Labeling Perfusion Magnetic Resonance Imaging Research Articles

Connectivity of the insular subdivisions differentiates posttraumatic headache-associated from nonheadache-associated mild traumatic brain injury: an arterial spin labelling study

ObjectiveThe insula is an important part of the posttraumatic headache (PTH) attributed to mild traumatic brain injury (mTBI) neuropathological activity pattern. It is composed of functionally different subdivisions and each of which plays different role in PTH neuropathology.MethodsNinety-four mTBI patients were included in this study. Based on perfusion imaging data obtained from arterial spin labelling (ASL) perfusion magnetic resonance imaging (MRI), this study evaluated the insular subregion perfusion-based functional connectivity (FC) and its correlation with clinical characteristic parameters in patients with PTH after mTBI and non-headache mTBI patients.ResultsThe insular subregions of mTBI + PTH (mTBI patients with PTH) and mTBI-PTH (mTBI patients without PTH) group had positive perfusion-based functional connections with other insular nuclei and adjacent discrete cortical regions. Compared with mTBI-PTH group, significantly increased resting-state perfusion-based FC between the anterior insula (AI) and middle cingulate cortex (MCC)/Rolandic operculum (ROL), between posterior insula (PI) and supplementary motor area (SMA), and decreased perfusion-based FC between PI and thalamus were found in mTBI + PTH group. Changes in the perfusion-based FC of the left posterior insula/dorsal anterior insula with the thalamus/MCC were significant correlated with headache characteristics.ConclusionsOur findings provide new ASL-based evidence for changes in the perfusion-based FC of the insular subregion in PTH patients attributed to mTBI and the association with headache features, revealing the possibility of potential neuroplasticity after PTH. These findings may contribute to early diagnosis of the disease and follow-up of disease progression.

Role of Histogram Features on Arterial Spin Labeling Perfusion Magnetic Resonance Imaging in Identifying Isocitrate Dehydrogenase Genotypes and Glioma Malignancies.

To explore the use of histogram features on noninvasive arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) in differentiating isocitrate dehydrogenase mutant-type (IDH-mut) from isocitrate dehydrogenase wild-type (IDH-wt) gliomas, and lower-grade gliomas (LGGs) from glioblastomas. This retrospective study included 131 patients who underwent ASL MRI and anatomic MRI. Cerebral blood flow (CBF) maps were calculated, from which 10 histogram features describing the CBF distribution were extracted within the tumor region. Correlation analysis was performed to determine the correlations between histogram features as well as tumor grades and IDH genotypes. The independent t-test and Fisher's exact test were used to determine differences in the extracted histogram features, age at diagnosis, and sex in different glioma subtypes. Multivariate binary logistic regression analysis was performed, and diagnostic performances were evaluated with the receiver operating characteristic curves. CBF histogram features were significantly correlated with tumor grades and IDH genotypes. These features can effectively differentiate LGGs from glioblastomas, and IDH-mut from IDH-wt gliomas. The area under the receiving operating characteristic curve of the model calculated using combined CBF 30th percentile and age at diagnosis in differentiating LGGs from glioblastomas was 0.73. Integrating age at diagnosis and CBF 10th percentile could be more effective in differentiating IDH-mut from IDH-wt gliomas. Furthermore, the combined model had a better area under the receiving operating characteristic curve at 0.856 (sensitivity: 84.4%, specificity: 82.9%). The histogram features on ASL were significantly correlated with tumor grade and IDH genotypes. Moreover, the use of these features could effectively differentiate glioma subtypes. The combined application of age at diagnosis and perfusion histogram features resulted in a more comprehensive identification of tumor subtypes. Therefore, ASL can be a noninvasive tool for the pre-surgical evaluation of gliomas.

Sex differences in cerebral blood flow among adolescents with bipolar disorder.

