Lag-Optimized Blood Oxygenation Level Dependent Cerebrovascular Reactivity Estimates Derived From Breathing Task Data Have a Stronger Relationship With Baseline Cerebral Blood Flow

Published: 15 June 2022Cerebrovascular reactivity (CVR), an important indicator of cerebrovascular health, is commonly studied with the Blood Oxygenation Level Dependent functional MRI (BOLD-fMRI) response to a vasoactive stimulus. Theoretical and empirical evidence suggests that baseline cerebral blood flow (CBF) modulates BOLD signal amplitude and may influence BOLD-CVR estimates. We address how acquisition and modeling choices affect the relationship between baseline cerebral blood flow (bCBF) and BOLD-CVR: whether BOLD-CVR is modeled with the inclusion of a breathing task, and whether BOLD-CVR amplitudes are optimized for hemodynamic lag effects. We assessed between-subject correlations of average GM values and within-subject spatial correlations across cortical regions. Our results suggest that a breathing task addition to a resting-state acquisition, alongside lag-optimization within BOLD-CVR modeling, can improve BOLD-CVR correlations with bCBF, both between- and within-subjects, likely because these CVR estimates are more physiologically accurate. We report positive correlations between bCBF and BOLD-CVR, both between- and within-subjects. The physiological explanation of this positive correlation is unclear; research with larger samples and tightly controlled vasoactive stimuli is needed. Insights into what drives variability in BOLD-CVR measurements and related measurements of cerebrovascular function are particularly relevant when interpreting results in populations with altered vascular and/or metabolic baselines or impaired cerebrovascular reserve.This work was supported by the Center for Translational Imaging at Northwestern University. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health [K12HD073945]. KZ was supported by an NIH-funded training program [T32EB025766]. SM was supported by the European Union’s Horizon 2020 research and innovation program [Marie Skłodowska-Curie grant agreement No. 713673] and a fellowship from La Caixa Foundation [ID 100010434, fellowship code LCF/BQ/IN17/11620063]. CC-G was supported by the Spanish Ministry of Economy and Competitiveness [Ramon y Cajal Fellowship, RYC2017-21845], the Basque Government [BERC 2018-2021 and PIBA_2019_104], and the Spanish Ministry of Science, Innovation and Universities [MICINN; PID2019- 105520GB-100]

ICA-based denoising strategies in breath-hold induced cerebrovascular reactivity mapping with multi echo BOLD fMRI

Available online 6 March 2021.Performing a BOLD functional MRI (fMRI) acquisition during breath-hold (BH) tasks is a non-invasive, robust method to estimate cerebrovascular reactivity (CVR). However, movement and breathing-related artefacts caused by the BH can substantially hinder CVR estimates due to their high temporal collinearity with the effect of interest, and attention has to be paid when choosing which analysis model should be applied to the data. In this study, we evaluate the performance of multiple analysis strategies based on lagged general linear models applied on multi- echo BOLD fMRI data, acquired in ten subjects performing a BH task during ten sessions, to obtain subject-specific CVR and haemodynamic lag estimates. The evaluated approaches range from conventional regression models, i.e. including drifts and motion timecourses as nuisance regressors, applied on single-echo or optimally-combined data, to more complex models including regressors obtained from multi-echo independent component analysis with different grades of orthogonalization in order to preserve the effect of interest, i.e. the CVR. We compare these models in terms of their ability to make signal intensity changes independent from motion, as well as the reliability as measured by voxelwise intraclass correlation coefficients of both CVR and lag maps over time. Our results reveal that a conservative independent component analysis model applied on the optimally-combined multi-echo fMRI signal offers the largest reduction of motion-related effects in the signal, while yielding reliable CVR amplitude and lag estimates, although a conventional regression model applied on the optimally-combined data results in similar estimates. This work demonstrates the usefulness of multi-echo based fMRI acquisitions and independent component analysis denoising for precision mapping of CVR in single subjects based on BH paradigms, fostering its potential as a clinically-viable neuroimaging tool for individual patients. It also proves that the way in which data-driven regressors should be incorporated in the analysis model is not straight-forward due to their complex interaction with the BH-induced BOLD response.This research was supported by the European Union’s Horizon 2020 research and innovation program ( Marie Sk ł odowska-Curie grant agreement No. 713673 ), a fellowship from La Caixa Foundation (ID 100010434 , fellowship code LCF/BQ/IN17/11620063 ), the Spanish Ministry of Economy and Competitiveness ( Ramon y Cajal Fellowship, RYC-2017- 21845 ), the Spanish State Research Agency (BCBL “Severo Ochoa ”excellence accreditation, SEV- 2015-490 ), the Basque Govern- ment ( BERC 2018-2021 and PIBA_2019_104 ), the Spanish Ministry of Science, Innovation and Universities (MICINN; PID2019-105520GB-100 and FJCI-2017-31814 ), and the Eunice Kennedy Shriver National Insti- tute of Child Health and Human Development of the National Institutes of Health under award number K12HD073945

