Non-invasive evaluation of cerebral perfusion in patients with transient ischemic attack: an fMRI study
- 185 Downloads
Detection of hypoperfused tissue due to the ischemia is considered to be important in understanding the cerebral perfusion status and may be helpful in guiding therapeutic decisions for patients with transient ischemic attack (TIA). We hypothesized that the combination of two non-invasive fMRI techniques: resting-state BOLD-fMRI time-shift analysis (TSA) approach and 3D ASL, could detect the cerebral hemodynamic status in TIA patients noninvasively. From April 2015 to June 2016, 51 TIA patients were recruited in this study. We calculated the time delay between the resting-state BOLD signal at each voxel and the whole-brain signal using TSA approach and compared the results to CBF map derived from ASL. Out of the 51 patients, 24 patients with normal arrival time and CBF were in Stage 0; 14 patients who showed delayed arrival time and normal CBF which indicated elevated CBV were in Stage I; the other 13 patients who had both delayed arrival time and decreased CBF were in Stage II, the group average spatial overlap, i.e., Dice coefficient, of the two measurements was 0.55. Four patients in Stage 0 (17.4%), three patients in Stage I (23.1%) and five patients in Stage II (45.5%) suffered ischemic stroke or TIA symptoms in 1 year after MRI scan. The patients in Stage II was at highest risk of subsequent events when compared to other two stages. The combination of resting-state BOLD-fMRI and ASL hold the potential to noninvasively identify the hemodynamic status in TIA patients and help predict the risk of subsequent events.
KeywordsPerfusion Resting-state fMRI Arterial spin labeling Time-shift analysis Transient ischemic attack Cerebral blood flow
We thank two professional radiologists (Ni Ling and Chen Qian) for helping delineate the data. We thank all the patients and volunteers for participating in this study. This work was supported by grants from National Key R&D Program of China (No. 2017YFC1310000), National Natural Science Foundation of China (No. 81771911, 81301210, 81271652, 81520108016, 31471084, 81661148045), Dr. Zang is partly supported by “Qian Jiang Distinguished Professor” program.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
This study was approved by the Ethics Committee of the Center for Cognition and Brain Disorders, Hangzhou Normal University. Written informed consent was obtained from each participant.
- 1.Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, Hatsukami TS, Higashida RT, Johnston SC, Kidwell CS, Lutsep HL, Miller E, Sacco RL (2009) Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 40:2276–2293. https://doi.org/10.1161/STROKEAHA.108.192218 CrossRefGoogle Scholar
- 5.Giles MF, Albers GW, Amarenco P, Arsava EM, Asimos AW, Ay H, Calvet D, Coutts SB, Cucchiara BL, Demchuk AM, Johnston SC, Kelly PJ, Kim AS, Labreuche J, Lavallee PC, Mas JL, Merwick A, Olivot JM, Purroy F, Rosamond WD, Sciolla R, Rothwell PM (2011) Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a multicenter study. Neurology 77:1222–1228. https://doi.org/10.1212/WNL.0b013e3182309f91 CrossRefGoogle Scholar
- 8.Coutts SB, Eliasziw M, Hill MD, Scott JN, Subramaniam S, Buchan AM, Demchuk AM (2008) An improved scoring system for identifying patients at high early risk of stroke and functional impairment after an acute transient ischemic attack or minor stroke. Int J Stroke 3:3–10. https://doi.org/10.1111/j.1747-4949.2008.00182.x CrossRefGoogle Scholar
