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. 2021 Feb 25:12:643468.
doi: 10.3389/fphys.2021.643468. eCollection 2021.

Cerebrovascular Reactivity Measurement Using Magnetic Resonance Imaging: A Systematic Review

Emilie Sleight  1   2 , Michael S Stringer  1   2 , Ian Marshall  1   2 , Joanna M Wardlaw  1   2 , Michael J Thrippleton  1   2
Affiliations

Cerebrovascular Reactivity Measurement Using Magnetic Resonance Imaging: A Systematic Review

Emilie Sleight et al. Front Physiol. .

Erratum in

Abstract

Cerebrovascular reactivity (CVR) magnetic resonance imaging (MRI) probes cerebral haemodynamic changes in response to a vasodilatory stimulus. CVR closely relates to the health of the vasculature and is therefore a key parameter for studying cerebrovascular diseases such as stroke, small vessel disease and dementias. MRI allows in vivo measurement of CVR but several different methods have been presented in the literature, differing in pulse sequence, hardware requirements, stimulus and image processing technique. We systematically reviewed publications measuring CVR using MRI up to June 2020, identifying 235 relevant papers. We summarised the acquisition methods, experimental parameters, hardware and CVR quantification approaches used, clinical populations investigated, and corresponding summary CVR measures. CVR was investigated in many pathologies such as steno-occlusive diseases, dementia and small vessel disease and is generally lower in patients than in healthy controls. Blood oxygen level dependent (BOLD) acquisitions with fixed inspired CO2 gas or end-tidal CO2 forcing stimulus are the most commonly used methods. General linear modelling of the MRI signal with end-tidal CO2 as the regressor is the most frequently used method to compute CVR. Our survey of CVR measurement approaches and applications will help researchers to identify good practice and provide objective information to inform the development of future consensus recommendations.

Keywords: Hypercapnia (CO(2)) inhalation; arterial spin labelling MRI; blood oxygen-level dependent; cerebrovascular reactivity; magnetic resonance imaging; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the literature search.
Figure 2
Figure 2
Distribution of the MRI sequences used in studies with the associated year of publication of the paper. BOLD, blood-oxygen-level-dependent; ASL, arterial spin-labelling; DE, dual-echo; PC, phase-contrast; DSC, dynamic susceptibility contrast; VASO, vascular space occupancy.
Figure 3
Figure 3
Distribution of the (A) stimuli with the associated MRI sequence and (B) paradigm types with associated total duration of the CVR experiment. In (A), the “breath modulation” stimulus includes breath-holding, paced breathing, and hyperventilation stimuli. ACZ, acetazolamide injection; RS, resting-state; BOLD, blood oxygen-level dependent; ASL, arterial spin-labelling; PC, phase contrast; DSC, dynamic susceptibility contrast; VASO, vascular space occupancy.
Figure 4
Figure 4
Bar chart showing the number of studies that apply different pre-processing steps. ROI, region of interest; WB, whole brain; HRF, haemodynamic response function.
Figure 5
Figure 5
Distribution of the (A) CVR processing and (B) delay computation methods with the associated year of publication of the paper. The category “Others” in (B) includes deconvolution to find the HRF between the EtCO2 and the MRI signal, and GLM with two (“fast” and “slow”) regressors. STD, standard deviation of MRI signal; HRF, haemodynamic response function; GLM, general linear model.
See this image and copyright information in PMC

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