A practical modification to a resting state fMRI protocol for improved characterization of cerebrovascular function

Available online 24 June 2021.Cerebrovascular reactivity (CVR), defined here as the Blood Oxygenation Level Dependent (BOLD) response to a CO 2 pressure change, is a useful metric of cerebrovascular function. Both the amplitude and the timing (hemo- dynamic lag) of the CVR response can bring insight into the nature of a cerebrovascular pathology and aid in understanding noise confounds when using functional Magnetic Resonance Imaging (fMRI) to study neural ac- tivity. This research assessed a practical modification to a typical resting-state fMRI protocol, to improve the characterization of cerebrovascular function. In 9 healthy subjects, we modelled CVR and lag in three resting- state data segments, and in data segments which added a 2–3 minute breathing task to the start of a resting-state segment. Two different breathing tasks were used to induce fluctuations in arterial CO 2 pressure: a breath-hold task to induce hypercapnia (CO 2 increase) and a cued deep breathing task to induce hypocapnia (CO 2 decrease). Our analysis produced voxel-wise estimates of the amplitude (CVR) and timing (lag) of the BOLD-fMRI response to CO 2 by systematically shifting the CO 2 regressor in time to optimize the model fit. This optimization inher- ently increases gray matter CVR values and fit statistics. The inclusion of a simple breathing task, compared to a resting-state scan only, increases the number of voxels in the brain that have a significant relationship between CO 2 and BOLD-fMRI signals, and improves our confidence in the plausibility of voxel-wise CVR and hemody- namic lag estimates. We demonstrate the clinical utility and feasibility of this protocol in an incidental finding of Moyamoya disease, and explore the possibilities and challenges of using this protocol in younger populations. This hybrid protocol has direct applications for CVR mapping in both research and clinical settings and wider applications for fMRI denoising and interpretation.This research was supported by the Eunice Kennedy Shriver Na- tional Institute of Child Health and Human Development of the Na- tional Institutes of Health under award number K12HD073945. The pediatric dataset and cerebral palsy dataset were collected with sup- port of National Institutes of Health award R03 HD094615–01A1. The authors would like to acknowledge Marie Wasielewski and Carson Ingo for their support in acquiring these data. K.Z. was supported by an NIH-funded training program (T32EB025766). S.M. was supported by the European Union’s Horizon 2020 research and innovation pro- gram (Marie Sk ł odowska-Curie grant agreement No. 713673), a fel- lowship from La Caixa Foundation (ID 100010434, fellowship code LCF/BQ/IN17/11620063) and C.C.G was supported by the Spanish Ministry of Economy and Competitiveness (Ramon y Cajal Fellowship, RYC-2017- 21845), the Basque Government (BERC 2018–2021 and PIBA_2019_104) and the Spanish Ministry of Science, Innovation and Universities (MICINN; PID2019–105520GB-100)