- 9.Giles MF, Albers GW, Amarenco P, Arsava MM, Asimos A, Ay H, Calvet D, Coutts SB, Cucchiara BL, Demchuk AM, Johnston SC, Kelly PJ, Kim AS, Labreuche J, Lavallee PC, Mas JL, Merwick A, Olivot JM, Purroy F, Rosamond WD, Sciolla R, Rothwell PM (2010) Addition of brain infarction to the ABCD2 Score (ABCD2I): a collaborative analysis of unpublished data on 4574 patients. Stroke 41:1907–1913. https://doi.org/10.1161/STROKEAHA.110.578971 CrossRefGoogle Scholar
- 10.Krol AL, Coutts SB, Simon JE, Hill MD, Sohn CH, Demchuk AM, Group VS (2005) Perfusion MRI abnormalities in speech or motor transient ischemic attack patients. Stroke 36:2487–2489. https://doi.org/10.1161/01.STR.0000185936.05516.fc CrossRefGoogle Scholar
- 12.Mlynash M, Olivot JM, Tong DC, Lansberg MG, Eyngorn I, Kemp S, Moseley ME, Albers GW (2009) Yield of combined perfusion and diffusion MR imaging in hemispheric TIA. Neurology 72:1127–1133. https://doi.org/10.1212/01.wnl.0000340983.00152.69 CrossRefGoogle Scholar
- 15.Restrepo L, Jacobs MA, Barker PB, Wityk RJ (2004) Assessment of transient ischemic attack with diffusion- and perfusion-weighted imaging. AJNR Am J Neuroradiol 25:1645–1652Google Scholar
- 20.MacIntosh BJ, Lindsay AC, Kylintireas I, Kuker W, Gunther M, Robson MD, Kennedy J, Choudhury RP, Jezzard P (2010) Multiple inflow pulsed arterial spin-labeling reveals delays in the arterial arrival time in minor stroke and transient ischemic attack. AJNR Am J Neuroradiol 31:1892–1894. https://doi.org/10.3174/ajnr.A2008 CrossRefGoogle Scholar
- 22.Zaharchuk G, Olivot JM, Fischbein NJ, Bammer R, Straka M, Kleinman JT, Albers GW (2012) Arterial spin labeling imaging findings in transient ischemic attack patients: comparison with diffusion- and bolus perfusion-weighted imaging. Cerebrovasc Dis 34:221–228. https://doi.org/10.1159/000339682 CrossRefGoogle Scholar
- 25.Khalil AA, Ostwaldt AC, Nierhaus T, Ganeshan R, Audebert HJ, Villringer K, Villringer A, Fiebach JB (2017) Relationship between changes in the temporal dynamics of the blood-oxygen-level-dependent signal and hypoperfusion in acute ischemic stroke. Stroke 48:925–931. https://doi.org/10.1161/STROKEAHA.116.015566 CrossRefGoogle Scholar
- 26.Lv Y, Margulies DS, Cameron Craddock R, Long X, Winter B, Gierhake D, Endres M, Villringer K, Fiebach J, Villringer A (2013) Identifying the perfusion deficit in acute stroke with resting-state functional magnetic resonance imaging. Ann Neurol 73:136–140. https://doi.org/10.1002/ana.23763 CrossRefGoogle Scholar
- 27.Ni L, Li J, Li W, Zhou F, Wang F, Schwarz CG, Liu R, Zhao H, Wu W, Zhang X, Li M, Yu H, Zhu B, Villringer A, Zang Y, Zhang B, Lv Y, Xu Y (2017) The value of resting-state functional MRI in subacute ischemic stroke: comparison with dynamic susceptibility contrast-enhanced perfusion MRI. Sci Rep 7:41586. https://doi.org/10.1038/srep41586 CrossRefGoogle Scholar
- 32.Villringer A, Dirnagl U (1995) Coupling of brain activity and cerebral blood flow: basis of functional neuroimaging. Cerebrovasc Brain Metab Rev 7:240–276Google Scholar
- 34.Rossini PM, Altamura C, Ferretti A, Vernieri F, Zappasodi F, Caulo M, Pizzella V, Del Gratta C, Romani GL, Tecchio F (2004) Does cerebrovascular disease affect the coupling between neuronal activity and local haemodynamics? Brain 127:99–110. https://doi.org/10.1093/brain/awh012 CrossRefGoogle Scholar