Abstract
AbstractFor the prognosis of stroke, patients with moyamoya disease (MMD) require the estimation of remaining cerebrovascular reactivity. For this purpose, CO2-triggered BOLD fMRI by use of short breath-hold periods seems to be a highly available alternative to nuclear medicine methods. Too long breath-hold periods are difficult to perform, too short breath-hold periods do not lead to sufficient BOLD signal changes. We aimed to investigate the required minimum breath-hold duration to detect distinct BOLD signals in the tissue of healthy subjects to find out how long the minimum breath-hold duration in clinical diagnostics of MMD should be. A prospective study was performed. Fourteen healthy subjects underwent fMRI during end-expiration breath-hold periods of different duration (3, 6, 9, and 12 s). Additionally, we compared the influence of paced and self-paced breathing altering the breath-hold periods. Data of a patient with MMD was evaluated to investigate whether the tested procedure is suitable for clinical use. Significant global BOLD signal increases were detected after breath-hold periods of 6, 9, and 12 s. The signals were significantly higher after breath-hold periods of 9 s than after 6 s, while not when the duration was extended from 9 to 12 s. Furthermore, we found additional BOLD signal changes before the expected signal increases, which could be avoided by paced respiratory instructions. This investigation indicates that end-expiration breath-hold period of at least 9 s might be used to measure the cerebrovascular reactivity. This time period resulted in distinct BOLD signal changes and could be performed easily.
Funder
Universitätsklinikum Tübingen
Publisher
Springer Science and Business Media LLC
Reference48 articles.
1. Tarasow E, Kulakowska A, Lukasiewicz A, Kapica-Topczewska K, Korneluk-Sadzynska A, Brzozowska J, et al. Moyamoya disease: diagnostic imaging. Pol J Radiol. 2011;76(1):73–9.
2. Kim JS. Moyamoya disease: epidemiology, clinical features, and diagnosis. J Stroke. 2016;18(1):2–11. https://doi.org/10.5853/jos.2015.01627.
3. Khan N, Schuknecht B, Boltshauser E, Capone A, Buck A, Imhof HG, et al. Moyamoya disease and moyamoya syndrome: experience in Europe; choice of revascularisation procedures. Acta Neurochir. 2003;145(12):1061–71. https://doi.org/10.1007/s00701-003-0148-5.
4. Roder C, Burkle E, Ebner FH, Tatagiba M, Ernemann U, Buck A, et al. Estimation of severity of moyamoya disease with [(15)O]water-positron emission tomography compared with magnetic resonance imaging and angiography. World Neurosurg. 2018;117:e75–81. https://doi.org/10.1016/j.wneu.2018.05.163.
5. Lee M, Zaharchuk G, Guzman R, Achrol A, Bell-Stephens T, Steinberg GK. Quantitative hemodynamic studies in moyamoya disease: a review. Neurosurg Focus. 2009;26(4):E5. https://doi.org/10.3171/2009.1.FOCUS08300.