Application of Neuroimaging Evaluations of Cerebrovascular Reactivity in Intra-extracranial Arterial Stenosis

doi:10.3969/j.issn.1673-5765.2019.08.012

Abstract

Abstract:

Good cerebrovascular reactivity (CVR) is an important compensatory pathway during cerebral hemodynamic decompensation in patients with intra-extracranial arterial severe stenosis or occlusion. CVR assessment can be used to predict the risk and prognosis of ischemic stroke, and evaluate the efficacy of vascular reconstruction. The detection method of CVR as follows: firstly cerebral small vessels are induced to dilatating by CO2 stimulation test or tilt table test, then the cerebral hemodynamic changes before and after vasodilatation are detected by neuroimaging examination. At present, CVR detection techniques include direct detection techniques, such as CTP, PWI, single photon emission computed tomography, Xenon CT, positron emission tomography, blood oxygen level dependent-functional MRI, and arterial spin labeling, and indirect detection techniques such as TCD.

Key words: Cerebrovascular reactivity; Neuroimaging; Intra-extracranial arterial stenosis

摘要：

良好的脑血管反应性（cerebrovascular reactivity，CVR）是颅内外动脉狭窄或闭塞性病变患者脑血流动力学失代偿期的重要代偿途径，CVR检测可以预测缺血性卒中的风险和预后，评价血管重建术的效果。CVR的检测依赖于CO2激发试验或者倾斜实验诱导脑小血管扩张，并通过神经影像技术检测试验前后脑血流动力学的变化，从而评估CVR。目前常用的CVR检测技术包括直接检测技术，如CTP、PWI、单光子发射计算机断层扫描、正电子发射断层扫描、氙CT、血氧水平依赖性功能性磁共振成像、动脉自旋标记技术和间接检测技术TCD。

关键词: 脑血管反应性; 神经影像; 颅内外动脉狭窄性疾病

XU Yu-Zhu, XUE Hong-Lian, LIU Jun-Yan. Application of Neuroimaging Evaluations of Cerebrovascular Reactivity in Intra-extracranial Arterial Stenosis[J]. Chinese Journal of Stroke, 2019, 14(08): 797-802.

徐玉珠，薛红莲，刘俊艳. 脑血管反应性的影像学评估及其在颅内外动脉狭窄性疾病中的应用[J]. 中国卒中杂志, 2019, 14(08): 797-802.

References

[1] LIU P，LI Y，PINHO M，et al. Cerebrovascular

reactivity mapping without gas challenges[J/OL].

Neuroimage，2017，146：320-326. https：//doi.org/10.

1016/j.neuroimage.2016.11.054.

[2] SETTAKIS G，MOLNÁR C，KERÉNYI L，et

al. Acetazolamide as a vasodilatory stimulus in

cerebrovascular diseases and in conditions affecting

the cerebral vasculature[J]. Eur J Neurol，2003，10 （6）：609-620.

[3] MAGON S，BASSO G，FARACE P，et al.

Reproducibility of BOLD signal change induced by

breath holding[J]. Neuroimage，2009，45（3）：702-

712.

[4] URBACK A L，MACINTOSH B J，GOLDSTEIN

B I. Cerebrovascular reactivity measured by

functional magnetic resonance imaging during

breath-hold challenge：asystematicReview[J/OL].

Neurosci Biobehav Rev，2017，79：27-47. https：//doi.

org/10.1016/j.neubiorev.2017.05.003.

[5] GOODE S D，KRISHAN S，ALEXAKIS C，et al.

Precision of cerebrovascular reactivity assessment

with use of different quantification methods for

hypercapnia functional MR imaging[J]. AJNR Am J

Neuroradiol，2009，30（5）：972-977.

[6] NOGUCHI T A. Technical perspective for

understanding quantitative arterial spin-labeling MR

imaging using continuous ASL[J]. Pol J Radiol，2016，

81（1）：317-321.

[7] GRADE M，HERNANDEZ TAMAMES J A，

PIZZINI F B，et al. A neuroradiologist's guide to

arterial spin labeling MRI in clinical practice[J].

Neuroradiology，2015，57（12）：1181-1202.

[8] Meyer J S，Shinohara T，Imai A，et al. Imaging local

cerebral blood flow by xenon-enhanced computed

tomography-technical optimization procedures[J].

Neuroradiology，1988，30（4）：283-292.

[9] LATCHAW R E，YONAS H，HUNTER G J，et

al. Guidelines and recommendations for perfusion

imaging in cerebral ischemia：a scientific statement

for healthcare professionals by the writing group

on perfusion imaging，from the Council on

Cardiovascular Radiology of the American Heart

Association[J]. Stroke，2003，34（4）： 1084-1104.

[10] 朱慧敏，周志明，徐格林，等. 脑血管反应性的检测

方法[J]. 中国卒中杂志，2009，4（12）：1001-1007.

[11] 戴峰，张秀明，卢万俊，等. CT灌注成像分析颈内动

脉重度狭窄或闭塞患者脑血管储备损害[J]. 中国医

学影像技术，2012，28（1）：59-63.

[12] TUROWSKI B，HEIROTH H J，STEIGER H

J，et al. A comparative study of perfusion CT and

99m Tc-HMPAO SPECT measurement to assess

cerebrovascular reserve capacity in patients with

internal carotid artery occlusion[J]. Eur J Med Res，

2011，16（11）：484-490.