Abnormalities in cerebral blood flow (CBF) are common in bipolar disorder (BD). Despite known differences in CBF between healthy adolescent males and females, sex differences in CBF among adolescents with BD have never been studied. To examine sex differences in CBF among adolescents with BD versus healthy controls (HC). CBF images were acquired using arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) in 123 adolescents (72 BD: 30M, 42F; 51 HC: 22M, 29F) matched for age (13-20 years). Whole brain voxel-wise analysis was performed in a general linear model with sex and diagnosis as fixed factors, sex-diagnosis interaction effect, and age as a covariate. We tested for main effects of sex, diagnosis, and their interaction. Results were thresholded at cluster forming p = 0.0125, with posthoc Bonferroni correction (p = 0.05/4 groups). A main effect of diagnosis (BD > HC) was observed in the superior longitudinal fasciculus (SLF), underlying the left precentral gyrus (F =10.24 (3), p < 0.0001). A main effect of sex (F > M) on CBF was detected in the precuneus/posterior cingulate cortex (PCC), left frontal and occipital poles, left thalamus, left SLF, and right inferior longitudinal fasciculus (ILF). No regions demonstrated a significant sex-by-diagnosis interaction. Exploratory pairwise testing in regions with a main effect of sex revealed greater CBF in females with BD versus HC in the precuneus/PCC (F = 7.1 (3), p < 0.01). Greater CBF in female adolescents with BD versus HC in the precuneus/PCC may reflect the role of this region in the neurobiological sex differences of adolescent-onset BD. Larger studies targeting underlying mechanisms, such as mitochondrial dysfunction or oxidative stress, are warranted.

Characteristic cerebral perfusion pattern in neuronal intranuclear inclusion disease.

Neuronal intranuclear inclusion disease (NIID), which pathogenesis remains largely unclear, is a neurodegenerative disease caused by GGC repeat expansion in NOTCH2NLC gene. As case studies have reported dynamic cortical perfusion changes in NIID, this study aimed to explore the cerebral perfusion pattern in NIID patients. A total of 38 NIID patients and 34 healthy controls (HCs) were recruited, and 2 NIID patients who had had episodic symptoms within 2 months were excluded. Data on demographic characteristics and clinical features were collected. All participants underwent three-dimensional pseudo-continuous arterial spin labeling perfusion magnetic resonance imaging (MRI) scanning. Voxel-based comparisons of cerebral blood flow (CBF) were conducted. NIID patients showed decreased perfusion in the cortex but increased perfusion in the deep brain regions compared with HCs. The regions with significant hypoperfusion were distributed in the bilateral frontal, temporal, parietal, and occipital gyri, with the left frontal gyrus being the most prominent. The regions with significant hyperperfusion included the bilateral basal ganglia, midbrain, pons, para-hippocampal, and parts of the bilateral cerebellum, fusiform, lingual, rectus, orbital, and cingulum anterior gyri, which were adjacent to the midline (all FDR-corrected p <0.05). When comparing the mean CBF value of the whole brain, no significant differences were observed between NIID patients and HCs (28.81 ± 10.1 vs. 27.99 ± 5.68 ml/100 g*min, p = 0.666). Voxel-based analysis showed no significant difference in cerebral perfusion between NIID patients with and without episodic symptoms. The perfusion within the bilateral middle frontal and anterior cingulate gyri showed positive correlations with MMSE and MoCA scores using age, sex, and education as covariates (p <0.005 uncorrected). NIID patients exhibited characteristic cortical hypoperfusion and deep brain hyperperfusion. The perfusion in the bilateral frontal lobe and cingulate gyrus was correlated with the severity of cognitive dysfunction. Cerebral perfusion change may be involved in NIID pathophysiology and serve as a potential indicator for monitoring NIID severity and progression.

Sulcal hyperintensity on magnetic resonance imaging with fluid-attenuated inversion recovery sequence in patients with chronic subdural hematoma

BackgroundSulcal hyperintensity on magnetic resonance images with fluid-attenuated inversion recovery sequences (FLAIR) can occur in patients without apparent cerebrospinal fluid (CSF) abnormalities. Taoka et al. speculated that pathological increases of the blood pool to CSF ratio within the sulcus, which could be caused by alterations in regional hemodynamics including venous congestion, do not suppress water signals on FLAIR images. However, few previous reports have described sulcal hyperintensity in patients with chronic subdural hematoma (CSDH). MethodsTo demonstrate the pathophysiological mechanism and clinical significance of sulcal hyperintensity in CSDH, we retrospectively reviewed the chronological changes in clinical, electroencephalographic (EEG), and neuroradiological findings, including arterial spin labeling perfusion magnetic resonance imaging (ASL) with dual post-labeling delays (PLDs) of 1.5 and 2.5 s, of three patients who had sulcal hyperintensity. ResultsIn all three cases, sulcal hyperintensity was observed just below the CSDH with mass effect, and became more prominent as it went to the vertex. In patients 1 and 2, ASL with dual PLDs showed a prolonged arterial transit time (ATT) in the region with sulcal hyperintensity, and the sulcal hyperintensity disappeared along with the improvement of the prolonged ATT. In patient 3, in whom the degree of sulcal hyperintensity was mild, the prolongation of ATT was also very mild. In patient 2, a coinciding ictal EEG and ASL hyperperfusion findings were present in the cortex showing sulcal hyperintensity. In patients 1 and 3, the laterality of the sulcal hyperintensity was consistent with that of the epileptic symptoms, which were controlled by the administration of antiepileptic drugs. ConclusionAlthough further studies with a larger number of patients are needed, the pathophysiological mechanism of sulcal hyperintensity in CSDH could be explained by the idea proposed by Taoka et al. Our findings also indicate that sulcal hyperintensity has a possible relationship with the development of epilepsy in the perioperative period of CSDH.

