Identifying cardiovascular risk factors that impact cerebrovascular reactivity: An ASL MRI study.


Soman S(1), Dai W(2), Dong L(3), Hitchner E(4), Lee K(5), Baughman BD(6), Holdsworth SJ(7), Massaband P(8), Bhat JV(6), Moseley ME(9), Rosen A(10), Zhou W(11), Zaharchuk G(12).
Author information:
(1)The Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
(2)Department of Computer Science, State University of New York at Binghamton, Binghamton, New York, USA.
(3)University of California Los Angeles, Los Angeles, California, USA.
(4)Department of Pediatrics, Stanford University School of Medicine, Los Altos Hills, California, USA.
(5)Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
(6)Palo Alto Veterans Affairs Health Care System, Palo Alto VAHCS, Palo Alto, California, USA.
(7)Faculty of Medical and Health Sciences, Division of Medical Science, University of Auckland, Auckland, New Zealand.
(8)Stanford University School of Medicine, Department of Radiology, Palo Alto, California, USA.
(9)Stanford University, Department of Radiology, Lucas Center for MR Spectroscopy and Imaging, Stanford, California, USA.
(10)Department of Behavioral Science and Psychiatry, Stanford University School of Medicine, Palo Alto, California, USA.
(11)Division of Vascular Surgery, University of Arizona, Tucson, Arizona, USA.
(12)Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.


BACKGROUND: To maintain cerebral blood flow (CBF), cerebral blood vessels dilate and contract in response to blood supply through cerebrovascular reactivity (CR). PURPOSE: Cardiovascular (CV) disease is associated with increased stroke risk, but which risk factors specifically impact CR is unknown. STUDY TYPE: Prospective longitudinal. SUBJECTS: Fifty-three subjects undergoing carotid endarterectomy or stenting. FIELD STRENGTH/SEQUENCE: 3T, 3D pseudo-continuous arterial spin labeling (PCASL) ASL, and T1 3D fast spoiled gradient echo (FSPGR). ASSESSMENT: We evaluated group differences in CBF changes for multiple cardiovascular risk factors in patients undergoing carotid revascularization surgery. STATISTICAL TESTS: 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. RESULTS: 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). DATA CONCLUSION: 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. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2020;51:734-747.

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