[13] NEMOTO E M，YONAS H，PINDZOLA R R，et al.

PET OEF reactivity for hemodynamic compromise

in occlusive vascular disease[J]. J Neuroimag，2007，

17（1）：54-60.

[14] 刘俊艳，魏娟红，罗艳利. 大脑中动脉粥样硬化性狭

窄患者脑血管自动调节能力分析[J]. 中国超声医学

杂志，2007，23（10）：737-740.

[15] WU J，DEHKHARGHANI S，NAHAB F，et

al. Acetazolamide-augmented dynamic BOLD

（aczBOLD）imaging for assessing cerebrovascular

reactivity in chronic steno-occlusive disease of the

anterior circulation：an initial experience[J/OL].

Neuroimage Clin，2017，13：116-122. https：//doi.

org/10.1016/j.nicl.2016.11.018.

[16] HARTKAMP N S，BOKKERS R P，VAN OSCH

M J，et al. Cerebrovascular reactivity in the caudate

nucleus，lentiform nucleus and thalamus in patients

with carotid artery disease[J]. J Neuroradiol，2016，

44（2）：143.

[17] REINHARD M，SCHWARZER G，BRIEL M，et al.

Cerebrovascular reactivity predicts stroke in highgrade

carotid artery disease[J]. Neurology，2014，83

（16）：1424-1431.

[18] HAN J S，ABOUHAMDEN A，MANDELL

D M，et al. Impact of extracranial-intracranial

bypass on cerebrovascular reactivity and clinical

outcome in patients with symptomatic moyamoya

vasculopathy[J]. Stroke，2011，42（11）：3047-3054.

[19] LATTANZI S，CARBONARI L，PAGLIARICCIO

G，et al. Neurocognitive functioning and

cerebrovascular reactivity after carotid

endarterectomy[J]. Neurology，2017：10.1212. https：

//doi.org/10.1212/WNL.0000000000004862.

[20] ENAIDA H，NAGATA S，TAKEDA A，et al.

Changes in chorioretinal blood flow velocity and

cerebral blood flow after carotid endarterectomy[J].

Jpn J Ophthalmol，2016，60（6）：459-465.

[21] ISHIKAWA M，KUSAKA G，TERAO S，et

al. Improvement of neurovascular function and

cognitive impairment after STA-MCA anastomosis[J/

OL]. J Neurol Sci，2017，373：201-207. https：//doi.

org/10.1016/j.jns.2016.12.065.

[22] ZHANG W，YIN Y，ZHANG Y，et al. Influence of

cerebrovascular reactivity on outcome of the patients

with ≥50% symptomatic unilateral middle cerebral

artery stenosis[J]. Int J Neurosc，2018，128（1）：1-15.

[23] NOH H J，KIM S J，KIM J S，et al. Long term

outcome and predictors of ischemic stroke

recurrence in adult moyamoya disease[J]. J Neurol

Sci，2015，359（1-2）：381-388.

[24] 张卫清，尹延伟，张英谦，等. 脑血管储备力对症状

性大脑中动脉重度狭窄患者卒中风险的预测[J]. 神

经损伤与功能重建，2017，12（6）：492.

[25] PORTEGIES M L，BRUIJIN R F，HOFMAN A.

et al. Cerebral vasomotor reactivity and risk of

mortality：The Rotterdam study[J]. Stroke，2014，45 （1）：42-47.

[26] VAN MOOK W N，RENNENBERG R J，

SCHURINK G W，et al. Cerebral hyperperfusion

syndrome[J]. Lancet Neurol，2006，4（12）：877-888.

[27] RAFIQ M K，CONNOLLY D，RANDALL M，et al.

Cerebral hyperperfusion syndrome[J]. Pract Neurol，

2014，14（1）：64-66.

[28] TEO K，CHOY D K，LWIN S，et al. Cerebral

hyperperfusion syndrome after superficial temporal

artery-middle cerebral artery bypass for severe

intracranial steno-occlusive disease：a case control

study[J]. Neurosurgery，2013，72（6）：936-943.

[29] BUCZEK J，KARLI?SKI M，KOBAYASHI

A，et al. Hyperperfusion syndrome after carotid

endarterectomy and carotid stenting[J]. Cerebrovasc

Dis，2013，35（6）：531-537.

[30] YOO D H，ROH H G，CHOI S S，et al. Staged

carotid artery stenting in patients with severe carotid

stenosis：Multicenter experience[J/OL]. J Clin

Neurosci，2018，53：74-78. https：//doi.org/10.1016/

j.jocn.2018.04.007.

[31] UCHIDA K，YOSHIMURA S，SHIRAKAWA

M，et al. Experience of staged angioplasty to

avoid hyperperfusion syndrome for carotid artery

stenosis[J]. Neurol Med Chir（Tokyo），2015，55

（11）：824-829.

[32] DONNELLY J，CZOSNYKA M，HARLAND S，et

al. Cerebral haemodynamics during experimental

intracranial hypertension[J]. Cereb Blood Flow

Metab，2017，37（2）：694-705.

[33] 杨雪，王雁. 脑血管储备能力在缺血性卒中中的作用

及研究进展[J]. 神经病学与神经康复学杂志，2017，

13（4）：213-220.