Cerebral perfusion changes of the basal ganglia and thalami in full-term neonates with hypoxic-ischaemic encephalopathy: a three-dimensional pseudo continuous arterial spin labelling perfusion magnetic resonance imaging study.

Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the common causes of neurological injury in full-term neonates following perinatal asphyxia. The conventional magnetic resonance technique has low sensitivity in detecting variations in cerebral blood flow in patients with HIE. This article evaluates the clinical diagnostic value of three-dimensional pseudo-continuous arterial spin labelling (3-D pcASL) perfusion magnetic resonance imaging (MRI) for early prediction of neurobehavioral outcomes in full-term neonates with HIE. All neonates diagnosed with HIE underwent MRI (conventional and 3-D pcASL perfusion MRI). Cerebral blood flow values were measured in the basal ganglia (caudate nuclei, lenticular nuclei), thalami and white matter regions (frontal lobes, corona radiata). After 1-month follow-up, the Neonatal Behavioral Neurological Assessment scores were used to divide patients into favourable outcome group versus adverse outcome group. Twenty-three patients were enrolled in this study. There were no statistical differences between the symmetrical cerebral blood flow values of bilateral basal ganglia, thalami and white matter regions. However, the cerebral blood flow values of grey matter nuclei were higher than the white matter regions. The average value of cerebral blood flow in the basal ganglia and thalami in the adverse outcome group was 37.28±6.42ml/100g/min, which is greater than the favourable outcome group (22.55 ± 3.21ml/100g/min) (P<0.01). The area under the curve (AUC) of 3-D pcASL perfusion MRI was 0.992 with a cutoff value of 28.75ml/100g/min, with a Youden's index of 0.9231. The sensitivity and specificity were 92.3% and 100%, respectively. The 3-D pcASL demonstrated higher perfusion alteration in the basal ganglia and thalami of neonatal HIE with adverse outcomes. The 3-D pcASL perfusion MRI has the potential to predict neurobehavioral outcomes of neonates with HIE.

Cerebral Blood Flow and its Connectivity Deficits in Patients With Lung Cancer After Chemotherapy.

Purpose: This study was performed to investigate the regional cerebral blood flow (CBF) and CBF connectivity in the chemotherapy-induced cognitive impairment of patients with lung cancer by using arterial spin labeling. Methods: Pseudocontinuous arterial spin labeling perfusion magnetic resonance imaging and neuropsychological tests were performed for 21 patients with non-small cell lung cancer who had received chemotherapy CT (+) and 25 non-small cell lung cancer patients who need chemotherapy but did not yet received CT (-). The CT (+) group previously received platinum-based therapy for 3 months to 6 months (the time from their first chemotherapy to the MRI scan). Group comparisons were performed in the regional normalized CBF and CBF connectivity, and the relationship between the regional normalized CBF and cognitive impairment were detected. Results: The CT (+) group exhibited higher CBF in the left insula, right caudate, right superior occipital gyrus, left superior temporal gyrus (STG), and right middle frontal gyrus (MFG). MoCA scores as well as the memory scores were negatively correlated with the increased CBF in the right MFG (r = −0.492, p = 0.023; r = −0.497, p = 0.022). Alterations in the CBF connectivity were detected only in the CT (+) group between the following: right MFG and the right precentral gyrus; the right caudate and the right lingual gyrus; right caudate and right precuneus; left STG and the bilateral MFG; and the left STG and the right middle cingulum. Conclusion: These findings indicated that chemotherapy is associated with abnormalities in the CBF and connectivity alterations, which may contribute to the cognitive impairment in patients with lung cancer.

Interpretation of infarct location in relationship to perfusion territories using territorial arterial spin labeling in a patient with multiple infarctions: A case report

We, herein, describe a 50-year-old man with steno-occlusive cerebrovascular disease and multiple infarcts that were expected to be within the perfusion territories of the basilar artery (BA) and left internal carotid artery. However, territorial arterial spin labeling (T-ASL) perfusion magnetic resonance imaging showed that the infarct lesions were only located in the perfusion territory of the BA and confirmed the stroke etiology of large artery atherosclerosis. This case implies that the diagnostic information provided by T-ASL is valuable for identifying the symptomatic perfusion territories and stroke etiology. This technique is, therefore, able to guide therapeutic management in patients with multiple infarcts.