Quantitative functional MRI of the Cerebrovascular Reactivity to CO2

Le dioxyde de carbone (CO2) est un résidu naturel du métabolisme cellulaire, la troisième substance la plus abondante du sang, et un important agent vasoactif. À la moindre variation de la teneur en CO2 du sang, la résistance du système vasculaire cérébral et la perfusion tissulaire cérébrale subissent des changements globaux. Bien que les mécanismes exacts qui sous-tendent cet effet restent à être élucidés, le phénomène a été largement exploité dans les études de réactivité vasculaire cérébrale (RVC). Une voie prometteuse pour l’évaluation de la fonction vasculaire cérébrale est la cartographie de la RVC de manière non-invasive grâce à l’utilisation de l’Imagerie par Résonance Magnétique fonctionnelle (IRMf). Des mesures quantitatives et non-invasives de de la RVC peuvent être obtenus avec l’utilisation de différentes techniques telles que la manipu- lation du contenu artériel en CO2 (PaCO2) combinée à la technique de marquage de spin artériel (Arterial Spin Labeling, ASL), qui permet de mesurer les changements de la perfusion cérébrale provoqués par les stimuli vasculaires. Toutefois, les préoccupations liées à la sensibilité et la fiabilité des mesures de la RVC limitent de nos jours l’adoption plus large de ces méthodes modernes de IRMf. J’ai considéré qu’une analyse approfondie ainsi que l’amélioration des méthodes disponibles pourraient apporter une contribution précieuse dans le domaine du génie biomédical, de même qu’aider à faire progresser le développement de nouveaux outils d’imagerie de diagnostique. Dans cette thèse je présente une série d’études où j’examine l’impact des méthodes alternatives de stimulation/imagerie vasculaire sur les mesures de la RVC et les moyens d’améliorer la sensibilité et la fiabilité de telles méthodes. J’ai aussi inclus dans cette thèse un manuscrit théorique où j’examine la possible contribution d’un facteur méconnu dans le phénomène de la RVC : les variations de la pression osmotique du sang induites par les produits de la dissolution du CO2. Outre l’introduction générale (Chapitre 1) et les conclusions (Chapitre 6), cette thèse comporte 4 autres chapitres, au long des quels cinq différentes études sont présentées sous forme d’articles scientifiques qui ont été acceptés à des fins de publication dans différentes revues scientifiques. Chaque chapitre débute par sa propre introduction, qui consiste en une description plus détaillée du contexte motivant le(s) manuscrit(s) associé(s) et un bref résumé des résultats transmis. Un compte rendu détaillé des méthodes et des résultats peut être trouvé dans le(s) dit(s) manuscrit(s). Dans l’étude qui compose le Chapitre 2, je compare la sensibilité des deux techniques ASL de pointe et je démontre que la dernière implémentation de l’ASL continue, la pCASL, offre des mesures plus robustes de la RVC en comparaison à d’autres méthodes pulsés plus âgées. Dans le Chapitre 3, je compare les mesures de la RVC obtenues par pCASL avec l’utilisation de quatre méthodes respiratoires différentes pour manipuler le CO2 artérielle (PaCO2) et je démontre que les résultats peuvent varier de manière significative lorsque les manipulations ne sont pas conçues pour fonctionner dans l’intervalle linéaire de la courbe dose-réponse du CO2. Le Chapitre 4 comprend deux études complémentaires visant à déterminer le niveau de reproductibilité qui peut être obtenu en utilisant des méthodes plus récentes pour la mesure de la RVC. La première étude a abouti à la mise au point technique d’un appareil qui permet des manipulations respiratoires du CO2 de manière simple, sécuritaire et robuste. La méthode respiratoire améliorée a été utilisée dans la seconde étude – de neuro-imagerie – où la sensibilité et la reproductibilité de la RVC, mesurée par pCASL, ont été examinées. La technique d’imagerie pCASL a pu détecter des réponses de perfusion induites par la variation du CO2 dans environ 90% du cortex cérébral humain et la reproductibilité de ces mesures était comparable