使用碳氧血红蛋白评估颅内狭窄患者的脑血管储备能力的常规临床评估。
Routine clinical evaluation of cerebrovascular reserve capacity using carbogen in patients with intracranial stenosis.
机构信息
From the Departments of Radiology (M.J.D., L.M.D., C.C.F., A.D., J.C., M.K.S.), Neurology (M.J.D., L.C.J., P.C., A.O., D.R., L.H., H.K.), Psychiatry (M.J.D.), Physics (M.J.D.), and Neurosurgery (J.M., J.C., M.K.S.) and Center for Quantitative Sciences (Y.S.), Vanderbilt University, Nashville, TN; and Department of Neurosurgery, Geisel School of Medicine, Dartmouth College, Lebanon, NH (R.S.);
出版信息
Stroke. 2014 Aug;45(8):2335-41. doi: 10.1161/STROKEAHA.114.005975. Epub 2014 Jun 17.
BACKGROUND AND PURPOSE
A promising method for identifying hemodynamic impairment that may serve as a biomarker for stroke risk in patients with intracranial stenosis is cerebrovascular reactivity (CVR) mapping using noninvasive MRI. Here, abilities to measure CVR safely in the clinic using hypercarbic hyperoxic (carbogen) gas challenges, which increase oxygen delivery to tissue, are investigated.
METHODS
In sequence with structural and angiographic imaging, blood oxygenation level-dependent carbogen-induced CVR scans were performed in patients with symptomatic intracranial stenosis (n=92) and control (n=10) volunteers, with a subgroup of patients (n=57) undergoing cerebral blood flow-weighted pseudocontinuous arterial spin labeling CVR. Subjects were stratified for 4 substudies to evaluate relationships between (1) carbogen and hypercarbic normoxic CVR in healthy tissue (n=10), (2) carbogen cerebral blood flow CVR and blood oxygenation level-dependent CVR in intracranial stenosis patients (n=57), (3) carbogen CVR and clinical measures of disease in patients with asymmetrical intracranial atherosclerotic (n=31) and moyamoya (n=29) disease, and (4) the CVR scan and immediate and longer-term complications (n=92).
RESULTS
Noninvasive blood oxygenation level-dependent carbogen-induced CVR values correlate with (1) lobar hypercarbic normoxic gas stimuli in healthy tissue (R=0.92; P<0.001), (2) carbogen-induced cerebral blood flow CVR in patients with intracranial stenosis (R=0.30-0.33; P<0.012), and (3) angiographic measures of disease severity both in atherosclerotic and moyamoya patients after appropriate processing. No immediate stroke-related complications were reported in response to carbogen administration; longer-term neurological events fell within the range for expected events in this patient population.
CONCLUSIONS
Carbogen-induced CVR elicited no added adverse events and provided a surrogate marker of cerebrovascular reserve consistent with intracranial vasculopathy.
背景与目的
使用无创 MRI 对脑血管反应性（CVR）进行映射，是识别可能作为颅内狭窄患者中风风险生物标志物的血流动力学损伤的一种很有前景的方法。在此，研究了使用高碳酸血症富氧（碳氧）气体挑战安全地在临床中测量 CVR 的能力，这种方法增加了组织的氧气输送。
方法
在有症状的颅内狭窄患者（n=92）和对照组（n=10）志愿者进行结构和血管造影成像的同时，进行了血氧水平依赖性碳氧诱导的 CVR 扫描，其中一部分患者（n=57）还进行了脑血流加权假性连续动脉自旋标记 CVR。将受试者分为 4 个子研究，以评估以下方面的关系：（1）健康组织中碳氧和高碳酸血症正常氧 CVR 的关系（n=10）；（2）颅内狭窄患者碳氧脑血流 CVR 和血氧水平依赖性 CVR 的关系（n=57）；（3）不对称性颅内动脉粥样硬化（n=31）和烟雾病（n=29）患者的碳氧 CVR 和疾病临床指标的关系；（4）CVR 扫描与即刻和长期并发症的关系（n=92）。
结果
无创血氧水平依赖性碳氧诱导的 CVR 值与（1）健康组织中脑叶高碳酸血症正常氧刺激（R=0.92；P<0.001），（2）颅内狭窄患者碳氧诱导的脑血流 CVR（R=0.30-0.33；P<0.012），以及（3）经适当处理后，在动脉粥样硬化和烟雾病患者中血管疾病严重程度的血管造影指标相关。对碳氧给药没有报告立即与中风相关的并发症；长期神经事件落在该患者人群中预期事件的范围内。
结论
碳氧诱导的 CVR 没有引起额外的不良事件，并提供了与颅内血管病变一致的脑血管储备的替代标志物。
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