Improving Sensitivity of Arterial Spin Labeling Perfusion MRI in Alzheimer's Disease Using Transfer Learning of Deep Learning-Based ASL Denoising.

Arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) denoising through deep learning (DL) often faces insufficient training data from patients. One solution is to train DL models using healthy subjects' data which are more widely available and transfer them to patients' data. To evaluate the transferability of a DL-based ASL MRI denoising method (DLASL). Retrospective. Four hundred and twenty-eight subjects (189 females) from three cohorts. 3 T two-dimensional (2D) echo-planar imaging (EPI)-based pseudo-continuous ASL (PCASL) and 2D EPI-based pulsed ASL (PASL) sequences. DLASL was trained using young healthy adults' PCASL data (Dataset 1: 250/30 subjects as training/validation set) and was directly transferred (DTF) to PCASL data from Dataset 2 (45 subjects test set) of normal controls (NC) and Alzheimer's disease (AD) groups. DLASL was fine-tuned (DLASLFT) and tested on PASL data from Dataset 3 (103 subjects test set) of NC and AD. An existing non-DL method (NonDL) was used for comparison. Cerebral blood flow (CBF) images from ASL MRI were compared between NC and AD to assess characteristic hypoperfusion (lower CBF) patterns in AD. CBF image quality and CBF map sensitivity for detecting hypoperfusion using peak t-value and suprathreshold cluster size are outcome measures. Paired t-test, two-sample t-test, one-way analysis of variance, and Tukey honestly significant difference, and linear mixed-effects models were used. P < 0.05 was considered statistically significant. Mean contrast-to-noise ratio (CNR) of Dataset 2 showed that DTF outperformed NonDL (AD: 3.38 vs. 2.64, NC: 3.80 vs. 3.36). On Dataset 3, DLASLFT outperformed NonDL measured by mean CNR (AD: 2.45 vs. 1.87, NC: 2.54 vs. 2.17) and mean radiologic score (2.86 vs. 2.44). Image quality improvement was significant on both test sets. DTF and DLASLFT improved sensitivity for detecting AD-related hypoperfusion patterns compared with NonDL. We demonstrated the DLASL's transferability across different ASL sequences and different populations. 3 TECHNICAL EFFICACY: Stage 2.

Cerebral Blood Flow Difference Between Acute and Chronic Tinnitus Perception: A Perfusion Functional Magnetic Resonance Imaging Study.

Purpose: The central nervous mechanism of acute tinnitus is different from that of chronic tinnitus, which may be related to the difference of cerebral blood flow (CBF) perfusion in certain regions. To verify this conjecture, we used arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) in this study to compare the CBF alterations of patients with acute and chronic tinnitus.Methods: The current study included patients with chronic tinnitus (n = 35), acute tinnitus (n = 30), and healthy controls (n = 40) who were age-, sex-, and education-matched. All participants underwent MRI scanning and then ASL images were obtained to measure CBF of the entire brain and analyze the differences between groups as well as the correlations with tinnitus characteristics.Results: The chronic tinnitus group showed increased z-CBF in the right superior temporal gyrus (STG) and superior frontal gyrus (SFG) when compared with the acute tinnitus patients. Further connectivity analysis found enhanced CBF connectivity between the right STG and fusiform gyrus (FG), the right SFG and left middle occipital gyrus (MOG), as well as the right parahippocampal gyrus (PHG). Moreover, in the chronic tinnitus group, the tinnitus handicap questionnaire (THQ) score was positively correlated with the normalized z-CBF of right STG (r = 0.440, p = 0.013).Conclusion: Our results confirmed that the CBF changes in some brain regions were different between acute and chronic tinnitus patients, which was correlated with certain tinnitus characteristics. This is of great value to further research on chronicity of tinnitus, and ASL has a promising application in the measurement of CBF.

Firefighters Have Cerebral Blood Flow Reductions in the Orbitofrontal and Insular Cortices That are Associated with Poor Sleep Quality.