à celle d’autres mesures hémodynamiques déjà adoptées dans la pratique clinique. Enfin, dans le Chapitre 5, je présente un modèle mathématique qui décrit la RVC en termes de changements du PaCO2 liés à l’osmolarité du sang. Les réponses prédites par ce modèle correspondent étroitement aux changements hémodynamiques mesurés avec pCASL ; suggérant une contribution supplémentaire à la réactivité du système vasculaire cérébral en lien avec le CO2.Carbon dioxide (CO2) is a natural byproduct of cellular metabolism, the third most abundant substance of blood, and a potent vasoactive agent. The resistance of cerebral vasculature and perfusion of the brain tissue respond to the slightest change in blood CO2 content. The physiology of such an effect remains elusive, yet the phenomenon has been widely exploited in studies of the cerebral vascular function. A promising avenue for the assessment of brain’s vascular function is to measure the cerebrovascular reactivity to CO2 (CVR) non-invasively using functional MRI. Quantitative and non-invasive mapping of CVR can be obtained using respiratory manipulations in arterial CO2 and Arterial Spin Labeling (ASL) to measure the perfusion changes associated with the vascular stimulus. However, concerns related to the sensitivity and reliability of CVR mea- sures by ASL still limit their broader adoption. I considered that a thorough analysis and amelioration of available methods could bring a valuable contribution in the domain of biomedical engineering, helping to advance new diagnostic imaging tools. In this thesis I present a series of studies where I exam the impact of alternative manipulation/ASL methods on CVR measures, and ways to improve the sensitivity and reliability of these measures. I have also included in this thesis a theoretical paper, where I exam the possible contribution of an unappreciated factor in the CVR phenomenon: the changes in blood osmotic pressure induced by the products of CO2 dissolution. Apart from a general introduction (Chapter 1) and conclusion (Chapter 6), this thesis comprises 4 other chapters, in which five different research studies are presented in the form of articles accepted for publication in scientific journals. Each of these chapters begins with its own specific introduction, which consists of a description of the background motivating the study and a brief summary of conveyed findings. A detailed account of methods and results can be found in the accompanying manuscript(s). The study composing Chapter 2 compares the sensitivity of two state-of-the-art ASL techniques and show that a recent implementation of continuous ASL, pCASL, affords more robust measures of CVR than older pulsed methods. The study described in Chapter 3 compares pCASL CVR measures obtained using 4 different respiratory methods to manipulate arterial CO2 (PaCO2) and shows that results can differ significantly when manipulations are not designed to operate at the linear range of the CO2 dose-response curve. Chapter 4 encompasses two complementary studies seeking to determine the degree of reproducibility that can be attained measuring CVR using the most recent methods. The first study resulted in the technical development of a breathing apparatus allowing simple, safe and robust respiratory CO2 manipulations. The improved respiratory method was used in the second – neuroimaging – study, in which I and co-authors investigate the sensitivity and reproducibility of pCASL measuring CVR. The pCASL imaging technique was able to detect CO2-induced perfusion responses in about 90% of the human brain cortex and the reproducibility of its measures was comparable to other hemodynamic measures already adopted in the clinical practice. Finally, in Chapter 5 I present a mathematical model that describes CVR in terms of PaCO2-related changes in blood osmolarity. The responses predicted by this model correspond closely to the hemodynamic changes measured with pCASL, suggesting an additional contribution to the reactivity of cerebral vasculature to CO2

