Changes In Cortical Blood Flow Research Articles

Increased NOX2 expression in astrocytes leads to eNOS uncoupling through dihydrofolate reductase in endothelial cells after subarachnoid hemorrhage.

Endothelial nitric oxide synthase (eNOS) uncoupling plays a significant role in acute vasoconstriction during early brain injury (EBI) after subarachnoid hemorrhage (SAH). Astrocytes in the neurovascular unit extend their foot processes around endothelia. In our study, we tested the hypothesis that increased nicotinamide adenine dinucleotide phosphate oxidase 2 (NOX2) expression in astrocytes after SAH leads to eNOS uncoupling. We utilized laser speckle contrast imaging for monitoring cortical blood flow changes in mice, nitric oxide (NO) kits to measure the level of NO, and a co-culture system to study the effect of astrocytes on endothelial cells. Moreover, the protein levels were assessed by Western blot and immunofluorescence staining. We used CCK-8 to measure the viability of astrocytes and endothelial cells, and we used the H2O2 kit to measure the H2O2 released from astrocytes. We used GSK2795039 as an inhibitor of NOX2, whereas lentivirus and adeno-associated virus were used for dihydrofolate reductase (DHFR) knockdown in vivo and in vitro. The expression of NOX2 and the release of H2O2 in astrocytes are increased, which was accompanied by a decrease in endothelial DHFR 12 h after SAH. Moreover, the eNOS monomer/dimer ratio increased, leading to a decrease in NO and acute cerebral ischemia. All of the above were significantly alleviated after the administration of GSK2795039. However, after knocking down DHFR both in vivo and in vitro, the protective effect of GSK2795039 was greatly reversed. The increased level of NOX2 in astrocytes contributes to decreased DHFR in endothelial cells, thus aggravating eNOS uncoupling, which is an essential mechanism underlying acute vasoconstriction after SAH.

Laser speckle contrast imaging for blood flow monitoring in predicting outcomes after cerebral ischemia-reperfusion injury in mice

BackgroundIn the treatment of ischemic cerebral stroke (ICS), most conventional treatments, including carotid endarterectomy and carotid artery stenting, may cause cerebral ischemia-reperfusion injury (CIRI). For treated ICS patients, changes in cerebral blood flow are directly related to brain function. At present, computed tomography perfusion, dynamic susceptibility contrast-enhanced perfusion weighted imaging and magnetic resonance arterial spin labeling perfusion imaging are used to monitor cerebral blood flow, but they still have some limitations. Our study aimed to monitor the changes in cerebral cortical blood flow by laser speckle contrast imaging (LSCI) in CIRI model mice and to propose a new method for predicting outcomes after CIRI. C57BL/6 N mice were used to establish a mouse CIRI model based on a modified thread-occlusion method and divided into a good outcome group and a poor outcome group according to survival within 7 days. The cerebral cortical blood flow of the area supplied by the left middle cerebral artery was monitored by LSCI at baseline (before modeling), 1 h after ischemia, immediately after reperfusion and 24 h after reperfusion. Then, the brains of the mice were removed immediately and stained with hematoxylin and eosin to observe the pathological changes in brain neurons.ResultsThe cerebral cortical blood flow in the poor outcome group was obviously reduced compared with that less in the good outcome group at 24 h after reperfusion (180.8 ± 20.9 vs. 113.9 ± 6.4, p = 0.001), and at 24 h after reperfusion, the cerebral cortical blood flow was negatively correlated with the severity of brain tissue injury (p = − 0.710, p = 0.010).ConclusionsLSCI can monitor the changes in cerebral cortical blood flow during CIRI in mice and could be used as a feasible method for predicting outcomes after CIRI in mice.