PurposeTo investigate the cerebral blood flow (CBF) alterations associated with poor sleep quality and memory performance in firefighters.Participants and MethodsThirty-seven firefighters (the FF group) and 37 non-firefighter controls (the control group) with sleep complaints were enrolled in this study. We performed brain arterial spin labeling perfusion magnetic resonance imaging (MRI) and compared the CBF between the two groups using whole-brain voxel-wise analyses. Self-reported sleep problems and actigraphy-measured sleep parameters, including the sleep efficiency, wake after sleep onset (WASO), total sleep time, and sleep latency, were assessed. Spatial working memory and learning performances were evaluated on the day of the MRI scan.ResultsThe FF group, relative to the control group, had lower CBF in the right hemispheric regions: Middle temporal/lateral occipital, orbitofrontal, and insular cortices. Lower CBF in the right orbitofrontal cortex was linearly associated with poor sleep quality, as indicated by lower sleep efficiency and longer WASO. The CBF of the right insular cortex was also associated with longer WASO. Despite comparable degrees of self-reported sleep problems between the two groups, the FF group had lower sleep efficiency and longer WASO in the actigraphy, and lower spatial working memory and learning performance, relative to the control group. Poor sleep efficiency was linearly associated with lower spatial working memory performance.ConclusionThese results demonstrated an association of poor sleep quality with decreased brain perfusion in the right orbitofrontal and insular cortices, as well as with reduced working memory performance.

Silent Cerebral Infarct Pathophysiology Study in Sickle Cell Anemia Children By a Multimodal Approach

▪Context and objectives:Infra clinical cerebral infarcts have emerged as a central problem in sickle cell anemia (SCA) since the effective reduction of clinical cerebral infarcts following systematic vasculopathy screening and prevention. They are found in up to 37% of SCA children at 14 years old, and correlate with neurocognitive deficit. The tendency of silent infarcts to occur in the border zone areas of the brain, mainly the deep subcortical white matter, highly suggests that they could be due to hypoperfusion or hypoxic events but no clear pathophysiological process has been demonstrated. The aim of this study was to better decipher the mechanisms involved in infra clinical cerebral injury by analyzing the determinants of cerebral oxygenation and perfusion at the microcirculatory level in children with SCA and without cerebral or cervical vasculopathy. We conducted a multimodal prospective pilot study combining conventional brain exploration and laboratory biomarkers as well as novel brain investigational tools such as Arterial Spin Labeling (ASL) perfusion Magnetic Resonance imaging (MRI) and brain Near Infra-Red Spectroscopy (NIRS).Patients and Methods:Following parental approval, children with SCA aged 5-17 years, with no past history of abnormal or conditional transcranial Doppler (TCD), at steady state (> 3 months from any vaso occlusive event, transfusion or infection) were enrolled in two investigating centers in Ile de France. Relevant medical history and biological parameters were recorded and all investigation was performed during an out-patient visit.Results:Fifty-nine SCA patients (11.4± 3.9 yrs) at steady state were included between February 2015 and August 2016. Eight (13%) children had infra clinical lesions on MRI (3-5 mm: n= 6; 5-15 mm: n=4; > 15mm: n=0), predominating in the middle cerebral artery border zone in five children. The two groups of patients with lesions (MRI+) and without lesions (MRI-) were comparable in terms of age, hydroxycarbamide (HC) treatment, G6PD or alpha thalassemia status. Conversely, the MRI+ group had a lower annual VOC rate (0.2 ± 0.2 vs 0.7 ± 0.6/year, p< 0.05) and lower mean arterial pressure (76 ± 8 vs 83 ± 9mmHg, p< 0.05), hematocrit (23.0 ± 3.0 vs 25.3 ± 3.2 %, p < 0.05), RBC deformability (Elongation index: 0.44 ± 0.07 vs 0.50 ± 0.08, p < 0.05) but higher P selectin level (73.5 ± 21.7 vs 57.1 ± 20.7ng/mL, p < 0.05) and RBC aggregate strength (491 ± 236 vs 358 ± 190 s-1, p < 0.05), when compared to the MRI- group.ASL perfusion in all cerebral territories showed no major asymmetry. High ASL perfusion was significantly inversely correlated with Hb level, RBC deformability, cerebral oximetry, HbF level and blood viscosity. High ASL perfusion correlated positively with vasomotion, hemolysis markers (AST, LDH, absolute reticulocyte count), platelets, P-and E- selectin levels, RBC aggregate strength, neutrophil count. Furthermore and importantly, silent lesions in the right anterior border zone were associated with high ASL perfusion (p<0.05).Discussion and conclusion:Among this cohort of highly selected SCA children with no vasculopathy, we found a prevalence of infra clinical cerebral injury of 13.5%. Our results altogether suggest that marked hemolysis, anemia and hypoxia result in an increased compensatory cerebral perfusion, as well as endothelial lesions as evidenced by elevated E and P selectins. Our results comfort the hypothesis that infra clinical cerebral lesions in the border zone territories occur when the compensatory perfusion of the brain, which is increased at steady state, is unable to further adapt. Our results argue for early treatment of SCA children with marked hemolytic anemia to avoid cerebral injury in case of acute hypoxia, anemia or increased metabolic demand. DisclosuresBrousse:Add Medica: Membership on an entity's Board of Directors or advisory committees. De Montalembert:Addmedica: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding.

