% to 0.27% ± 0.03%; P = .028).

CONCLUSIONS: Preoperative measurement of CVR by using CO2 BOLD MR imaging predicts the hemodynamic effect of ECIC bypass in patients with intracranial steno-occlusive disease. The technique is potentially useful for selecting patients for surgical revascularization.

Abbreviations

ACA
anterior cerebral artery
AFNI
Analysis of Functional NeuroImages
BOLD
blood oxygen level−dependent
CBF
cerebral blood flow
CO2
carbon dioxide
CTA
CT angiography
CVR
cerebrovascular reactivity
DSA
digital subtraction angiography
ECIC bypass
extracranial-intracranial bypass
FiCO2
inspiratory partial pressure of CO2
FLAIR
fluid-attenuated inversion recovery
L
left
MCA
middle cerebral artery
MRA
MR angiography
OEF
oxygen extraction fraction
PaCO2
arterial partial pressure of carbon dioxide
PET
positron-emission tomography
PetCO2
end-tidal partial pressure of carbon dioxide
PetO2
end-tidal partial pressure of oxygen
R
right
STA
superficial temporal artery
TCD
transcranial Doppler
TIA
transient ischemic attack
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American Journal of Neuroradiology: 32 (4)
American Journal of Neuroradiology
Vol. 32, Issue 4
1 Apr 2011
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D.M. Mandell, J.S. Han, J. Poublanc, A.P. Crawley, J. Fierstra, M. Tymianski, J.A. Fisher, D.J. Mikulis
Quantitative Measurement of Cerebrovascular Reactivity by Blood Oxygen Level-Dependent MR Imaging in Patients with Intracranial Stenosis: Preoperative Cerebrovascular Reactivity Predicts the Effect of Extracranial-Intracranial Bypass Surgery
American Journal of Neuroradiology Apr 2011, 32 (4) 721-727; DOI: 10.3174/ajnr.A2365

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Quantitative Measurement of Cerebrovascular Reactivity by Blood Oxygen Level-Dependent MR Imaging in Patients with Intracranial Stenosis: Preoperative Cerebrovascular Reactivity Predicts the Effect of Extracranial-Intracranial Bypass Surgery
D.M. Mandell, J.S. Han, J. Poublanc, A.P. Crawley, J. Fierstra, M. Tymianski, J.A. Fisher, D.J. Mikulis
American Journal of Neuroradiology Apr 2011, 32 (4) 721-727; DOI: 10.3174/ajnr.A2365
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  • Imaging Brain Oxygenation with MRI Using Blood Oxygenation Approaches: Methods, Validation, and Clinical Applications
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