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Background Carotid occlusive disease is a type of progressive disease resulting in ischemic stroke. Extracranial-intracranial bypass surgery represents a valid therapeutic option when medical treatment does not make effects. The appearance of cerebral edema following bypass is common during acute stage. Additionally, there are many causes of mild cerebral edema, such as hemodynamic changes, venous congestion and others. However, severe edema involving large brain tissue, which presents as reversible aphasia and hemiplegia, remains to be elucidated. Case presentation A 55-year-old man was admitted to the neurosurgery department for repeated dizziness for over a year and sudden onset of syncope 1 month prior, and he was diagnosed with carotid occlusive disease. After surgical contraindications were excluded, dual bypass and encephalo-duro-myo-synangiosis were performed. Although blood pressure and fluid management were strictly under control promptly after surgery, massive cerebral edema involving the left anterior cerebral artery and middle cerebral artery territories occurred from the 6th day after surgery. Additionally, no discernible cerebral infarction or hemorrhage occurred. Moreover, the cerebral blood flow of the middle cerebral artery displayed an early decrease followed by delayed elevation on the left side. Without restricting the spreading of cerebral edema, life-threatening cerebral herniation could develop at any time. Mannitol and furosemide were administered for impending cerebral herniation. The amelioration of symptoms was noticed on the 16th day after surgery. The patient felt relief on the 21st day after surgery. Digital subtraction angiography performed on the 180th day after surgery demonstrated the patency of dual anastomosed vessels, and the patient recovered without any permanent neurological deficit. Conclusion Based on changes in cerebral blood flow and reversible symptoms, the “watershed shift” phenomenon could explain such a severe deficit. However, this deficit was not the same as the classical presentation of the “watershed shift”, which involves a moderate amount of brain tissue and presents significant increases in cerebral blood flow. In addition to the “watershed shift”, a swollen temporal muscle may also participate in the progression of focal edema.

We performed interictal arterial spin labeling (ASL) in 73 migraine patients, including those who underwent antibody switching, before and after anti-calcitonin gene-related peptide (anti-CGRP) therapy, classified cerebral blood flow (CBF) changes after treatment, compared clinical features, and identified predictors of treatment response. As a result, CBF in patients with cortical hyperperfusion (CHP) before treatment and decreased CBF after treatment (27 patients) or with no CHP before treatment and increased CBF after treatment (18 patients) became more normal. Notably, the latter group showed the highest percentage of patients with a > 50% decrease in monthly headache days (94%). Approximately 90% of patients with no CHP before treatment and decreased CBF after treatment (19 patients) showed inappropriate changes in CBF after treatment, with CBF decreasing below normal levels. Only one patient among those with no change in CBF before or after treatment regardless of pretreatment CHP (9 patients) responded to treatment. Multivariable analysis revealed CHP findings despite presentation with insomnia and insomnia with white matter hyperintensities as significant negative neuroradiological predictors of > 50% response. Interictal CBF measurements from ASL before and after anti-CGRP therapy may be clinically useful for predicting treatment efficacy.

We analyzed cortical renal blood flow (cRBF) by ASL-MRI in ten donors (4 females, mean age 46 ± 6) and dedicated pediatric recipients (4 females, mean age 14 ± 4) before transplantation and at 3-, 6-, and 12-months post-transplant to identify allograft functional adaptation. Baseline values were compared to post-transplant values and correlated with estimated glomerular filtration rate (eGFR). Additionally, renal plasma flow (RPF) and estimated filtration fraction (eFF) were calculated. Both cRBF and eGFR demonstrated a highly significant increase at 3 months compared to baseline (mean cRBF 251.71 ± 78.27 vs. 486.61 ± 156.08 ml/kidney/min, p  = 0.0001; mean eGFR 46.62 ± 16.36 vs. 69.81 ± 24.83 ml/min/1.73 m 2 ; p  = 0.02) and remained consistent until the end of the observed period. Patients with impaired function and lower eGFR at 3 months exhibited a smaller increase in cRBF compared to the rest of the group ( p  = 0.01). eFF did not change significantly throughout the observed period ( p  = 0.07, p  = 0.07, and p  = 0.68, respectively), suggesting absence of hyperfiltration. cRBF may serve as a significant renal biomarker for longitudinal follow-up of renal allografts, enabling tracking of perfusion adaptation and identification of critical timepoints for clinical intervention.

