Impaired Cerebrovascular Reactivity With Steal Phenomenon Is Associated With Increased Diffusion in White Matter of Patients With Moyamoya Disease

Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.
Stroke (Impact Factor: 5.72). 08/2010; 41(8):1610-6. DOI: 10.1161/STROKEAHA.110.579540
Source: PubMed


Reduced cerebrovascular reactivity (CVR) with steal phenomenon is an independent predictor for stroke and may indicate tissue exposed to episodic low-grade ischemia. The apparent diffusion coefficient (ADC) calculated using diffusion-weighted MRI is effective in characterizing focal brain ischemia and subtle structural changes in normal-appearing white matter (WM). We hypothesized that regions of steal phenomenon are associated with increased ADC in normal-appearing WM of patients with Moyamoya disease.
Twenty-two patients with unilateral CVR impairment secondary to Moyamoya disease and 12 healthy control subjects underwent diffusion-weighted MRI and functional MRI mapping of the cerebrovascular response to hypercapnia. Parametric maps of ADC and CVR were calculated, coregistered, and segmented using automated image processing methods. ADC of normal-appearing WM was compared between hemispheres, and between WM with negative CVR (ie, steal phenomenon) and WM with positive CVR.
In patients, ADC of normal-appearing WM was elevated in the hemisphere ipsilateral to the CVR impairment compared with the contralateral hemisphere (P<0.005) and in WM with negative CVR compared with WM with positive CVR (P<0.001). WM in regions of steal phenomenon within the affected hemisphere had higher ADC than homologous contralateral WM (P<0.005). In control subjects, negative CVR in WM was not associated with elevated ADC.
Regions of steal phenomenon are spatially correlated with elevated ADC in normal-appearing WM of patients with Moyamoya disease. This structural abnormality may reflect low-grade ischemic injury after exhaustion of the cerebrovascular reserve capacity.

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Available from: John Conklin, Jan 06, 2016
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    • "TFA provides the estimates of both the magnitude of the response to CO 2 as well as the phase relationship to the stimulus, which would reflect the speed of the response. Measuring not only the magnitude of the response but also an indication of its speed may be of clinical benefit (Conklin et al. 2010; Regan et al. 2013). Our aim in these experiments was, therefore, to investigate how changes in MAP, and different body positions, stimulus patterns and analysis techniques affect the calculation of CVR. "
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