Arterial CO2 pressure changes during hypercapnia are associated with changes in brain parenchymal volume

The Monro-Kellie hypothesis (MKH) states that volume changes in any intracranial component (blood, brain tissue, cerebrospinal fluid) should be counterbalanced by a co-occurring opposite change to maintain intracranial pressure within the fixed volume of the cranium. In this feasibility study, we investigate the MKH application to structural magnetic resonance imaging (MRI) in observing compensating intracranial volume changes during hypercapnia, which causes an increase in cerebral blood volume. Seven healthy subjects aged from 24 to 64 years (median 32), 4 males and 3 females, underwent a 3-T three-dimensional T1-weighted MRI under normocapnia and under hypercapnia. Intracranial tissue volumes were computed. According to the MKH, the significant increase in measured brain parenchymal volume (median 6.0 mL; interquartile range 4.5, 8.5; p = 0.016) during hypercapnia co-occurred with a decrease in intracranial cerebrospinal fluid (median -10.0 mL; interquartile range -13.5, -6.5; p = 0.034). These results convey several implications: (i) blood volume changes either caused by disorders, anaesthesia, or medication can affect outcome of brain volumetric studies; (ii) besides probing tissue displacement, this approach may assess the brain cerebrovascular reactivity. Future studies should explore the use of alternative sequences, such as three-dimensional T2-weighted imaging, for improved quantification of hypercapnia-induced volume changes

Anesthesia depresses cerebrovascular reactivity to acetazolamide in pediatric moyamoya vasculopathy

Measurements of cerebrovascular reactivity (CVR) are essential for treatment decisions in moyamoya vasculopathy (MMV). Since MMV patients are often young or cognitively impaired, anesthesia is commonly used to limit motion artifacts. Our aim was to investigate the effect of anesthesia on the CVR in pediatric MMV. We compared the CVR with multidelay-ASL and BOLD MRI, using acetazolamide as a vascular stimulus, in all awake and anesthesia pediatric MMV scans at our institution. Since a heterogeneity in disease and treatment influences the CVR, we focused on the (unaffected) cerebellum. Ten awake and nine anesthetized patients were included. The post-acetazolamide CBF and ASL-CVR were significantly lower in anesthesia patients (47.1 ± 15.4 vs. 61.4 ± 12.1, p = 0.04; 12.3 ± 8.4 vs. 23.7 ± 12.2 mL/100 g/min, p = 0.03, respectively). The final BOLD-CVR increase (0.39 ± 0.58 vs. 3.6 ± 1.2% BOLD-change (mean/SD), p Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Blood Flow and Brain Function: Investigations of neurovascular coupling using BOLD fMRI at 7 tesla

The advent of ultra high field (7 tesla) MRI systems has opened the possibility to probe biological processes of the human body in great detail. Especially for studying brain function using BOLD fMRI there is a large benefit from the increased magnetic field strength. BOLD fMRI is the working horse in neuroscience for studying brain function as it can non-invasively detect blood flow changes due to increased neuronal activity. Besides the overall increase in signal-to-noise-ratio at 7 tesla , there is an increase in the BOLD signal changes from the vasculature upon neuronal activation. In this thesis, the increased signal strength at 7 tesla allowed us to study the BOLD signal characteristics in depth, obtaining detailed spatial and temporal information of the underlying neurovascular coupling mechanisms. Also, in two studies we had the opportunity to scan patients before implantation of electrode grids (electrocorticography or intra-cranial EEG, ECoG), and thus link 7 tesla BOLD fMRI to the underlying neuronal physiology. We show that subsecond temporal differences in BOLD signal changes can be resolved as function of cortical depth, which is at millimeter spatial scale. Results also highlight the challenge that BOLD responses contain a multitude of neuronal and non-neuronal, i.e. solely blood drainage, related hemodynamics. Nonetheless, the early phase of the BOLD signal in gray matter was found to be mainly associated with microvascular hemodynamics (capillary bed), which is probably the most specific vascular marker for neuronal activity. Furthermore, by combining 7 tesla BOLD fMRI and electrophysiology (ECoG) we revealed that there is a tight neuronal correlate of the elicited hemodynamics in sensorimotor cortex. This was found to manifest at a fine spatial scale (millimeters) but also in the situation of apparent nonlinearities in both hemodynamic and neuronal responses. In conclusion, these results promise a high potential for 7 tesla BOLD fMRI to separate neuronal and non-neuronal related hemodynamic events, and hence the opportunity to elucidate brain function

The many layers of BOLD: the effect of hypercapnic and hyperoxic stimuli on macro- and micro-vascular compartments quantified by CVR, M, and CBV across cortical depth

Ultra-high field functional magnetic resonance imaging (fMRI) offers the spatial resolution to measure neuronal activity at the scale of cortical layers. However, cortical depth dependent vascularization differences, such as a higher prevalence of macro-vascular compartments near the pial surface, have a confounding effect on depth-resolved blood-oxygen-level dependent (BOLD) fMRI signals. In the current study, we use hypercapnic and hyperoxic breathing conditions to quantify the influence of all venous vascular and micro-vascular compartments on laminar BOLD fMRI, as measured with gradient-echo (GE) and spin-echo (SE) scan sequences, respectively. We find that all venous vascular and micro-vascular compartments are capable of comparable theoretical maximum signal intensities, as represented by the M-value parameter. However, the capacity for vessel dilation, as reflected by the cerebrovascular reactivity (CVR), is approximately two and a half times larger for all venous vascular compartments combined compared to the micro-vasculature at superficial layers. Finally, there is roughly a 35% difference in estimates of CBV changes between all venous vascular and micro-vascular compartments, although this relative difference was approximately uniform across cortical depth. Thus, our results suggest that fMRI BOLD signal differences across cortical depth are likely caused by differences in dilation properties between macro- and micro-vascular compartments. Radiolog