Longitudinal Cerebral Blood Flow Changes in Normal Aging and the Alzheimer's Disease Continuum Identified by Arterial Spin Labeling MRI.

Cross-sectional studies have shown lower cerebral blood flow (CBF) in Alzheimer's disease (AD), but longitudinal CBF changes in AD are still unknown. To reveal the longitudinal CBF changes in normal control (NC) and the AD continuum using arterial spin labeling perfusion magnetic resonance imaging (ASL MRI). CBF was calculated from two longitudinal ASL scans acquired 2.22±1.43 years apart from 140 subjects from the Alzheimer's Disease Neuroimaging Initiative (ADNI). At the baseline scan, the cohort contained 41 NC, 74 mild cognitive impairment patients (MCI), and 25 AD patients. 21 NC converted into MCI and 17 MCI converted into AD at the follow-up. Longitudinal CBF changes were assessed using paired-t test for non-converters and converters separately at each voxel and in the meta-ROI. Age and sex were used as covariates. CBF reductions were observed in all subjects. Stable NC (n = 20) showed CBF reduction in the hippocampus and precuneus. Stable MCI patients (n = 57) showed spatially more extended CBF reduction patterns in hippocampus, middle temporal lobe, ventral striatum, prefrontal cortex, and cerebellum. NC-MCI converters showed CBF reduction in hippocampus and cerebellum and CBF increase in caudate. MCI-AD converters showed CBF reduction in hippocampus and prefrontal cortex. CBF changes were not related with longitudinal neurocognitive changes. Normal aging and AD continuum showed common longitudinal CBF reductions in hippocampus independent of disease and its conversion. Disease conversion independent longitudinal CBF reductions escalated in MCI subjects.

Hippocampal cerebral blood flow increased following low-pressure hyperbaric oxygenation in firefighters with mild traumatic brain injury and emotional distress.

Recent evidence suggests that hyperbaric oxygenation (HBO), which has been used as an effective treatment for certain types of tissue injury, may change neural activities in the human brain and subsequently improve symptoms of psychiatric disorders. To scrutinize the neural mechanism of HBO in the human brain, we investigated whether 20 sessions of HBO changed regional cerebral blood flow (rCBF) of the limbic system in firefighters with mild traumatic brain injury (mTBI) and subjective emotional distress. Twenty firefighters with mTBI and mild emotional distress were treated with HBO at a relatively low pressure of 1.3 atmospheres absolute for 45 min a day for 20 consecutive days (the mild emotional distress group). The rCBF of the limbic system was measured using an arterial spin labeling perfusion magnetic resonance imaging before and after the HBO. Analyses were performed on the data from fourteen individuals who completed the study and 14 age- and sex-matched healthy firefighters (the comparison group). Firefighters in the mild emotional distress group showed increase rCBF following HBO in a cluster encompassing the right hippocampal and parahippocampal regions (peak t = 4.31; cluster size = 248 mm3)(post-hoc analysis, z = 5.92, p < 0.001) that had lower rCBF relative to the comparison group at baseline (post-hoc analysis, t = -2.20, p = 0.04). The current study demonstrated that low-pressure HBO might increase rCBF of the hippocampal and parahippocampal regions, suggesting a potential underpinning mechanism of HBO in the human brain.

Decreased Relative Cerebral Blood Flow in Unmedicated Heroin-Dependent Individuals.