Neuropharmacological Investigation Of Stress And Nicotine Self-Administration Among Current Cigarette Smokers

ABSTRACT NEUROPHARMACOLOGICAL INVESTIGATION OF STRESS AND NICOTINE SELF-ADMINISTRATION AMONG CURRENT CIGARETTE SMOKERS by ERIC ANDREW WOODCOCK August 2017 Advisor: Dr. Mark K. Greenwald Major: Neuroscience (Translational) Degree: Doctor of Philosophy Nicotine use, especially cigarette smoking, is a significant public health problem. Existing pharmacotherapies attenuate nicotine craving and withdrawal symptoms. However, the majority of patients relapse within the first year of treatment. Treatment studies indicate a commonly cited precipitant to smoking relapse is stress. Pharmacotherapies do not attenuate, and may exacerbate, the effects of acute stress. Experimental studies (preclinical and clinical) indicate that acute stress potentiates drug-seeking behavior across drugs of abuse. Despite a robust literature linking acute stress and substance use, neurobiological mechanisms remain poorly understood. A more complete understanding of the neurobiological effects of acute stress on brain function may facilitate development of novel interventions. Adjunctive stress-blunting medications may improve the effectiveness of existing pharmacotherapies. The present study investigated the effects of pharmacological stress-induction among cigarette smokers. Non-treatment-seeking cigarette smokers were recruited locally and screened for psychiatric, medical, and neuroimaging contraindications. Using a double-blind, placebo-controlled within-subject random cross-over design, participants (N = 21) completed two oral-dosing experimental sessions: active (yohimbine [YOH] 54mg + hydrocortisone [HYD] 10mg) and placebo (YOH 0mg + HYD 0mg) stress. Prior research indicated that YOH+HYD is a robust pharmacological stress-induction technique that stimulates the Autonomic Nervous System (ANS) and Hypothalamic-Pituitary-Adrenal (HPA) axis systems, increases circulating levels of noradrenaline and cortisol (two primary stress hormones), and potentiates drug-seeking behavior. Throughout each experimental session, subjective and physiological effects were measured. In addition, participants completed a 60min magnetic resonance imaging (MRI) scan which consisted of three task paradigms: 1) letter 2-back, 2) smoking cued letter N-back, and 3) breath-hold challenge. Participants completed a working memory paradigm (letter 2-back) during proton functional magnetic resonance spectroscopy (1H fMRS). Left dorsolateral prefrontal cortex (dlPFC) neurochemistry was evaluated during letter 2-back task performance. Next, participants completed a cued N-back paradigm that consisted of images (cigarette smoking or neutral) centered behind capitalized letters across three levels of N-back task difficulty: 0-, 1-, and 2-back. Finally, participants were instructed (visually) to control their breathing across three phases: ‘normal’ breathing, paced breathing (3s in/3s out), and breath-hold challenge (11s). After the MRI scan, participants completed a choice progressive ratio task. Across 11 independent choice trials, participants could earn one cigarette puff (preferred brand) or money ($0.25) via behavioral responding. Each successive unit earned (puffs or money, independently) was associated with a higher response requirement (progressive ratio schedule). At the end of the 30min task, participants smoked the exact number of cigarette puffs earned and/or were provided the amount of money earned. Number of puffs earned and smoked was a direct measure of nicotine-seeking and self-administration behavior (nicotine motivation). Participants were compensated for their time. Results indicated that oral pretreatment with YOH+HYD increased biomarkers of a physiological stress response: systolic and diastolic blood pressure, heart rate, saliva cortisol and α-amylase (indirect biomarker of noradrenaline levels), relative to placebo. YOH+HYD potentiated nicotine-seeking and self-administration behavior (controlling for nicotine dependence level), relative to placebo. Appetitive and relief-motivated cigarette craving, nicotine withdrawal symptoms, negative affect, and anxiety levels increased throughout each session, but did not differ by experimental session (active vs. placebo stress). Similarly, positive affect decreased throughout each session, but did not as a function of stress. 1H fMRS indicated that letter 2-back performance increased left dlPFC glutamate (GLU) levels relative to interleaved fixation cross rest (indicative of task engagement) during the placebo, but not active stress, session. Further, YOH+HYD impaired letter 2-back response accuracy, relative to placebo. Across N-back levels (0-, 1-, and 2-back), fMRI indicated more robust neural activation across ‘reward’-associated brain regions in response to smoking images (\u3e neutral images) during placebo, relative to active stress. Results demonstrated YOH+HYD induced a sustained physiological stress response (ANS and HPA axis) and potentiated nicotine-seeking and self-administration. YOH+HYD attenuated dlPFC task engagement and impaired response accuracy during a well-established working memory task. These findings provide experimental support for a plausible neurobiological mechanism through which acute stress may potentiate nicotine self-administration. Acute stress-impaired dlPFC function may potentiate nicotine self-administration and, among abstinence-motivated individuals, precipitate smoking relapse. Prior research demonstrated dlPFC function is associated with a host of cognitive processes (e.g. delayed gratification, self-control, decision making, etc.) associated with prolonged smoking abstinence. Future studies are needed to confirm this hypothesis, investigate dose-response relationships, and evaluate the efficacy of stress-blunting medications in combination with existing pharmacotherapies for smoking cessation

Optimisation, evaluation and application of cerebrovascular reactivity measurement using magnetic resonance imaging in patients with cerebral small vessel disease