Habitual physical activity is beneficial for cerebrovascular health and cognitive function. Physical exercise therefore constitutes a clinically relevant cerebrovascular stimulus. This study demonstrates the feasibility of quantitative cerebral blood flow (CBF) measurements during supine bicycling exercise with pseudo-continuous arterial spin labeling (pCASL) magnetic resonance imaging (MRI) at 3 Tesla. Twelve healthy volunteers performed a steady-state exercise-recovery protocol on an MR-compatible bicycle ergometer, while dynamic pCASL data were acquired at rest, during moderate (60% of the age-predicted supine maximal heart rate (HRmax)) and vigorous (80% of supine HRmax) exercise, and subsequent recovery. These CBF measurements were compared with 2D phase-contrast MRI measurements of blood flow through the carotid arteries. Procedures were repeated on a separate day for an assessment of measurement repeatability. Whole-brain (WB) CBF was 41.2 ± 6.9 mL/100 g/min at rest (heart rate 63 [57-71] beats/min), remained similar at moderate exercise (102 [97-107] beats/min), decreased by 10% to 37.1 ± 5.7 mL/100 g/min (p = 0.001) during vigorous exercise (139 [136-142] beats/min) and decreased further to 34.2 ± 6.0 mL/100 g/min (p < 0.001) during recovery. Hippocampus CBF decreased by 12% (p = 0.001) during moderate exercise, decreased further during vigorous exercise (-21%; p < 0.001) and was even lower during recovery (-31%; p < 0.001). In contrast, motor cortex CBF increased by 12% (p = 0.027) during moderate exercise, returned to resting-state values during vigorous exercise, and decreased by 17% (p = 0.006) during recovery. The inter-session repeatability coefficients for WB CBF were approximately 20% for all stages of the exercise-recovery protocol. Phase-contrast blood flow measurements through the common carotid arteries overestimated the WB CBF because of flow directed to the face and scalp. This bias increased with exercise. We have demonstrated the feasibility of dynamic pCASL-MRI of the human brain for a quantitative evaluation of cerebral perfusion during bicycling exercise. Our spatially resolved measurements revealed a differential response of CBF in the motor cortex as well as the hippocampus compared with the brain as a whole. Caution is warranted when using flow through the common carotid arteries as a surrogate measure for cerebral perfusion.

This study utilized arterial spin labeling-magnetic resonance imaging (ASL-MRI) to explore the developmental trajectory of brain activity associated with attention deficit hyperactivity disorder (ADHD). Pulsed arterial spin labeling (ASL) data were acquired from 157 children with ADHD and 109 children in a control group, all aged 6–12 years old. Participants were categorized into the age groups of 6–7, 8–9, and 10–12, after which comparisons were performed between each age group for ASL analysis of cerebral blood flow (CBF). In total, the ADHD group exhibited significantly lower CBF in the left superior temporal gyrus and right middle frontal gyrus regions than the control group. Further analysis revealed: (1) The comparison between the ADHD group (N = 70) aged 6–7 and the age-matched control group (N = 33) showed no statistically significant difference between. (2) However, compared with the control group aged 8–9 (N = 39), the ADHD group of the same age (N = 53) showed significantly lower CBF in the left postcentral gyrus and left middle frontal gyrus regions. (3) Further, the ADHD group aged 10–12 (N = 34) demonstrated significantly lower CBF in the left superior occipital region than the age-matched control group (N = 37). These age-specific differences suggest variations in ADHD-related domains during brain development post age 6–7.

Mild traumatic brain injury (mTBI) is a common occurrence around the world, associated with a variety of blunt force and torsion injuries affecting all age groups. Most never reach medical attention, and the identification of acute injury and later clearance to return to usual activities is relegated to clinical evaluation—particularly in sports injuries. Advanced structural imaging is rarely performed due to the usual absence of associated acute anatomic/hemorrhagic changes. This review targets physiologic imaging techniques available to identify subtle blood–brain barrier dysfunction and white matter tract shear injury and their association with chronic traumatic encephalopathy. These techniques provide needed objective measures to assure recovery from injury in those patients with persistent cognitive/emotional symptoms and in the face of repetitive mTBI.

Intracranial dural arteriovenous fistula (dAVF) is a pathologic shunt between dural arteries and veins. The indication for invasive treatment of intracranial dAVF is primarily determined by the bleeding risk based on the location of the shunt and venous drainage. DSA is still the gold standard for diagnosing dAVF, but its invasive nature limits its use for early detection of disease progression or recurrence during follow-up. This study evaluates the clinical utility of noninvasive pseudo-continuous arterial spin-labeling MRI (ASL-MRI) in intracranial dAVFs, particularly its potential to detect progression, recanalization and de-novo formation. We conducted a retrospective study including patients with intracranial dAVF who were diagnosed with DSA or treated at our institution between April 2016 and December 2023. The proportion of patients was determined based on ASL-MRI signal changes in the cerebral parenchyma and venous sinuses during follow-up. If bright signal intensity was observed on ASL-MRI, repeat DSA was performed. Of the 65 patients with intracranial dAVF, 54 (83.1 %) received early therapeutic intervention immediately after diagnosis, while the remaining (n = 11; 16.9 %) followed up with MRI. Of the 11 patients, four patients transitioned to treatment, cortical ASL-MRI hyperintensity was exhibited interval augmentation. Of the 58 patients, 63 treatment procedures were performed, ASL-MRI successfully detected two cases of recurrent dangerous dAVF and three cases of de-novo dAVF. ASL-MRI is a minimally invasive diagnostic modality that is useful both before and after treatment, providing support in determining treatment timing, identifying new lesions, and conducting post-treatment follow-up assessments. ●ASL-MRI evaluated for detecting disease evolution in intracranial dAVF.●Retrospective study of 65 patients diagnosed or treated between 2016–2023.●Four of 11 MRI follow-up patients progressed and required intervention.●ASL-MRI detected 2 recurrent and 3 de-novo dAVF cases during follow-up.●ASL-MRI supports timing of treatment, new lesion detection, and monitoring.