Understanding the brain mechanisms of heroin dependence is invaluable for developing effective treatment. Measurement of regional cerebral blood flow (CBF) provides a method to visualize brain circuits that are functionally impaired by heroin dependence. This study examined regional CBF alterations and their clinical associations in unmedicated heroin-dependent individuals (HDIs) using a relatively large sample. Sixty-eight (42 males, 26 females; age: 40.9 ± 7.3 years) HDIs and forty-seven (34 males, 13 females; age: 39.3 ± 9.2 years) matched healthy controls (HCs) underwent high-resolution T1 and whole-brain arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) scans. Additionally, clinical characteristics were collected for neurocognitive assessments. HDIs showed worse neuropsychological performance than HCs and had decreased relative CBF (rCBF) in the bilateral middle frontal gyrus (MFG), inferior temporal gyrus, precuneus, posterior cerebellar lobe, cerebellar vermis, and the midbrain adjacent to the ventral tegmental area; right posterior cingulate gyrus, thalamus, and calcarine. rCBF in the bilateral MFG was negatively correlated with Trail Making Test time in HDIs. HDIs had limbic, frontal, and parietal hypoperfusion areas. Low CBF in the MFG indicated cognitive impairment in HDIs. Together, these findings suggest the MFG as a critical region in HDIs and suggest ASL-derived CBF as a potential marker for use in heroin addiction studies.

Cerebral Blood Flow and Its Connectivity Deficits in Mild Traumatic Brain Injury at the Acute Stage

Objective The influence of cognitive impairment after mild traumatic brain injury (mTBI) on cerebral vascular perfusion has been widely concerned, yet the resting-state cerebral blood flow (CBF) connectivity alterations based on arterial spin labeling (ASL) in mild traumatic brain injury (mTBI) remain unclear. This study investigated region CBF and CBF connectivity features in acute mTBI patients, as well as the associations between CBF changes and cognitive impairment. Materials and Methods Forty-five acute mTBI patients and 42 health controls underwent pseudocontinuous arterial spin labeling (pCASL) perfusion magnetic resonance imaging (MRI). The alterations in regional CBF and relationship between the CBF changes and cognitive impairment were detected. The ASL-CBF connectivity of the brain regions with regional CBF significant differences was also compared between two groups. Neuropsychological tests covered seven cognitive domains. Associations between the CBF changes and cognitive impairment were further investigated. Results Compared with the healthy controls, the acute mTBI patients exhibited increased CBF in the bilateral inferior temporal gyrus (ITG) and decreased CBF in the right middle frontal gyrus (MFG), the bilateral superior frontal gyrus (SFG), and the right cerebellum posterior lobe (CPL). In the mTBI patients, significant correlations were identified between the CBF changes and cognitive impairment. Importantly, the acute mTBI patients exhibited CBF disconnections between the right CPL and right fusiform gyrus (FG) as well as bilateral ITG, between the left SFG and left middle occipital gyrus (MOG), and between the right SFG and right FG as well as right parahippocampal gyrus. Conclusion Our results suggest that acute mTBI patients exhibit both regional CBF abnormalities and CBF connectivity deficits, which may underlie the cognitive impairment of the acute mTBI patients.

Disrupted Regional Cerebral Blood Flow in Children With Newly-Diagnosed Type 1 Diabetes Mellitus: An Arterial Spin Labeling Perfusion Magnetic Resonance Imaging Study.

Object: Diabetes is associated with cerebral vascular dysfunction and increased vascular cognitive impairment. The objective of this study was to use arterial spin labeling (ASL) perfusion-weighted magnetic resonance imaging to investigate whether cerebral perfusion was changed in newly-diagnosed children with type 1 diabetes mellitus (T1DM) and the possible relationship between aberrant cerebral blood flow (CBF) with cognitive as well as clinical variables.Methods: Between January 2017 and February 2018, 34 children with newly-diagnosed T1DM and 34 age, gender, and education-matched healthy controls were included. Three dimensional pseudo-continuous ASL perfusion MRI was used to evaluate CBF. A conventional T2WI sequence was added to exclude intracranial disease. Regions with CBF differences between T1DM children and the controls were detected via voxel-wise comparisons in REST software. Associations among the result of neuropsychological test, clinical variables, and CBF values of different brains were investigated by using partial correlation analysis.Results: Compared with the controls, T1DM children show decreased CBF in the left calcarine and postcentral gyrus, and right precentral gyrus. The perfusion in the postcentral gyrus was positively correlated with IQ performance. No significant correlations were found between CBF and HbA1c, blood glucose level before imaging and IQ in other brain regions in T1DM children.Conclusion: There is an abnormal cerebral perfusion in children with newly diagnosed T1DM. The visual and sensorimotor areas are brain areas where perfusion is prone to change at the beginning of T1DM. Our study provided clues for cerebral pathophysiological changes in the initial stage of T1DM.

Altered resting cerebral blood flow specific to patients with diabetic retinopathy revealed by arterial spin labeling perfusion magnetic resonance imaging.