Small vessel disease (SVD) is a common cause of strokes and dementia. Currently, there are no treatments; therefore, developing and validating early biomarkers of disease progression and treatment response is important for future drug trials. Though SVD pathogenesis is not well understood, findings from previous studies suggest that blood-brain barrier dysfunction and impaired cerebrovascular reactivity (CVR) contribute to the disease. The latter can be measured in vivo using a vasoactive stimulus in parallel with magnetic resonance imaging (MRI) techniques sensitive to blood flow, such as blood oxygen level dependent (BOLD) contrast, and has frequently been assessed in patients with steno-occlusive diseases. However, it is unclear if the technique is reliable when investigating cerebrovascular health in deep structures of the brain where SVD is prevalent. Therefore, this thesis aimed to assess and optimise the reliability of CVR measurements and deepen our understanding of its role in SVD pathogenesis. A systematic review was performed to provide a detailed overview of CVR MRI methodologies and clinical applications, including SVD, present in the literature, which identified several acquisition and analysis methods, a need for greater standardisation and lack of data on reliability. Specifically in SVD research, there was limited application of CVR MRI in SVD populations, little optimisation and reliability assessment of CVR in deep brain structures relevant to SVD, such as in white and subcortical grey matter. Following those findings, the effects of voxel- and region-based analysis approaches on reliability of CVR estimates were investigated using simulations and test-retest data from healthy volunteers. Voxel-based CVR magnitude estimates in tissues with high noise levels were prone to bias, whereas biases in region-based estimates were independent of noise level, but consistently underestimated CVR magnitude relative to the ground-truth mean. Furthermore, the test-retest study confirmed the repeatability of CVR estimates from a BOLD-CVR experiment with fixed inhaled stimulus, although a systematic, but small, bias was detected due to habituation to the gas challenge. The data from healthy volunteers were further used to conduct a proof-of-concept and investigate the feasibility of extracting cerebral pulsatility from BOLD-CVR data. Small-to-moderate correlations with pulsatility from phase-contrast MRI were found depending on the regions considered. CVR pulsatility was also computed in a small cohort of SVD patients: it was higher than in healthy volunteers, but no associations were found with SVD burden. It was concluded that further optimisation and validation of the technique is needed before being suitable for clinical research. Following the optimisation of the CVR MRI technique, relationships between CVR and SVD neuroimaging features, cognition, stroke severity and outcome were investigated cross-sectionally and longitudinally in a cohort of patients with mild stroke. In the cross-sectional analysis, CVR impairment in normal-appearing and damaged tissues was associated with worse SVD burden and cognition deficit. Furthermore, the longitudinal analysis showed that baseline CVR impairment predicted worsening of white matter hyperintensity and perivascular space volumes after one year. In conclusion, assessment of CVR in the brain and its deeper structures was successfully conducted in healthy volunteers and patients with SVD using MRI. However, this required appropriate optimisation of processing strategy as the latter can affect accuracy of CVR parameters and inter-study comparability. Importantly, applying the technique in a cohort of SVD patients led to the findings that CVR impairment was related to worse SVD burden and is a potential marker of SVD severity and progression

Assessing microvascular function with breathing maneuvers : an oxygenation-sensitive CMR study

