Investigation of the BOLD-Based MRI Signal Time Course During Short Breath-Hold Periods for Estimation of the Cerebrovas
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MEDICINE
Investigation of the BOLD-Based MRI Signal Time Course During Short Breath-Hold Periods for Estimation of the Cerebrovascular Reactivity Leonie Zerweck 1
&
Till-Karsten Hauser 1
&
Constantin Roder 2
&
Uwe Klose 1
Accepted: 28 July 2020 / Published online: 10 August 2020 # The Author(s) 2020
Abstract For 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 breathhold 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. Keywords Functional magnetic resonance imaging . Cerebrovascular reactivity . Moyamoya disease . Hypercapnia . Breath-holding
Introduction Moyamoya disease (MMD) is a cerebrovascular disease that leads to progressive stenosis of terminal parts of the internal carotid arteries (ICA) and the circulus of Willis. The reactively formed collateral vessels serving to maintain the cerebral blood flow (CBF) remind on angiograms of MMD patients
This article is part of the Topical Collection on Medicine * Leonie Zerweck [email protected] 1
Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
2
Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
of “puff of smoke” (Japanese: “moyamoya”) and therefore gave the disease its name. The most frequent symptoms of patients with MMD are ischemic or hemorrhagic strokes and transient ischemic attacks (TIA) [1, 2]. A causal therapy o
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