PD-0245 Changes in cortical blood flow >1 year after radiation for glioma using arterial spin labelling MRI

PD-0245 Changes in cortical blood flow >1 year after radiation for glioma using arterial spin labelling MRI

Comparison of Cortical and Cutaneous Vascular Hemodynamic Changes in Hypoxia by Usingin VivoSkull and Skin Optical Clearing Techniques

Hypoxia occurs in various pathophysiological conditions. Especially, brain can be seriously affected by the oxygen deficiency. However, challenges exist in optically monitoring cerebral hemodynamics with high resolution. As an easily-detected vessel bed, peripheral skin is a potential target for predicting cerebrovascular hemodynamic changes. However, the similarities and differences between cerebral and cutaneous hemodynamics during hypoxia are still unclear. One of the main reasons is that optical imaging techniques are fundamentally depth/resolution-limited due to high scattering properties of turbid tissue. Fortunately, in vivo tissue optical clearing techniques can efficiently overcome these problems, and avoid the side-effects of surgical windows. In this work, we simultaneously monitor the changes in cortical and cutaneous microvascular blood oxygen and blood flow under the assistance of in vivo skull and skin optical clearing techniques, and quantitatively compared the differences between cerebral and cutaneous arteriovenous functional responses to the hypoxic stimulus. The results indicated that the variation tendency of blood oxygen response might be more similar, and cutaneous vascular blood oxygen response has the potential to serve as an accessible indicator for revealing cerebrovascular dysfunction. Moreover, it provides a feasible approach to realize visualization of in vivo monitoring cerebral and cutaneous microvascular reactivity with minimal invasiveness.

Progression of cortical dysfunction in CSF1R‐related leukoencephalopathy detected using single‐photon emission computed tomography

AbstractBackgroundHereditary diffuse leukoencephalopathy with spheroids (HDLS) is a rare autosomal dominant disease progressively affecting cognitive and motor functions, most often caused by mutations in the colony‐stimulating factor 1 receptor gene (CSF1R).AimTo elucidate the mechanism of disease progression, changes in white matter lesions and cortical cerebral blood flow (CBF) were evaluated in cases during various stages of the disease.MethodsAll patients were diagnosed with HDLS by confirming mutations in CSF1R. Regional CBF was evaluated using single‐photon emission computed tomography and was analyzed semiquantitatively.ResultsThree cases (2 males and 1 female, ages 51, 53, and 48 years on admission, disease duration from 1 to 8 years) were registered. All cases exhibited different CSF1R mutations and progressive frontal dysfunction. Scores of the Frontal Assessment Battery and time in the Trail Making Test worsened as the disease progressed, whereas the Mini‐Mental State Examination score remained relatively stable. MRI revealed progressive white matter lesions in the frontal lobe and atrophy of the anterior body of the corpus callosum. Regional CBF was low in the medial frontal cortex in the early case, and the area of hypoperfusion spread to the lateral frontal cortex and parietal cortex as the disease progressed. CBF was maintained in the basal ganglia, thalamus, and occipital lobes.ConclusionsHypoperfusion was initially observed in the medial frontal lobe and spread to the lateral frontal lobe and parietal lobe with disease progression. Spreading of accumulated abnormal proteins induced by mutation in CSF1R may be involved as a molecular mechanism of disease progression.

Rapid hematoma growth triggers spreading depolarizations in experimental intracortical hemorrhage

Recurrent waves of spreading depolarization (SD) occur in brain injury and are thought to affect outcomes. What triggers SD in intracerebral hemorrhage is poorly understood. We employed intrinsic optical signaling, laser speckle flowmetry, and electrocorticography to elucidate the mechanisms triggering SD in a collagenase model of intracortical hemorrhage in mice. Hematoma growth, SD occurrence, and cortical blood flow changes were tracked. During early hemorrhage (0–4 h), 17 out of 38 mice developed SDs, which always originated from the hematoma. No SD was detected at late time points (8–52 h). Neither hematoma size, nor peri-hematoma perfusion were associated with SD occurrence. Further, arguing against ischemia as a trigger factor, normobaric hyperoxia did not inhibit SD occurrence. Instead, SDs always occurred during periods of rapid hematoma growth, which was two-fold faster immediately preceding an SD compared with the peak growth rates in animals that did not develop any SDs. Induced hypertension accelerated hematoma growth and resulted in a four-fold increase in SD occurrence compared with normotensive animals. Altogether, our data suggest that spontaneous SDs in this intracortical hemorrhage model are triggered by the mechanical distortion of tissue by rapidly growing hematomas.