Ce projet illustre cinq études, mettant l'emphase sur le développement d'une nouvelle approche diagnostique cardiovasculaire afin d'évaluer le niveau d’oxygène contenu dans le myocarde ainsi que sa fonction microvasculaire. En combinant une séquence de résonance magnétique cardiovasculaire (RMC) pouvant détecter le niveau d’oxygène (OS), des manœuvres respiratoires ainsi que des analyses de gaz artériels peuvent être utilisés comme procédure non invasive destinée à induire une réponse vasoactive afin d’évaluer la réserve d'oxygénation, une mesure clé de la fonction vasculaire. Le nombre de tests diagnostiques cardiaques prescrits ainsi que les interventions, sont en pleine expansion. L'imagerie et tests non invasifs sont souvent effectués avant l’utilisation de procédures invasives. L'imagerie cardiaque permet d’évaluer la présence ou absence de sténoses coronaires, un important facteur économique dans notre système de soins de santé. Les techniques d'imagerie non invasives fournissent de l’information précise afin d’identifier la présence et l’emplacement du déficit de perfusion chez les patients présentant des symptômes d'ischémie myocardique. Néanmoins, plusieurs techniques actuelles requièrent la nécessité de radiation, d’agents de contraste ou traceurs, sans oublier des protocoles de stress pharmacologiques ou physiques. L’imagerie RMC peut identifier une sténose coronaire significative sans radiation. De nouvelles tendances d’utilisation de RMC visent à développer des techniques diagnostiques qui ne requièrent aucun facteur de stress pharmacologiques ou d’agents de contraste. L'objectif principal de ce projet était de développer et tester une nouvelle technique diagnostique afin d’évaluer la fonction vasculaire coronarienne en utilisant l' OS-RMC, en combinaison avec des manœuvres respiratoires comme stimulus vasoactif. Ensuite, les objectifs, secondaires étaient d’utilisés l’OS-RMC pour évaluer l'oxygénation du myocarde et la réponse coronaire en présence de gaz artériels altérés. Suite aux manœuvres respiratoires la réponse vasculaire a été validée chez un modèle animal pour ensuite être utilisé chez deux volontaires sains et finalement dans une population de patients atteints de maladies cardiovasculaires. Chez le modèle animal, les manœuvres respiratoires ont pu induire un changement significatif, mesuré intrusivement par débit sanguin coronaire. Il a été démontré qu’en présence d'une sténose coronarienne hémodynamiquement significative, l’OS-RMC pouvait détecter un déficit en oxygène du myocarde. Chez l’homme sain, l'application de cette technique en comparaison avec l'adénosine (l’agent standard) pour induire une vasodilatation coronarienne et les manœuvres respiratoires ont pu induire une réponse plus significative en oxygénation dans un myocarde sain. Finalement, nous avons utilisé les manœuvres respiratoires parmi un groupe de patients atteint de maladies coronariennes. Leurs myocardes étant altérées par une sténose coronaire, en conséquence modifiant ainsi leur réponse en oxygénation. Par la suite nous avons évalué les effets des gaz artériels sanguins sur l'oxygénation du myocarde. Ils démontrent que la réponse coronarienne est atténuée au cours de l’hyperoxie, suite à un stimuli d’apnée. Ce phénomène provoque une réduction globale du débit sanguin coronaire et un déficit d'oxygénation dans le modèle animal ayant une sténose lorsqu’un supplément en oxygène est donné. En conclusion, ce travail a permis d'améliorer notre compréhension des nouvelles techniques diagnostiques en imagerie cardiovasculaire. Par ailleurs, nous avons démontré que la combinaison de manœuvres respiratoires et l’imagerie OS-RMC peut fournir une méthode non-invasive et rentable pour évaluer la fonction vasculaire coronarienne régionale et globale.This project encompasses five studies, which focus on developing a new cardiovascular diagnostic approach for assessing myocardial oxygenation and microvascular function. In combination with oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) imaging, breathing maneuvers and altered arterial blood gases can be used as a non-invasive method for inducing a vasoactive response to test the oxygenation reserve, a key measurement in vascular function. The number of prescribed cardiac diagnostic tests and interventions is rapidly growing. In particular, imaging and other non-invasive tests are frequently performed prior to invasive procedures. One of the most common uses of cardiac imaging is for the diagnosis of significant coronary artery stenosis, a critical cost factor in today’s health care system. Non-invasive imaging techniques provide the most reliable information for the presence and location of perfusion or oxygenation deficits in patients with symptoms suggestive of myocardial ischemia, yet many current techniques suffer from the need for radiation, contrast agents or tracers, and pharmacological or physical stress protocols. CMR imaging can identify significant coronary artery stenosis without radiation and new trends in CMR research aim to develop diagnostic techniques that do not require any pharmacological stressors or contrast agents. For this project, the primary aim was to develop and test a new diagnostic technique to assess coronary vascular function using OS-CMR in combination with breathing maneuvers as the vasoactive stimulus. Secondary aims then used OS-CMR to assess myocardial oxygenation and the coronary response in the presence of altered arterial blood gases. An animal model was used to validate the vascular response to breathing maneuvers before translating the technique to human subjects into both healthy volunteers, and a patient population with cardiac disease. In the animal models, breathing maneuvers could induce a significant change in invasively measured coronary blood flow and it was demonstrated that in the presence of a haemodynamically significant coronary stenosis, OS-CMR could detect a myocardial oxygen deficit. This technique was then applied in a human model, with healthy participants. In a direct comparison to the infusion of the coronary vasodilator adenosine, which is considered a standard agent for inducing vasodilation in cardiac imaging, breathing maneuvers induced a stronger response in oxygenation of healthy myocardium. The final study then implemented the breathing maneuvers in a patient population with coronary artery disease; in which myocardium compromised by a coronary stenosis had a compromised oxygenation response. Furthermore, the observed effects of arterial blood gases on myocardial oxygenation were assessed. This demonstrated that the coronary response to breath-hold stimuli is attenuated during hyperoxia, and this causes an overall reduction in coronary blood flow, and consequently an oxygenation deficit in a coronary stenosis animal model when supplemental oxygen is provided. In conclusion, this work has improved our understanding of potential new diagnostic techniques for cardiovascular imaging. In particular, it demonstrated that combining breathing maneuvers with oxygenation-sensitive CMR can provide a non-invasive and cost-effective method for assessing global and regional coronary vascular function