Previous neuroimaging studies have shown that patients with diabetic retinopathy (DR) were accompanied by abnormalities in cerebral functional and structural architecture, whereas the resting cerebral blood flow (CBF) alterations in patients with DR are not well understood. To explore CBF alterations in patients with DR using pseudo-continuous arterial spin labeling (pCASL) imaging. Thirty-one individuals with DR (15 men, 16 women; mean age = 53.38 ± 9.12 years) and 33 healthy controls (HC) (12 men, 21 women; mean age = 51.61 ± 9.84 years) closely matched for age, sex, and education, underwent pCASL imaging scans. Two-sample T test was conducted to compare different CBF values between two groups. Patients with DR exhibited significantly increased CBF values in the left middle temporal gyrus (Brodmann's area, BA 22) and the bilateral supplementary motor area (BA3) and decreased CBF values in the bilateral calcarine (BA17,18) and bilateral caudate relative to HC group (two-tailed, voxel level at P < 0.01, Gaussian random field (GRF), cluster level at P < 0.05). Moreover, the HbA1c (%) level showed a positive correlation with CBF values in the bilateral caudate (r = 0.473, P = 0.007) in patients with DR. Our results highlighted that patients with DR had abnormal CBF values in the visual cortices, caudate, middle temporal gyrus, and supplementary motor area, which might reflect vision and sensorimotor and cognition dysfunction in patients with DR. These findings might help us to understanding the neural mechanism of patients with DR.

Cerebrovascular Reactivity Measured with ASL Perfusion MRI, Ivy Sign, and Regional Tissue Vascularization in Moyamoya

Arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) may be used to determine brain regions at risk for ischemia in patients with moyamoya vasculopathy and to identify patients who may benefit from surgical revascularization. We aimed to investigate whether 1) the severity of moyamoya is related to the presence of leptomeningeal collaterals and cerebrovascular reactivity (CVR), 2) the presence of collaterals and ivy sign reflects disturbed CVR, and 3) arterial transit artefacts (ATAs) and ivy sign reflect the presence of collaterals. We determined severity of moyamoya on digital subtraction angiography (DSA) according to the modified Suzuki classification in 20 brain regions and scored regional tissue revascularization using a 4-point scale. Regional CVR and ATAs were assessed on ASL perfusion MRI, ivy sign on fluid attenuation inversion recovery MRI. In 11 patients (median age 36 years; 91% female), we studied 203 regions. ATAs were associated with the presence of collaterals on DSA (P < 0.01). Of all regions with clearly visible collateral vessels on DSA, however, only 24% had ATAs. Ivy sign was not related to the presence or absence of collaterals nor to CVR. In 10% of regions with good vascularization on DSA, CVR was poor or showed steal. ATAs were associated with the presence of collaterals on DSA. Although DSA vascularization scores correlated with CVR, 10% of regions with good vascularization on DSA had absent CVR or steal on ASL-MRI. DSA and ivy sign did not provide adequate information on the hemodynamic status of brain tissue in patients with moyamoya vasculopathy.

Cerebral blood flow changes after a day of wake, sleep, and sleep deprivation

Elucidating the neurobiological effects of sleep and wake is an important goal of the neurosciences. Whether and how human cerebral blood flow (CBF) changes during the sleep-wake cycle remain to be clarified. Based on the synaptic homeostasis hypothesis of sleep and wake, we hypothesized that a day of wake and a night of sleep deprivation would be associated with gray matter resting CBF (rCBF) increases and that sleep would be associated with rCBF decreases. Thirty-eight healthy adult males (age 22.1 ± 2.5 years) underwent arterial spin labeling perfusion magnetic resonance imaging at three time points: in the morning after a regular night's sleep, the evening of the same day, and the next morning, either after total sleep deprivation (n = 19) or a night of sleep (n = 19). All analyses were adjusted for hematocrit and head motion. rCBF increased from morning to evening and decreased after a night of sleep. These effects were most prominent in bilateral hippocampus, amygdala, thalamus, and in the occipital and sensorimotor cortices. Group × time interaction analyses for evening versus next morning revealed significant interaction in bilateral lateral and medial occipital cortices and in bilateral insula, driven by rCBF increases in the sleep deprived individuals and decreases in the sleepers, respectively. Furthermore, group × time interaction analyses for first morning versus next morning showed significant effects in medial and lateral occipital cortices, in anterior cingulate gyrus, and in the insula, in both hemispheres. These effects were mainly driven by CBF increases from TP1 to TP3 in the sleep deprived individuals. There were no associations between the rCBF changes and sleep characteristics, vigilant attention, or subjective sleepiness that remained significant after adjustments for multiple analyses. Altogether, these results encourage future studies to clarify mechanisms underlying sleep-related rCBF changes.