Establishment of transparent cranial window after cerebral subarachnoid hemorrhage and studying of cerebral cortical blood flow in rats

Objective Establishment of a transparent cranial window model of subarachnoid hemorrhage in rats for 7 days of continuous monitoring of cortical blood flow after subarachnoid hemorrhage Methods Thirty SD male rats were randomly divided into normal control group (n=10), saline group (n=10)and blood injection group (n=10). The transcranial subarachnoid hemorrhage transparent cranial window observation model was established by injecting autologous non-anticoagulation tail artery blood 0.3 ml twice in the occipital large pool and using a transparent flexible material made of silicon-based polydimethylsiloxane. Seven-day dynamic changes in cerebral cortical blood flow within the cranial window were monitored by laser speckle imaging. Results The imaging of 27 rats were clear; the blood flow velocity of the cortex decreased after SAH, which was statistically different from the control group and the saline group (P<0.01), and the blood flow on the 3rd, 5th, and 7th day after SAH. The percentage speeds were (83.20±4.16)%, (64.00±3.05)%, (75.70±3.79)%, and the 5 d was statistically different from the 3rd and 7 d (P<0.01); cortical blood perfusion after SAH The amount decreased, which was statistically different from the control group and the saline group (P<0.05). The percentage blood perfusion of the cortex on the 3rd, 5th, and 7th after SAH was (75.40±4.18)%, (31.80±5.34)%, (68.90±6.31)%, the 5th was statistically different from the 3rd and 7 d (P<0.01). Conclusion Through the use of a new flexible transparent material to establish a subarachnoid hemorrhage transparent cranial window imaging model, combined with laser speckle imaging technology can clearly detect the decline of cortical blood flow velocity and cortical blood perfusion in rats after subarachnoid hemorrhage 5 d is the peak of decline, and recovery begins on the 7th day, providing a new method for studying the pathophysiological changes in the acute and subacute phases after subarachnoid hemorrhage. Key words: Subarachnoid hemorrhage; Transparent cranial window imaging; Cerebral cortex blood flow; Laser speckle imaging technique; Rat

Platelet microvesicles promote the recovery of neurological function in mouse model of cerebral infarction by inducing angiogenesis

The aim of this study is to investigate the effect of PMVs on mice with ischemic cerebral infarction and its mechanism. Male C57BL/6 mice were selected, and the right focal cortical infarction model was established via cauterization under a microscope and randomly divided into sham operation (Sham) group, normal saline control (Saline) group and platelet microvesicles intervention (PMVs) group. At 1 h after modeling, 5 μL of PMVs (50 μg/mL) or normal saline was injected into the lateral ventricle. The neurological function of mice in each group was evaluated at 1, 3, 7, 14 and 28 d after modeling. After 28 d, the cerebral infarction area was detected via 2,3,5-triphenyltetrazolium chloride (TTC) staining. At 7 and 28 d after modeling, the blood vessel density, proliferation rate of new vessels and encapsulation rate of pericytes were detected via immunofluorescence staining. Moreover, the changes in cerebral cortical blood flow at the infarction side were detected before modeling and at 7 and 28 d after modeling, respectively. Finally, the expressions of proangiogenic factors vascular endothelial growth factor (VEGF), angiopoietin-1 (Ang-1) and N-Cadherin were detected via Western blotting at 3, 7 and 28 d after modeling. PMVs could promote the improvement of neurological function and significantly reduce the cerebral infarction volume in mice with cerebral infarction. PMVs promoted proliferation of new vessels and increased blood vessel density at the infarction edge in mice with cerebral infarction. PMVs could increase the encapsulation rate of pericytes at the infarction edge and improve the permeability of blood-brain barrier in mice with cerebral infarction. PMVs could increase the cerebral cortical blood flow perfusion in mice with cerebral infarction. PMVs could increase proangiogenic factors in brain tissues in mice with cerebral infarction. PMVs could significantly improve the recovery of neurological function in mice with cerebral infarction, which is closely related to the ability of PMVs to promote angiogenesis at the infarction edge. The possible mechanism is that PMVs facilitate angiogenesis after cerebral infarction through promoting the expressions of VEGF, Ang-1 and N-Cadherin. More importantly, the new vessels promoted by PMVs have complete structure and perfect function, and can improve the cerebral blood flow perfusion at the infarction side.

Effects of nicotine on odor-induced increases in regional blood flow in the olfactory bulb in rats.

