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Björnfot, C., Eklund, A., Larsson, J., Hansson, W., Birnefeld, J., Garpebring, A., . . . Wåhlin, A. (2024). Cerebral arterial stiffness is linked to white matter hyperintensities and perivascular spaces in older adults: a 4D flow MRI study. Journal of Cerebral Blood Flow and Metabolism
Open this publication in new window or tab >>Cerebral arterial stiffness is linked to white matter hyperintensities and perivascular spaces in older adults: a 4D flow MRI study
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2024 (English)In: Journal of Cerebral Blood Flow and Metabolism, ISSN 0271-678X, E-ISSN 1559-7016Article in journal (Refereed) Epub ahead of print
Abstract [en]

White matter hyperintensities (WMH), perivascular spaces (PVS) and lacunes are common MRI features of small vessel disease (SVD). However, no shared underlying pathological mechanism has been identified. We investigated whether SVD burden, in terms of WMH, PVS and lacune status, was related to changes in the cerebral arterial wall by applying global cerebral pulse wave velocity (gcPWV) measurements, a newly described marker of cerebral vascular stiffness. In a population-based cohort of 190 individuals, 66–85 years old, SVD features were estimated from T1-weighted and FLAIR images while gcPWV was estimated from 4D flow MRI data. Additionally, the gcPWV’s stability to variations in field-of-view was analyzed. The gcPWV was 10.82 (3.94) m/s and displayed a significant correlation to WMH and white matter PVS volume (r = 0.29, p < 0.001; r = 0.21, p = 0.004 respectively from nonparametric tests) that persisted after adjusting for age, blood pressure variables, body mass index, ApoB/A1 ratio, smoking as well as cerebral pulsatility index, a previously suggested early marker of SVD. The gcPWV displayed satisfactory stability to field-of-view variations. Our results suggest that SVD is accompanied by changes in the cerebral arterial wall that can be captured by considering the velocity of the pulse wave transmission through the cerebral arterial network.

Place, publisher, year, edition, pages
Sage Publications, 2024
Keywords
4D flow MRI, cerebral small vessel disease, perivascular spaces, pulse wave velocity, white matter hyperintensities
National Category
Cardiac and Cardiovascular Systems Neurology Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-221120 (URN)10.1177/0271678X241230741 (DOI)001157963000001 ()38315044 (PubMedID)2-s2.0-85184419786 (Scopus ID)
Funder
Swedish Foundation for Strategic Research, RMX18-0152Swedish Heart Lung Foundation, 20180513Swedish Heart Lung Foundation, 20210653The Swedish Brain Foundation, F2022-0216Swedish Research Council, 2017-04949Swedish Research Council, 2022-04263Region Västerbotten
Available from: 2024-02-22 Created: 2024-02-22 Last updated: 2024-02-22
Birnefeld, J., Petersson, K., Wåhlin, A., Eklund, A., Birnefeld, E., Qvarlander, S., . . . Zarrinkoob, L. (2024). Cerebral blood flow assessed with phase-contrast magnetic resonance imaging during blood pressure changes with noradrenaline and labetalol: a trial in healthy volunteers . Anesthesiology, 140(4), 669-678
Open this publication in new window or tab >>Cerebral blood flow assessed with phase-contrast magnetic resonance imaging during blood pressure changes with noradrenaline and labetalol: a trial in healthy volunteers 
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2024 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 140, no 4, p. 669-678Article in journal (Refereed) Published
Abstract [en]

Background: Adequate cerebral perfusion is central during general anesthesia. However, perfusion is not readily measured bedside. Clinicians currently rely mainly on MAP as a surrogate even though the relationship between blood pressure and cerebral blood flow is not well understood. The aim of this study was to apply phase contrast MRI to characterize blood flow responses in healthy volunteers to commonly used pharmacological agents that increase or decrease arterial blood pressure.