Biomedical Signal Analysis of the Brain and Systemic Physiology

Near-infrared spectroscopy (NIRS) is a non-invasive and easy-to-use diagnostic technique that enables real-time tissue oxygenation measurements applied in various contexts and for different purposes. Continuous monitoring with NIRS of brain oxygenation, for example, in neonatal intensive care units (NICUs), is essential to prevent lifelong disabilities in newborns. Moreover, NIRS can be applied to observe brain activity associated with hemodynamic changes in blood flow due to neurovascular coupling. In the latter case, NIRS contributes to studying cognitive processes allowing to conduct experiments in natural and socially interactive contexts of everyday life. However, it is essential to measure systemic physiology and NIRS signals concurrently. The combination of brain and body signals enables to build sophisticated systems that, for example, reduce the false alarms that occur in NICUs. Furthermore, since fNIRS signals are influenced by systemic physiology, it is essential to understand how the latter impacts brain signals in functional studies. There is an interesting brain body coupling that has rarely been investigated yet. To take full advantage of these brain and body data, the aim of this thesis was to develop novel approaches to analyze these biosignals to extract the information and identify new patterns, to solve different research or clinical questions. For this the development of new methodological approaches and sophisticated data analysis is necessary, because often the identification of these patterns is challenging or not possible with traditional methods. In such cases, automatic machine learning (ML) techniques are beneficial. The first contribution of this work was to assess the known systemic physiology augmented (f)NIRS approach for clinical use and in everyday life. Based on physiological and NIRS signals of preterm infants, an ML-based classification system has been realized, able to reduce the false alarms in NICUs by providing a high sensitivity rate. In addition, the SPA-fNIRS approach was further applied in adults during a breathing task. The second contribution of this work was the advancement of the classical fNIRS hyperscanning method by adding systemic physiology measures. For this, new biosignal analyses in the time-frequency domain have been developed and tested in a simple nonverbal synchrony task between pairs of subjects. Furthermore, based on SPA-fNIRS hyperscanning data, another ML-based system was created, which is able distinguish familiar and unfamiliar pairs with high accuracy. This approach enables to determine the strength of social bonds in a wide range of social interaction contexts. In conclusion, we were the first group to perform a SPA-fNIRS hyperscanning study capturing changes in cerebral oxygenation and hemodynamics as well as systemic physiology in two subjects simultaneously. We applied new biosignals analysis methods enabling new insights into the study of social interactions. This work opens the door to many future inter-subjects fNIRS studies with the benefit of assessing the brain-to-brain, the brain-to-body, and body-to-body coupling between pairs of subjects

Mapping the Impact and Plasticity of Cortical-Cardiovascular Interactions in Vascular Disease Using Structural and Functional MRI

There is growing interest in the role of vascular disease in accelerating age-related decline in cerebrovascular structural and functional integrity. Since an increased number of older adults are surviving chronic diseases, of which cardiovascular disease (CVD) is prevalent, there is an urgent need to understand relationships between cardiovascular dysfunction and brain health. It is unclear if CVD puts the brains of older adults, already experiencing natural brain aging, at greater risk for degeneration. In this thesis, the role of CVD in accelerating brain aging is explored. Because physical activity is known to provide neuroprotective benefits to brains of older adults, the role of physical activity in mediating disease effects were also explored. Using novel neuroimaging techniques, measures of gray matter volume and cerebrovascular hemodynamics were compared between groups of coronary artery disease patients and age-matched controls, to describe regional effects of CVD on the brain. In a sub-set of patients, imaging measures were repeated after completion of a 6-month exercise training, part of a cardiac rehabilitation program, to examine exercise effects. Differences in cerebrovascular hemodynamics were measured as changes in resting cerebral blood flow (CBF) and changes in cerebrovascular reactivity (CVR) to hypercapnia (6% CO2) using a non-invasive perfusion magnetic resonance imaging technique, arterial spin labelling (ASL). We found decreased brain volume, CBF and CVR in several regions of the brains of coronary artery disease patients compared to age-matched healthy controls. The reductions in CBF and CVR were independent of underlying brain atrophy, suggesting that changes in cerebrovascular function could precede changes in brain structure. In addition, increase in brain volume and CBF were observed in some regions of the brain after exercise training, indicating that cardiac rehabilitation programs may have neurorehabiliation effects as well. Since, CBF measured with ASL is not the [gold] standard measure of functional brain activity, we examined the regional correlation of ASL-CBF to glucose consumption rates (CMRglc) measured with positron emission tomography (PET), a widely acceptable marker of brain functional activity. Simultaneous measurements of ASL-CBF and PET-CMRglc were performed in a separate study in a group of older adults with no neurological impairment. Across brain regions, ASL-CBF correlated well with PET-CMRglc, but variations in regional coupling were found and demonstrate the role of certain brain regions in maintaining higher level of functional organization compared to other regions. In general, the results of the thesis demonstrate the impact of CVD on brain health, and the neurorehabiliation capacity of cardiac rehabilitation. The work presented also highlights the ability of novel non-invasive neuroimaging techniques in detecting and monitoring subtle but robust changes in the aging human brain