The present study examined the effects of nicotinic acetylcholine receptor activation on the odor-induced blood flow response in the olfactory bulb. In urethane-anesthetized rats, odor stimulation (5% amyl acetate, 30s) produced an increase in olfactory bulb blood flow (reaching 107% ± 3% of the pre-stimulus basal values), without changes in frontal cortical blood flow or mean arterial pressure. Intravenous injection of nicotine (30μg/kg), a nicotinic acetylcholine receptor agonist, significantly augmented the odor-induced increase response of olfactory bulb blood flow, without changes in the basal blood flow level. The nicotine-induced augmentation of the olfactory bulb blood flow response to odor was negated by dihydro-β-erythroidine, an α4β2-preferring nicotinic acetylcholine receptor antagonist. Our results suggest that the activation of α4β2-like neuronal nicotinic acetylcholine receptors in the brain potentiates an odor-induced blood flow response in the olfactory bulb.

Characterization of the microvascular cerebral blood flow response to obstructive apneic events during night sleep.

.Obstructive apnea causes periodic changes in cerebral and systemic hemodynamics, which may contribute to the increased risk of cerebrovascular disease of patients with obstructive sleep apnea (OSA) syndrome. The improved understanding of the consequences of an apneic event on the brain perfusion may improve our knowledge of these consequences and then allow for the development of preventive strategies. Our aim was to characterize the typical microvascular, cortical cerebral blood flow (CBF) changes in an OSA population during an apneic event. Sixteen patients (age , 75% male) with a high risk of severe OSA were measured with a polysomnography device and with diffuse correlation spectroscopy (DCS) during one night of sleep with 1365 obstructive apneic events detected. All patients were later confirmed to suffer from severe OSA syndrome with a mean of apneas and hypopneas per hour. DCS has been shown to be able to characterize the microvascular CBF response to each event with a sufficient contrast-to-noise ratio to reveal its dynamics. It has also revealed that an apnea causes a peak increase of microvascular CBF () at the end of the event followed by a drop () similar to what was observed in macrovascular CBF velocity of the middle cerebral artery. This study paves the way for the utilization of DCS for further studies on these populations.

Dissociation between CSD-Evoked Metabolic Perturbations and Meningeal Afferent Activation and Sensitization: Implications for Mechanisms of Migraine Headache Onset.

The onset of the headache phase during attacks of migraine with aura, which occur in ∼30% of migraineurs, is believed to involve cortical spreading depression (CSD) and the ensuing activation and sensitization of primary afferent neurons that innervate the intracranial meninges, and their related large vessels. The mechanism by which CSD enhances the activity and mechanosensitivity of meningeal afferents remains poorly understood, but may involve cortical metabolic perturbations. We used extracellular single-unit recording of meningeal afferent activity and monitored changes in cortical blood flow and tissue partial pressure of oxygen (tpO2) in anesthetized male rats to test whether the prolonged cortical hypoperfusion and reduction in tissue oxygenation that occur in the wake of CSD contribute to meningeal nociception. Suppression of CSD-evoked cortical hypoperfusion with the cyclooxygenase inhibitor naproxen blocked the reduction in cortical tpO2, but had no effect on the activation of meningeal afferents. Naproxen, however, distinctly prevented CSD-induced afferent mechanical sensitization. Counteracting the CSD-evoked persistent hypoperfusion and reduced tpO2 by preemptively increasing cortical blood flow using the ATP-sensitive potassium [K(ATP)] channel opener levcromakalim did not inhibit the sensitization of meningeal afferents, but prevented their activation. Our data show that the cortical hypoperfusion and reduction in tpO2 that occur in the wake of CSD can be dissociated from the activation and mechanical sensitization of meningeal afferent responses, suggesting that the metabolic changes do not contribute directly to these neuronal nociceptive responses.SIGNIFICANCE STATEMENT Cortical spreading depression (CSD)-evoked activation and mechanical sensitization of meningeal afferents is thought to mediate the headache phase in migraine with aura. We report that blocking the CSD-evoked cortical hypoperfusion and reduced tissue partial pressure of oxygen by cyclooxygenase inhibition is associated with the inhibition of the afferent sensitization, but not their activation. Normalization of these CSD-evoked metabolic perturbations by activating K(ATP) channels is, however, associated with the inhibition of afferent activation but not sensitization. These results question the contribution of cortical metabolic perturbations to the triggering mechanism underlying meningeal nociception and the ensuing headache in migraine with aura, further point to distinct mechanisms underlying the activation and sensitization of meningeal afferents in migraine, and highlight the need to target both processes for an effective migraine therapy.