Methods: Eighteen healthy volunteers aged 30-50 years were investigated with phase contrast MRI. Intraarterial blood pressure monitoring was used. First, intravenous noradrenaline was administered to a target MAP of 20% above baseline. After a wash-out period, intravenous labetalol was given to a target MAP of 15% below baseline. Cerebral blood flow was measured using phase contrast MRI and defined as the sum of flow in the internal carotid arteries and vertebral arteries. CO was defined as the flow in the ascending aorta.

Baseline median cerebral blood flow was 772 ml/min (interquartile range, 674 to 871), and CO was 5,874 ml/min (5,199 to 6,355). The median dose of noradrenaline was 0.17 µg · kg−1 · h−1 (0.14 to 0.22). During noradrenaline infusion, cerebral blood flow decreased to 705 ml/min (606 to 748; P = 0.001), and CO decreased to 4,995 ml/min (4,705 to 5,635; P = 0.01). A median dose of labetalol was 120 mg (118 to 150). After labetalol boluses, cerebral blood flow was unchanged at 769 ml/min (734 to 900; P = 0.68). CO increased to 6,413 ml/min (6,056 to 7,464; P = 0.03).

Conclusion: In healthy awake subjects, increasing MAP using intravenous noradrenaline decreased cerebral blood flow and CO. This data does not support inducing hypertension with noradrenaline to increase cerebral blood flow. Cerebral blood flow was unchanged when decreasing MAP using labetalol.

Place, publisher, year, edition, pages
Wolters Kluwer, 2024
National Category
Neurology Radiology, Nuclear Medicine and Medical Imaging Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-220047 (URN)10.1097/ALN.0000000000004775 (DOI)37756527 (PubMedID)2-s2.0-85187724522 (Scopus ID)
Funder
Region Västerbotten
Available from: 2024-01-26 Created: 2024-01-26 Last updated: 2024-04-08Bibliographically approved
Zarrinkoob, L., Myrnäs, S., Wåhlin, A., Eklund, A. & Malm, J. (2024). Cerebral blood flow patterns in patients with low-flow carotid artery stenosis, a 4D-PCMRI assessment. Journal of Magnetic Resonance Imaging
Open this publication in new window or tab >>Cerebral blood flow patterns in patients with low-flow carotid artery stenosis, a 4D-PCMRI assessment
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2024 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Compromised cerebral blood flow can contribute to future ischemic events in patients with symptomatic carotid artery disease. However, there is limited knowledge of the effects on cerebral hemodynamics resulting from a reduced internal carotid artery (ICA) blood flow rate (BFR).

Purpose: Investigate how reduced ICA-BFR, relates to BFR in the cerebral arteries.

Study Type: Prospective.

Subjects: Thirty-eight patients, age 72 ± 6 years (11 female).

Field Strength/Sequence: 3-Tesla, four-dimensional phase-contrast magnetic resonance imaging (4D-PCMRI).

Assessment: Patients with ischemic stroke or transient ischemic attack were evaluated regarding the degree of stenosis. 4D-PCMRI was used to measure cerebral BFR in 38 patients with symptomatic carotid stenosis (≥50%). BFR in the cerebral arteries was assessed in two subgroups based on symptomatic ICA-BFR: reduced ICA-flow (<160 mL/minutes) and preserved ICA-flow (≥160 mL/minutes). BFR laterality was defined as a difference in the paired ipsilateral-contralateral arteries.

Statistical Tests: Patients were grouped based on ICA-BFR (reduced vs. preserved). Statistical tests (independent sample t-test/paired t-test) were used to compare groups and hemispheres. Significance was determined at P < 0.05.

Results: The degree of stenosis was not significantly different, 80% (95% confidence interval [CI] = 73%–87%) in the reduced ICA-flow vs. 72% (CI = 66%–76%) in the preserved ICA-flow; P = 0.09. In the reduced ICA-flow group, a significantly reduced BFR was found in the ipsilateral middle cerebral artery and anterior cerebral artery (A1), while significantly increased in the contralateral A1. Retrograde BFR was found in the posterior communicating artery and ophthalmic artery. Significant BFR laterality was present in all paired arteries in the reduced ICA-flow group, contrasting the preserved ICA-flow group (P = 0.14–0.93).

