Soman Salil, Dai Weiying, Dong Lucy, Hitchner Elizabeth, Lee Kyuwon, Baughman Brittanie D, Holdsworth Samantha J, Massaband Payam, Bhat Jyoti V, Moseley Michael E, Rosen Allyson, Zhou Wei, Zaharchuk Greg
The Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Department of Computer Science, State University of New York at Binghamton, Binghamton, New York, USA.
J Magn Reson Imaging. 2020 Mar;51(3):734-747. doi: 10.1002/jmri.26862. Epub 2019 Jul 11.
To maintain cerebral blood flow (CBF), cerebral blood vessels dilate and contract in response to blood supply through cerebrovascular reactivity (CR).
Cardiovascular (CV) disease is associated with increased stroke risk, but which risk factors specifically impact CR is unknown.
Prospective longitudinal.
Fifty-three subjects undergoing carotid endarterectomy or stenting.
FIELD STRENGTH/SEQUENCE: 3T, 3D pseudo-continuous arterial spin labeling (PCASL) ASL, and T 3D fast spoiled gradient echo (FSPGR).
We evaluated group differences in CBF changes for multiple cardiovascular risk factors in patients undergoing carotid revascularization surgery.
PRE (baseline), POST (48-hour postop), and 6MO (6 months postop) whole-brain CBF measurements, as 129 CBF maps from 53 subjects were modeled as within-subject analysis of variance (ANOVA). To identify CV risk factors associated with CBF change, the CBF change from PRE to POST, POST to 6MO, and PRE to 6MO were modeled as multiple linear regression with each CV risk factor as an independent variable. Statistical models were performed controlling for age on a voxel-by-voxel basis using SPM8. Significant clusters were reported if familywise error (FWE)-corrected cluster-level was P < 0.05, while the voxel-level significance threshold was set for P < 0.001.
The entire group showed significant (cluster-level P < 0.001) CBF increase from PRE to POST, decrease from POST to 6MO, and no significant difference (all voxels with P > 0.001) from PRE to 6MO. Of multiple CV risk factors evaluated, only elevated systolic blood pressure (SBP, P = 0.001), chronic renal insufficiency (CRI, P = 0.026), and history of prior stroke (CVA, P < 0.001) predicted lower increases in CBF PRE to POST. Over POST to 6MO, obesity predicted lower (P > 0.001) and cholesterol greater CBF decrease (P > 0.001).
The CV risk factors of higher SBP, CRI, CVA, BMI, and cholesterol may indicate altered CR, and may warrant different stroke risk mitigation and special consideration for CBF change evaluation.
1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2020;51:734-747.
为维持脑血流量（CBF），脑血管会通过脑血管反应性（CR）对血液供应做出扩张和收缩反应。
心血管（CV）疾病与中风风险增加相关，但具体哪些风险因素会影响CR尚不清楚。
前瞻性纵向研究。
53名接受颈动脉内膜切除术或支架置入术的患者。
场强/序列：3T，三维伪连续动脉自旋标记（PCASL）ASL，以及三维快速扰相梯度回波（FSPGR）。
我们评估了接受颈动脉血运重建手术患者中多种心血管风险因素在CBF变化方面的组间差异。
术前（基线）、术后（术后48小时）和术后6个月（术后6个月）的全脑CBF测量值，因为来自53名受试者的129张CBF图被建模为受试者内方差分析（ANOVA）。为确定与CBF变化相关的CV风险因素，将术前到术后、术后到术后6个月以及术前到术后6个月的CBF变化建模为以每个CV风险因素为自变量的多元线性回归。使用SPM8在逐体素基础上对年龄进行控制来执行统计模型。如果经家族性错误（FWE）校正的簇水平P<0.05，则报告显著簇，而体素水平的显著性阈值设定为P<0.001。
整个组显示从术前到术后CBF显著增加（簇水平P<0.001），从术后到术后6个月减少，并且从术前到术后6个月无显著差异（所有体素P>0.001）。在评估的多种CV风险因素中，只有收缩压升高（SBP，P = 0.001）、慢性肾功能不全（CRI，P = 0.026）和既往中风史（CVA，P<0.001）预测了术前到术后CBF的较低增加。在术后到术后6个月期间，肥胖预测了较低的（P>0.001）CBF下降，而胆固醇则预测了更大的CBF下降（P>0.001）。
较高的SBP、CRI、CVA、BMI和胆固醇等CV风险因素可能表明CR改变，并且可能需要采取不同的中风风险缓解措施以及在评估CBF变化时给予特别考虑。
1技术疗效：5级 《磁共振成像杂志》2020年；51:734 - 747。