Caffeine does not affect susceptibility to cortical spreading depolarization in mice

Several factors that modulate migraine, a common primary headache disorder, also affect susceptibility to cortical spreading depolarization (CSD). CSD is a wave of neuronal and glial depolarization and thought to underlie the migraine aura and possibly headache. Here, we tested whether caffeine, known to alleviate or trigger headache after acute exposure or chronic use/withdrawal, respectively, modulates CSD. We injected C57BL/6J mice with caffeine (30, 60, or 120 mg/kg; i.p.) once (acute) or twice per day for one or two weeks (chronic). Susceptibility to CSD was evaluated by measuring the electrical CSD threshold and by assessing KCl-induced CSD. Simultaneous laser Doppler flowmetry was used to assess CSD-induced cortical blood flow changes. Recordings were performed 15 min after caffeine/vehicle administration, or 24 h after the last dose of chronic caffeine in the withdrawal group. The latter paradigm was also tested in mice carrying the familial hemiplegic migraine type 1 R192Q missense mutation, considered a valid migraine model. Neither acute/chronic administration nor withdrawal of caffeine affected CSD susceptibility or related cortical blood flow changes, either in WT or R192Q mice. Hence, adverse or beneficial effects of caffeine on headache seem unrelated to CSD pathophysiology, consistent with the non-migrainous clinical presentation of caffeine-related headache.

Structural and functional brain changes in early- and mid-stage primary open-angle glaucoma using voxel-based morphometry and functional magnetic resonance imaging

To investigate structural and functional brain changes in patients with primary open-angle glaucoma (POAG) by using voxel-based morphometry based on diffeomorphic anatomical registration through exponentiated Lie algebra (VBM-DARTEL) and blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI), respectively.Thirteen patients diagnosed with POAG and 13 age- and sex-matched healthy controls were enrolled in the study. For each participant, high-resolution structural brain imaging and blood flow imaging were acquired on a 3.0-Tesla magnetic resonance imaging (MRI) scanner. Structural and functional changes between the POAG and control groups were analyzed. An analysis was carried out to identify correlations between structural and functional changes acquired in the previous analysis and the retinal nerve fiber layer (RNFL).Patients in the POAG group showed a significant (P < 0.001) volume increase in the midbrain, left brainstem, frontal gyrus, cerebellar vermis, left inferior parietal lobule, caudate nucleus, thalamus, precuneus, and Brodmann areas 7, 18, and 46. Moreover, significant (P < 0.001) BOLD signal changes were observed in the right supramarginal gyrus, frontal gyrus, superior frontal gyrus, left inferior parietal lobule, left cuneus, and left midcingulate area; many of these regions had high correlations with the RNFL.Patients with POAG undergo widespread and complex changes in cortical brain structure and blood flow. (ClinicalTrials.gov number: NCT02570867).

Characterization and Activation of NLRP3 Inflammasomes in the Renal Medulla in Mice

Background/Aims: Recent studies have indicated that local inflammatory mediators are importantly involved in the regulation of renal function. However, it remains unknown how such local inflammation is triggered intracellularly in the kidney. The present study was designed to characterize the inflammasome centered by Nlrp3 in the kidney and also test the effect of its activation in the renal medulla. Methods and Results: By immunohistochemistry analysis, we found that inflammasome components, Nlrp3, Asc and caspase-1, were ubiquitously distributed in different kidney areas. The caspase-1 activity and IL-1β production were particularly high in the renal outer medulla compared to other kidney regions. Further confocal microscopy and RT-PCR analysis showed that Nlrp3, Asc and caspase-1 were particularly enriched in the thick ascending limb of Henle's loop. In anesthetized mice, medullary infusion of Nlrp3 inflammasome activator, monosodium urate (MSU), induced significant decreases in sodium excretion and medullary blood flow without changes in mean arterial blood pressure and renal cortical blood flow. Caspase-1 inhibitor, Ac-YVAD-CMK and deletion of Nlrp3 or Asc gene abolished MSU-induced decreases in renal sodium excretion and MBF. Conclusion: Our results indicate that renal medullary Nlrp3 inflammasomes represent a new regulatory mechanism of renal MBF and sodium excretion which may not depend on classical inflammatory response.