Data Conclusions: 4D-PCMRI revealed compromised cerebral BFR due to carotid stenosis, not possible to detect by solely analyzing the degree of stenosis. In patients with reduced ICA-flow, collaterals were not sufficient to maintain symmetrical BFR distribution to the two hemispheres.

Evidence Level: 2.

Technical Efficacy: Stage 3.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
4D-PCMRI, cerebral blood flow, cerebrovascular disease, Circle of Willis, MRI, symptomatic carotid stenosis
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-219323 (URN)10.1002/jmri.29216 (DOI)001135005100001 ()38168876 (PubMedID)2-s2.0-85181227868 (Scopus ID)
Funder
Swedish Research Council, 2015-05616Swedish Research Council, 2017-04949Region VästerbottenSwedish Heart Lung Foundation, 20140592
Available from: 2024-01-15 Created: 2024-01-15 Last updated: 2024-01-15
Holmgren, M., Henze, A., Wåhlin, A., Eklund, A., Fox, A. J. & Johansson, E. (2024). Phase-contrast magnetic resonance imaging of intracranial and extracranial blood flow in carotid near-occlusion. Neuroradiology, 66(4), 589-599
Open this publication in new window or tab >>Phase-contrast magnetic resonance imaging of intracranial and extracranial blood flow in carotid near-occlusion
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2024 (English)In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 66, no 4, p. 589-599Article in journal (Refereed) Published
Abstract [en]

Purpose: Compare extracranial internal carotid artery flow rates and intracranial collateral use between conventional ≥ 50% carotid stenosis and carotid near-occlusion, and between symptomatic and asymptomatic carotid near-occlusion.

Methods: We included patients with ≥ 50% carotid stenosis. Degree of stenosis was diagnosed on CTA. Mean blood flow rates were assessed with four-dimensional phase-contrast MRI.

Results: We included 110 patients of which 83% were symptomatic, and 38% had near-occlusion. Near-occlusions had lower mean internal carotid artery flow (70 ml/min) than conventional ≥ 50% stenoses (203 ml/min, P <.001). Definite use of ≥ 1 collateral was found in 83% (35/42) of near-occlusions and 10% (7/68) of conventional stenoses (P <.001). However, there were no differences in total cerebral blood flow (514 ml/min vs. 519 ml/min, P =.78) or ipsilateral hemispheric blood flow (234 vs. 227 ml/min, P =.52), between near-occlusions and conventional ≥ 50% stenoses, based on phase-contrast MRI flow rates. There were no differences in total cerebral or hemispheric blood flow, or collateral use, between symptomatic and asymptomatic near-occlusions.

Conclusion: Near-occlusions have lower internal carotid artery flow rates and more collateral use, but similar total cerebral blood flow and hemispheric blood flow, compared to conventional ≥ 50% carotid stenosis.

Place, publisher, year, edition, pages
Springer Nature, 2024
Keywords
Carotid near-occlusion, Carotid stenosis, Collaterals, CT angiography, Intracerebral flow, Phase-contrast MRI
National Category
Radiology, Nuclear Medicine and Medical Imaging Neurology
Identifiers
urn:nbn:se:umu:diva-221786 (URN)10.1007/s00234-024-03309-y (DOI)001169859900002 ()38400954 (PubMedID)2-s2.0-85185963642 (Scopus ID)
Funder
Knut and Alice Wallenberg FoundationRegion VästerbottenSwedish Heart Lung FoundationThe Swedish Stroke AssociationHarald Jeanssons stiftelseSwedish Society of Medicine
Available from: 2024-03-19 Created: 2024-03-19 Last updated: 2024-03-19Bibliographically approved
Hansson, W., Johansson, E., Birgander, R., Eklund, A. & Malm, J. (2023). Cerebral Microbleeds-Long-Term Outcome After Cerebrospinal Fluid Shunting in Idiopathic Normal Pressure Hydrocephalus. Neurosurgery, 93(2), 300-308
Open this publication in new window or tab >>Cerebral Microbleeds-Long-Term Outcome After Cerebrospinal Fluid Shunting in Idiopathic Normal Pressure Hydrocephalus
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2023 (English)In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 93, no 2, p. 300-308Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cerebral microbleeds (CMBs) are common in idiopathic normal pressure hydrocephalus (INPH) and have been suggested as radiological markers of a brain prone to bleeding. The presence of CMBs might be relevant when selecting patients for shunt surgery.

