Department of Neurology, Buffalo Neuroimaging Analysis Center (BNAC), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA.
IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy.
Eur Radiol. 2022 Sep;32(9):6468-6479. doi: 10.1007/s00330-022-08731-5. Epub 2022 Apr 1.
To determine the relationship between systemic arterial blood flow (SABF) and cerebral perfusion measures in multiple sclerosis (MS) patients.
Cerebral perfusion and SABF were assessed in 118 patients (75 clinically isolated syndrome (CIS)/relapsing-remitting MS and 43 progressive MS) through MRI examination with dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) and Doppler ultrasound, respectively. Measures of mean transit time (MTT) and time-to-peak (TTP), measured in seconds, of the normal-appearing whole brain (NAWB) and gray matter (GM) were calculated. Blood flow through the bilateral common carotid and vertebral arteries (in mL/min) represents the SABF. Whole brain volume (WBV) and body mass index (BMI) were used as additional covariates.
Higher systolic blood pressure was associated with lower SABF (-0.256, p = 0.006). In the total MS sample, higher SABF was associated with shorter MTT and TTP of the NAWB (r = -0.256, p = 0.007 and r = -0.307, p = 0.001) and GM (r = -0.239, p = 0.012 and r = -0.3, p = 0.001). The SABF and TTP associations were driven by the PMS patients (r = -0.451, p = 0.004 and r = -0.451, p = 0.011). Only in PMS, SABF remained a significant predictor of NAWB (standardized β = -0.394, p = 0.022) and GM TTP (standardized β = -0.351, p = 0.037). MTT and TTP were significantly lower in patients within lower SABF quartiles when compared to the higher quartiles (age-, sex-, BMI-, and WBV-adjusted ANCOVA p < 0.025).
The direct relationship between systemic and cerebral blood flow seen in PMS patients may suggest failure in cerebrovascular reactivity mechanisms and insufficient perfusion control. Cerebral blood flow in PMS may be increasingly dependent on the SABF.
• In progressive multiple sclerosis (MS) patients, the systemic arterial blood flow (SABF) is associated with perfusion-based measure of time-to-peak (TTP) of the normal-appearing whole brain (r = -0.451, p = 0.004) and gray matter (r = -0.451, p = 0.004). • Cerebral blood flow in progressive MS is directly dependent on systemic arterial blood flow and may be influenced by blood pressure changes. • Neurovascular unit impairment may play an important role in MS pathophysiology and contribute towards greater clinical disability.
确定多发性硬化症（MS）患者的全身动脉血流（SABF）与脑灌注测量之间的关系。
通过磁共振成像检查（DSC-PWI）和多普勒超声分别评估 118 例患者（75 例临床孤立综合征（CIS）/复发缓解型 MS 和 43 例进展型 MS）的脑灌注和 SABF。计算正常外观全脑（NAWB）和灰质（GM）的平均通过时间（MTT）和达峰时间（TTP）的秒数。通过双侧颈总动脉和椎动脉的血流（mL/min）表示 SABF。全脑体积（WBV）和体重指数（BMI）用作附加协变量。
较高的收缩压与较低的 SABF 相关（-0.256，p = 0.006）。在整个 MS 样本中，较高的 SABF 与 NAWB 的 MTT 和 TTP 缩短相关（r = -0.256，p = 0.007 和 r = -0.307，p = 0.001）和 GM（r = -0.239，p = 0.012 和 r = -0.3，p = 0.001）。SABF 和 TTP 的关联由 PMS 患者驱动（r = -0.451，p = 0.004 和 r = -0.451，p = 0.011）。仅在 PMS 中，SABF 仍然是 NAWB（标准化β= -0.394，p = 0.022）和 GM TTP（标准化β= -0.351，p = 0.037）的显著预测因子。与较高四分位组相比，处于较低 SABF 四分位组的患者的 MTT 和 TTP 明显较低（年龄、性别、BMI 和 WBV 调整后的 ANCOVA p < 0.025）。
PMS 患者中全身和脑血流之间的直接关系可能表明脑血管反应性机制失败和灌注控制不足。PMS 中的脑血流可能越来越依赖于 SABF。
在进展性多发性硬化症（MS）患者中，全身动脉血流（SABF）与正常外观全脑的达峰时间（TTP）的灌注测量值相关（r = -0.451，p = 0.004）和灰质（r = -0.451，p = 0.004）。
进展性 MS 中的脑血流直接依赖于全身动脉血流，可能受血压变化的影响。
神经血管单元损伤可能在 MS 病理生理学中发挥重要作用，并导致更大的临床残疾。