Laser speckle imaging of intra organ drug distribution.

Laminar flow in arteries causes streaming and uneven distribution of infused agents within the organ. This may lead to misinterpretation of experimental results and affect treatment outcomes. We monitor dynamical changes of superficial cortical blood flow in the rat kidney following different routes of administration of the vasoconstrictor angiotensin II. Our analysis reveals the appearance of large scale oscillations of the blood flow caused by inhomogeneous intra organ drug distribution.

Renal vasculature reactivity to agonist of P2X7 receptor is increased in streptozotocin-induced diabetes.

Diabetic nephropathy is characterized by the dysfunction of renal microvasculature. The involvement of the P2X7 receptor, being a part of the purinergic system, is presumable in this process. The aim of our study was to investigate the P2X7 receptor-mediated renal microvasculature response and renal metabolism of extracellular adenine nucleotides in diabetic rats. Study was performed on streptozotocin-induced diabetic Wistar rats. The vascular response to BzATP, an agonist of the P2X7 receptor, was monitored based on the changes of cortical blood flow (CBF), glomerular filtration rate (GFR) and glomerular inulin space (GIS). The renal interstitial fluid (RIF) was probed by microdialysis technique and concentrations of ATP and adenosine were measured. Activity on NTDPase and 5'-nucleotidases was measured on renal membranes. Diabetic kidneys were characterized by decreased ATP RIF and increased adenosine RIF concentrations with accompanied enhancement of NTDPase and 5'-nucleotidase activities. BzATP induced a more pronounced increase of CBF and decrease of GFR and GIS in diabetes rats. These effects were abolished by A438079, an antagonist of the P2X7 receptor. It is possible that increased P2X7 receptor reactivity may be involved in the pathogenesis of diabetic nephropathy.

Treatment of Epilepsy with Bipolar Electro-coagulation

Background:Bipolar electro-coagulation has a reported efficacy in treating epilepsy involving functional cortex by pure electro-coagulation or combination with resection. However, the mechanisms of bipolar electro-coagulation are not completely known. We studied the acute cortical blood flow and histological changes after bipolar electro-coagulation in 24 patients with intractable temporal lobe epilepsy.Methods:Twenty-four patients were consecutively enrolled, and divided into three groups according to the date of admission. The regional cortical blood flow (rCBF), electrocorticography, the depth of cortex damage, and acute histological changes (H and E staining, neuronal staining and neurofilament (NF) staining) were analyzed before and after the operation. The t-test analysis was used to compare the rCBF before and after the operation.Results:The rCBF after coagulation was significantly reduced (P < 0.05). The spikes were significantly reduced after electro-coagulation. For the temporal cortex, the depth of cortical damage with output power of 2–9 W after electro-coagulation was 0.34 ± 0.03, 0.48 ± 0.06, 0.69 ± 0.06, 0.84 ± 0.09, 0.98 ± 0.08, 1.10 ± 0.11, 1.11 ± 0.09, and 1.22 ± 0.11 mm, respectively. Coagulation with output power of 4–5 W completely damaged the neurons and NF protein in the molecular layer, external granular layer, and external pyramidal layer.Conclusions:The electro-coagulation not only destroyed the neurons and NF protein, but also reduced the rCBF. We concluded that the injuries caused by electro-coagulation would prevent horizontal synchronization and spread of epileptic discharges, and partially destroy the epileptic focus.

Identifying Renal Microstructural and Blood Flow Changes in Sickle Cell Disease Using Quantitative MRI Techniques