OBJECTIVE: To evaluate whether CMBs increases long-term risk of hemorrhagic complications and mortality or affects outcomes after cerebrospinal fluid shunt surgery in a cohort of patients with INPH.

METHODS: One hundred and forty nine shunted patients with INPH (mean age, 73 years) were investigated with MRI (T2* or susceptibility-weighted imaging sequences) preoperatively. CMBs were scored with the Microbleed Anatomic Rating Scale. Patients were observed for a mean of 6.5 years (range 2 weeks to 13 years) after surgery. Hemorrhagic events and death were noted. Improvement in gait was evaluated 3 to 6 months after surgery.

RESULTS: At baseline, 74 patients (50%) had CMBs. During follow-up, 7 patients (5%) suffered a hemorrhagic stroke and 43 (29%) suffered a subdural hematoma/hygroma with a median time from surgery of 30.2 months (IQR 50). Overall, having CMBs was not associated with suffering a subdural hematoma/hygroma or hemorrhagic stroke during follow-up with 1 exception that an extensive degree of CMBs (≥50 CMB) was more common in patients suffering a hemorrhagic stroke ( P = .03). CMBs were associated with increased mortality ( P = .02, Kaplan-Meier, log-rank test). The presence of CMBs did not affect gait outcome ( P = .28).

CONCLUSION: CMBs were associated with hemorrhagic stroke and mortality. CMBs do not seem to reduce the possibility of gait improvement after shunt surgery or contribute to the risk of hemorrhagic complications regarding subdural hematoma or hygroma.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-212403 (URN)10.1227/neu.0000000000002409 (DOI)36853021 (PubMedID)2-s2.0-85165222188 (Scopus ID)
Available from: 2023-07-28 Created: 2023-07-28 Last updated: 2023-07-28Bibliographically approved
Holmgren, M., Henze, A., Wåhlin, A., Eklund, A., Fox, A. J. & Johansson, E. (2023). Diagnostic separation of conventional ⩾50% carotid stenosis and near-occlusion with phase-contrast MRI. European Stroke Journal
Open this publication in new window or tab >>Diagnostic separation of conventional ⩾50% carotid stenosis and near-occlusion with phase-contrast MRI
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2023 (English)In: European Stroke Journal, ISSN 2396-9873, E-ISSN 2396-9881Article in journal (Refereed) Epub ahead of print
Abstract [en]

Introduction: The aim of this study was to assess sensitivity, specificity and interrater reliability of phase-contrast MRI (PC-MRI) for diagnosing carotid near-occlusion.

Patients and methods: Prospective cross-sectional study conducted between 2018 and 2021. We included participants with suspected 50%–100% carotid stenosis on at least one side, all were examined with CT angiography (CTA) and PC-MRI and both ICAs were analyzed. Degree of stenosis on CTA was the reference test. PC-MRI-based blood flow rates in extracranial ICA and intracranial cerebral arteries were assessed. ICA-cerebral blood flow (CBF) ratio was defined as ICA divided by sum of both ICAs and Basilar artery.

