使用基于对比增强的血氧水平依赖性功能磁共振成像评估脑血管反应性：一项为期15年的单中心经验
Assessment of Cerebrovascular Reactivity Using CO-BOLD MRI: A 15-Year, Single Center Experience.
作者信息
Raghavan Vishvak, Sobczyk Olivia, Sayin Ece Su, Poublanc Julien, Skanda Abby, Duffin James, Venkatraghavan Lashmi, Fisher Joseph A, Mikulis David J
机构信息
School of Computer Science, McGill University, Montreal, Quebec, Canada.
Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, Ontario, Canada.
出版信息
J Magn Reson Imaging. 2024 Sep;60(3):954-961. doi: 10.1002/jmri.29176. Epub 2023 Dec 22.
BACKGROUND
Cerebrovascular reactivity (CVR) is a measure of the change in cerebral blood flow (CBF) in response to a vasoactive challenge. It is a useful indicator of the brain's vascular health.
PURPOSE
To evaluate the factors that influence successful and unsuccessful CVR examinations using precise arterial and end-tidal partial pressure of CO control during blood oxygen level-dependent (BOLD) MRI.
STUDY TYPE
Retrospective.
SUBJECTS
Patients that underwent a CVR between October 2005 and May 2021 were studied (total of 1162 CVR examinations). The mean (±SD) age was 46.1 (±18.8) years, and 352 patients (43%) were female.
FIELD STRENGTH/SEQUENCE: 3 T; T1-weighted images, T2*-weighed two-dimensional gradient-echo sequence with standard echo-planar readout.
ASSESSMENT
Measurements were obtained following precise hypercapnic stimuli using BOLD MRI as a surrogate of CBF. Successful CVR examinations were defined as those where: 1) patients were able to complete CVR testing, and 2) a clinically useful CVR map was generated. Unsuccessful examinations were defined as those where patients were not able to complete the CVR examination or the CVR maps were judged to be unreliable due to, for example, excessive head motion, and poor PCO targeting.
STATISTICAL ANALYSIS
Successful and unsuccessful CVR examinations between hypercapnic stimuli, and between different patterns of stimulus were compared with Chi-Square tests. Interobserver variability was determined by using the intraclass correlation coefficient (P < 0.05 is significant).
RESULTS
In total 1115 CVR tests in 662 patients were included in the final analysis. The success rate of generating CVR maps was 90.8% (1012 of 1115). Among the different hypercapnic stimuli, those containing a step plus a ramp protocol was the most successful (95.18%). Among the unsuccessful examinations (9.23%), most were patient related (89.3%), the most common of which was difficulty breathing.
DATA CONCLUSION
CO-BOLD MRI CVR studies are well tolerated with a high success rate.
EVIDENCE LEVEL
4 TECHNICAL EFFICACY: Stage 3.
背景
脑血管反应性（CVR）是衡量脑血流量（CBF）对血管活性刺激反应变化的指标。它是大脑血管健康的有用指标。
目的
利用血氧水平依赖（BOLD）磁共振成像（MRI）期间精确的动脉血和呼气末二氧化碳分压控制，评估影响CVR检查成功与失败的因素。
研究类型
回顾性研究。
研究对象
对2005年10月至2021年5月期间接受CVR检查的患者进行研究（共1162次CVR检查）。平均（±标准差）年龄为46.1（±18.8）岁，352例患者（43%）为女性。
场强/序列：3T；T1加权图像，T2*加权二维梯度回波序列及标准回波平面读出。
评估
使用BOLD MRI作为CBF的替代指标，在精确的高碳酸血症刺激后进行测量。成功的CVR检查定义为：1）患者能够完成CVR测试；2）生成临床有用的CVR图。不成功的检查定义为患者无法完成CVR检查或由于例如头部运动过多和PCO目标不佳而判断CVR图不可靠。
统计分析
采用卡方检验比较高碳酸血症刺激之间以及不同刺激模式之间成功和不成功的CVR检查。观察者间的变异性通过组内相关系数确定（P<0.05具有显著性）。
结果
最终分析纳入了662例患者的1115次CVR测试。生成CVR图的成功率为90.8%（1115次中的1012次）。在不同的高碳酸血症刺激中，包含阶梯加斜坡方案的刺激最为成功（95.18%）。在不成功的检查中（9.23%），大多数与患者有关（89.3%），最常见的是呼吸困难。
数据结论
CO-BOLD MRI CVR研究耐受性良好，成功率高。
证据水平
4级 技术效能：3级
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