BACKGROUND: In patients with sickle cell disease (SCD), renal disease is strikingly high, with up to one third of adults developing chronic kidney disease. Renal disease is associated with considerable morbidity and mortality although it has not been as well studied as other SCD-related complications. Studies which could provide insight into clinically silent renal injury are limited. To date, no large studies of functional or structural renal changes have been published, particularly in the context of sickle cell crises. Magnetic Resonance Imaging (MRI) is safe and capable of providing quantitative assessments of disease without ionizing radiation. Clinically available MRI techniques have already been used to assess both acute and chronic kidney disease. This is the first study to evaluate these MRI techniques in SCD renal disease.OBJECTIVE: The objective of this pilot study was to evaluate the capability of quantitative MRI techniques to assess both structural changes and renal blood flow in patients with SCD.METHODS: Pediatric and adult patients were recruited to an IRB approved study from the Sickle Cell Anemia Centers at UH Rainbow Babies & Children’s Hospital and University Hospitals Case Medical Center. Six pediatric patients (age 12-18 years, 1 male, 5 female, eGFR 110-185 mL/min/1.73m2) have been recruited to date. Healthy controls were also recruited. Diffusion (DTI) and Arterial Spin Labeling (ASL) scans were performed to assess medullary microstructure and cortical perfusion (non-contrast), respectively. Apparent Diffusion Coefficient (ADC) and Fractional Anisotropy (FA) maps were calculated using established methods. Mean renal T2* was measured to assess iron burden. A Student’s t-test was performed to compare the mean renal DTI and ASL results between subjects and healthy controls.RESULTS: In the six pediatric subjects, medullary FA values were decreased, suggesting degradation of medullary microstructure. Both cortical ADC and medullary FA were significantly reduced, indicative of microstructural changes in SCD subjects compared to controls. ASL perfusion maps, likewise, showed reduced cortical perfusion for SCD subjects in comparison to controls. Preliminary differences in blood flow and microstructure were seen between SCD subjects on hydroxyurea (HU) and those not on HU. Analysis of the T2* data showed increased renal iron deposition that did not appear to correlate with serum ferritin.CONCLUSIONS: Our results suggest that quantitative diffusion and ASL MRI are sensitive to medullary microstructural and cortical blood flow changes in pediatric patients with SCD. Preliminarily, iron deposition in the kidney appears to relate to chronic hemolysis rather than transfusional iron. These sensitive techniques may be useful in assessing the impact of therapeutic interventions, such as HU, on renal function in children. There may also be utility in assessing the impact of acute hemolysis/sickling on renal microstructure and perfusion. DisclosuresPiccone:Novartis Pharmaceuticals Cooperation: Speakers Bureau.

O5.03 * APPLICATION OF LASER SPECKLE TO THE IDENTIFICATION OF FUNCTIONAL BRAIN AREAS IN AWAKE SURGERY

The laser speckle imaging is based on the analysis of speckle patterns produced by the reflection of a laser light on a surface. In a previous study, Klijn et al. used speckle laser imaging to monitor changes in motor cortex blood flow during motor tasks performed in awake patients by surgery, finding an activation pattern similar blood-oxygen-level dependent studied in functional MRI (fMRI). We report in this clinical case the study and detection of activation in brain areas involved in language by laser speckle imaging in a patient 30 years during awake. Mr J. was hospitalized in the Department of Neurosurgery of the University Hospital of Angers for a posterior temporal glial tumor. Brain areas involved in language were identified preoperatively using fMRI and during the surgery with cortical stimulation mapping. We studied during surgery the changes in cortical blood flow using a laser speckle Pericam PSI (Perimed) when the patient was performing naming tasks in a block paradigm, identical to that used during fMRI sequences. The acquired images were then realigned to remove motion artifacts. During surgery, stimulation of the posterior part of the supramarginal gyrus resulted in a reproducible suspension of language, corresponding to an identified langage area in fMRI. The laser speckle study showed a cyclic variation of the local blood flow of the previously identified area, increasing during the naming tests and returning to baseline levels during the sessions of rest. This case emphasizes the importance of laser speckle in the intraoperative analysis of changes in cortical blood flow. A study is ongoing in our service to validate the relevance of laser speckle as a means of identifying functional brain areas during awake surgery.

Reduction of cortical excitability and increase of thalamic activity in a low-frequency rTMS treatment for chronic tinnitus

Low-frequency repetitive transcranial magnetic stimulation (rTMS) has received increasing attention for the treatment of tinnitus, but its therapeutic mechanisms are unclear. We performed low-frequency rTMS treatment for a patient with chronic tinnitus and examined changes of cortical excitability and cerebral blood flow using paired-pulse TMS and single-photon emission computed tomography. After the rTMS treatment, tinnitus loudness was decreased, cortical excitability was reduced, and blood flow in the thalamus was increased. Our results suggest that low-frequency rTMS treatment reduces tinnitus loudness by an inhibitory effect on the cortical excitability and a remote activation effect on the thalamus through the corticothalamic networks.