Results: We included 136 participants. The ICAs were 102 < 50% stenosis, 88 conventional ⩾50% stenosis (31 with ⩾70%), 49 near-occlusion, 12 occlusions, 20 unclear cause of small distal ICA on CTA and one excluded. For separation of near-occlusion and conventional stenoses, ICA flow rate and ICA-CBF ratio had the highest area under the curve (AUC; 0.98–0.99) for near-occlusion. ICA-CBF ratio ⩽0.225 was 90% (45/49) sensitive and 99% (188/190) specific for near-occlusion. Inter-rater reliability for this threshold was excellent (kappa 0.98). Specificity was 94% (29/31) for cases with ⩾70% stenosis. PC-MRI had modest performance for separating <50% and conventional ⩾50% stenosis (highest AUC 0.74), and eight (16%) of near-occlusions were not distinguishable from occlusion (no visible flow).

Conclusion: ICA-CBF ratio ⩽0.225 on PC-MRI is an accurate and reliable method to separate conventional ⩾50% stenosis and near-occlusion that is feasible for routine use. PC-MRI should be considered further as a potential standard method for near-occlusion detection, to be used side-by-side with established modalities as PC-MRI cannot separate other degrees of stenosis.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
Carotid stenosis, CT angiography, near-occlusion, phase-contrast MRI
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-217715 (URN)10.1177/23969873231215634 (DOI)001112325800001 ()38032058 (PubMedID)2-s2.0-85178479481 (Scopus ID)
Funder
Knut and Alice Wallenberg FoundationRegion VästerbottenSwedish Heart Lung FoundationThe Swedish Stroke AssociationHarald and Greta Jeansson FoundationThe Swedish Medical AssociationUmeå University
Available from: 2023-12-14 Created: 2023-12-14 Last updated: 2023-12-14
Kristiansen, M., Holmlund, P., Linden, C., Eklund, A. & Jóhannesson, G. (2023). Optic nerve subarachnoid space posture dependency: an MRI study in subjects with normal tension glaucoma and healthy controls. Investigative Ophthalmology and Visual Science, 64(15), Article ID 20.
Open this publication in new window or tab >>Optic nerve subarachnoid space posture dependency: an MRI study in subjects with normal tension glaucoma and healthy controls
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2023 (English)In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 64, no 15, article id 20Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose of this study was to examine the differences of optic nerve subarachnoid space (ONSAS) volume in patients with normal tension glaucoma (NTG) and healthy controls in different body positions.

Methods: Eight patients with NTG and seven healthy controls underwent magnetic resonance imaging (MRI) examinations in head up tilt (HUT) +11 degrees and head down tilt (HDT) -5 degrees positions according to a randomized protocol determining the starting position. The ONSAS volume in both body positions was measured and compared between the two groups. The results were analyzed using a generalized linear model.

Results: Between HDT and HUT, the postural ONSAS volume change was dependent on starting position (P < 0.001) and group (P = 0.003, NTG versus healthy). A subgroup analysis of those that were randomized to HUT examination first, coming directly from an upright position, showed that the patients with NTG had significantly larger positional ONSAS volume changes compared to the healthy controls; 121 ± 22 µL vs. 65 ± 37 µL (P = 0.049). Analysis of the ONSAS volume distribution showed different profiles for patients with NTG and healthy controls.

Conclusions: There was a significant difference in ONSAS volume change between patients with NTG and healthy subjects when subjected to posture changes, specifically when going from upright to head-down posture. This indicates that patients with NTG had been exposed to a lower ONSAS pressure when they came from the upright posture, which suggests an increased translaminar pressure difference in upright position. This may support the theory that NTG has a dysfunction in an occlusion mechanism of the optic nerve sheath that could cause abnormally negative ONSAS pressures in upright posture.

Keywords
optic nerve subarachnoid space (ONSAS), glaucoma
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-218636 (URN)10.1167/iovs.64.15.20 (DOI)38099734 (PubMedID)2-s2.0-85179765988 (Scopus ID)
Available from: 2023-12-27 Created: 2023-12-27 Last updated: 2024-01-15Bibliographically approved
Luciano, M., Holubkov, R., Williams, M. A., Malm, J., Nagel, S., Moghekar, A., . . . Hamilton, M. G. (2023). Placebo-controlled effectiveness of idiopathic normal pressure hydrocephalus shunting: a randomized pilot trial. Neurosurgery, 92(3), 481-489
Open this publication in new window or tab >>Placebo-controlled effectiveness of idiopathic normal pressure hydrocephalus shunting: a randomized pilot trial
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2023 (English)In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 92, no 3, p. 481-489Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Multiple prospective nonrandomized studies have shown 60% to 70% of patients with idiopathic normal pressure hydrocephalus (iNPH) improve with shunt surgery, but multicenter placebo-controlled trial data are necessary to determine its effectiveness.

OBJECTIVE: To evaluate the effectiveness of cerebrospinal fluid shunting in iNPH through comparison of open vs placebo shunting groups at 4 months using a pilot study.

METHODS: Patients were randomized to a Codman Certas Plus valve (Integra LifeSciences) set at 4 (open shunt group) or 8 (“virtual off”; placebo group). Patients and assessors were blinded to treatment group. The primary outcome measure was 10-m gait velocity. Secondary outcome measures included functional scales for bladder control, activities of daily living, depression, and quality of life. Immediately after 4-month evaluation, all shunts were adjusted in a blinded fashion to an active setting and followed to 12 months after shunting.

RESULTS: A total of 18 patients were randomized. At the 4-month evaluation, gait velocity increased by 0.28 ± 0.28 m/s in the open shunt group vs 0.04 ± 0.17 m/s in the placebo group. The estimated treatment difference was 0.22 m/s ([P = .071], 95% CI −0.02 to 0.46). Overactive Bladder Short Form symptom bother questionnaire significantly improved in open shunt vs placebo (P = .007). The 4-month treatment delay did not reduce the subsequent response to active shunting, nor did it increase the adverse advents rate at 12 months.

CONCLUSION: This multicenter, randomized pilot study demonstrates the effectiveness, safety, and feasibility of a placebo-controlled trial in iNPH, and found a trend suggesting gait velocity improves more in the open shunt group than in the placebo group.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
Keywords
NPH (normal pressure hydrocephalus), Hydrocephalus, Shunting, RCT, Placebo, VPS (ventriculoperitoneal shunting)
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-202116 (URN)10.1227/neu.0000000000002225 (DOI)000936650300026 ()36700738 (PubMedID)2-s2.0-85148250280 (Scopus ID)
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-09-05Bibliographically approved
Wåhlin, A., Eklund, A. & Malm, J. (2022). 4D flow MRI hemodynamic biomarkers for cerebrovascular diseases. Journal of Internal Medicine, 291(2), 115-127
Open this publication in new window or tab >>4D flow MRI hemodynamic biomarkers for cerebrovascular diseases
2022 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 291, no 2, p. 115-127Article, review/survey (Refereed) Published
Abstract [en]

Alterations in cerebral blood flow are common in several neurological diseases among the elderly including stroke, cerebral small vessel disease, vascular dementia, and Alzheimer's disease. 4D flow magnetic resonance imaging (MRI) is a relatively new technique to investigate cerebrovascular disease, and makes it possible to obtain time-resolved blood flow measurements of the entire cerebral arterial venous vasculature and can be used to derive a repertoire of hemodynamic biomarkers indicative of cerebrovascular health.

The information that can be obtained from one single 4D flow MRI scan allows both the investigation of aberrant flow patterns at a focal location in the vasculature as well as estimations of brain-wide disturbances in blood flow. Such focal and global hemodynamic biomarkers show the potential of being sensitive to impending cerebrovascular disease and disease progression and can also become useful during planning and follow-up of interventions aiming to restore a normal cerebral circulation.

Here, we describe 4D flow MRI approaches for analyzing the cerebral vasculature. We then survey key hemodynamic biomarkers that can be reliably assessed using the technique. Finally, we highlight cerebrovascular diseases where one or multiple hemodynamic biomarkers are of central interest.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
Alzheimer's disease, atherosclerosis, carotid stenosis, cerebral blood flow, collateral circulation, phase-contrast MRI, small-vessel disease, stroke
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-190012 (URN)10.1111/joim.13392 (DOI)000722268700001 ()34813112 (PubMedID)2-s2.0-85119704251 (Scopus ID)
Available from: 2021-12-01 Created: 2021-12-01 Last updated: 2022-07-06Bibliographically approved
Vikner, T., Karalija, N., Eklund, A., Malm, J., Lundquist, A., Gallewicz, N., . . . Wåhlin, A. (2022). 5-year associations among cerebral arterial pulsatility, perivascular space dilation, and white matter lesions. Annals of Neurology, 92(5), 871-881
Open this publication in new window or tab >>5-year associations among cerebral arterial pulsatility, perivascular space dilation, and white matter lesions
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2022 (English)In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 92, no 5, p. 871-881Article in journal (Refereed) Published
Abstract [en]

Objective: High cerebral arterial pulsatility index (PI), white matter lesions (WMLs), enlarged perivascular spaces (PVSs), and lacunar infarcts are common findings in the elderly population, and considered indicators of small vessel disease (SVD). Here, we investigate the potential temporal ordering among these variables, with emphasis on determining whether high PI is an early or delayed manifestation of SVD.

Methods: In a population-based cohort, 4D flow MRI data for cerebral arterial pulsatility was collected for 159 participants at baseline (age 64–68), and for 122 participants at follow-up 5 years later. Structural MRI was used for WML and PVS segmentation, and lacune identification. Linear mixed-effects (LME) models were used to model longitudinal changes testing for pairwise associations, and latent change score (LCS) models to model multiple relationships among variables simultaneously.

Results: Longitudinal 5-year increases were found for WML, PVS, and PI. Cerebral arterial PI at baseline did not predict changes in WML or PVS volume. However, WML and PVS volume at baseline predicted 5-year increases in PI. This was shown for PI increases in relation to baseline WML and PVS volumes using LME models (R (Formula presented.) 0.24; p < 0.02 and R (Formula presented.) 0.23; p < 0.03, respectively) and LCS models ((Formula presented.) = 0.28; p = 0.015 and (Formula presented.) = 0.28; p = 0.009, respectively). Lacunes at baseline were unrelated to PI.

Interpretation: In healthy older adults, indicators of SVD are related in a lead–lag fashion, in which the expression of WML and PVS precedes increases in cerebral arterial PI. Hence, we propose that elevated PI is a relatively late manifestation, rather than a risk factor, for cerebral SVD. 

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-199208 (URN)10.1002/ana.26475 (DOI)000843724700001 ()36054261 (PubMedID)2-s2.0-85136905097 (Scopus ID)
Funder
Swedish Foundation for Strategic ResearchRegion Västerbotten, 2017‐04949Knut and Alice Wallenberg Foundation, 2017‐04949Max Planck SocietySwedish Research Council, 2017‐02217Swedish Research Council, 421‐2012‐648
Available from: 2022-09-08 Created: 2022-09-08 Last updated: 2023-05-04Bibliographically approved
Projects
Development of models, measurements and estimation methods for biofluid mechanics of the CNS for investigation of neurological disorders [2011-05216_VR]; Umeå UniversityMicrogravity physiology and intracranial pressure ? For understanding spaceflight induced intracranial hypertension and vision alterations [138/13_SNSB]; Umeå UniversityUnderstanding stroke, vascular dementia and cognitive aging through new techniques and models for assessment of cerebral blood flow and cerebrospinal fluid dynamics [2015-05616_VR]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2031-722X

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