Objective To investigate arterial spin labeling (ASL)-MRI for the early diagnosis of and differentiation between the two most common types of presenile dementia: Alzheimer’s disease (AD) and frontotemporal dementia (FTD), and for distinguishing age-related from pathological perfusion changes. Methods Thirteen AD and 19 FTD patients, and 25 age-matched older and 22 younger controls underwent 3D pseudo-continuous ASL-MRI at 3 T. Gray matter (GM) volume and cerebral blood flow (CBF), corrected for partial volume effects, were quantified in the entire supratentorial cortex and in 10 GM regions. Sensitivity, specificity and diagnostic performance were evaluated in regions showing significant CBF differences between patient groups or between patients and older controls. Results AD compared with FTD patients had hypoperfusion in the posterior cingulate cortex, differentiating these with a diagnostic performance of 74 %. Compared to older controls, FTD patients showed hypoperfusion in the anterior cingulate cortex, whereas AD patients showed a more widespread regional hypoperfusion as well as atrophy. Regional atrophy was not different between AD and FTD. Diagnostic performance of ASL to differentiate AD or FTD from controls was good (78-85 %). Older controls showed global hypoperfusion compared to young controls. Conclusion ASL-MRI contributes to early diagnosis of and differentiation between presenile AD and FTD. Key Points • ASL-MRI facilitates differentiation of early Alzheimer’s disease and frontotemporal dementia. • Posterior cingulate perfusion is lower in Alzheimer’s disease than frontotemporal dementia. • Compared to controls, Alzheimer’s disease patients show hypoperfusion in multiple regions. • Compared to controls, frontotemporal dementia patients show focal anterior cingulate hypoperfusion. • Global decreased perfusion in older adults differs from hypoperfusion in dementia.

BackgroundMigraine constitutes a global health burden, and its pathophysiology is not well-understood; research evaluating cerebral perfusion and altered blood flow between brain areas using non-invasive imaging techniques, such as arterial spin labeling, have been scarce. This study aimed to assess cerebral blood flow (CBF) and its connectivity of migraine.MethodsThis study enrolled 40 patients with episodic migraine without aura (MwoA), as well as 42 healthy patients as control (HC). Two groups of normalized CBF and CBF connectivity were compared, and the relationship between CBF variation and clinical scale assessment was further evaluated.ResultsIn comparison to HC subjects, MwoA patients exhibited higher CBF in the right middle frontal orbital gyrus (ORBmid.R) and the right middle frontal gyrus, while that in Vermis_6 declined. The increased CBF of ORBmid.R was positively correlated with both the Visual Light Sensitivity Questionnaire-8 (VLSQ-8) and the monthly attack frequency score. In MwoA, significantly decreased CBF connectivity was detected between ORBmid.R and the left superior frontal gyrus, the right putamen, the right caudate, as well as the right angular gyrus. In addition, increased CBF connectivity was observed between the left calcarine cortex and ORBmid.R.ConclusionsOur results indicate that migraine patients exhibit abnormalities in regional CBF and feature CBF connection defects at the resting state. The affected areas involve information perception, information integration, and emotional, pain and visual processing. Our findings might provide important clues for the pathophysiology of migraine.

Parkinson’s disease (PD) with mild cognitive impairment (PD-MCI) is currently diagnosed based on an arbitrarily predefined standard deviation of neuropsychological test scores, and more objective biomarkers for PD-MCI diagnosis are needed. The purpose of this study was to define possible brain perfusion-based biomarkers of not only mild cognitive impairment, but also risky gene carriers in PD using arterial spin labeling magnetic resonance imaging (ASL-MRI). Fifteen healthy controls (HC), 26 cognitively normal PD (PD-CN), and 27 PD-MCI subjects participated in this study. ASL-MRI data were acquired by signal targeting with alternating radio-frequency labeling with Look–Locker sequence at 3 T. Single nucleotide polymorphism genotyping for rs9468 [microtubule-associated protein tau ( MAPT ) H1/H1 versus H1/H2 haplotype] was performed using a Stratagene Mx3005p real-time polymerase chain-reaction system (Agilent Technologies, USA). There were 15 subjects with MAPT H1/H1 and 11 subjects with MAPT H1/H2 within PD-MCI, and 33 subjects with MAPT H1/H1 and 19 subjects with MAPT H1/H2 within all PD. Voxel-wise differences of cerebral blood flow (CBF) values between HC, PD-CN and PD-MCI were assessed by one-way analysis of variance followed by pairwise post hoc comparisons. Further, the subgroup of PD patients carrying the risky MAPT H1/H1 haplotype was compared with noncarriers ( MAPT H1/H2 haplotype) in terms of CBF by a two-sample t test. A pattern that could be summarized as “posterior hypoperfusion” (PH) differentiated the PD-MCI group from the HC group with an accuracy of 92.6% (sensitivity = 93%, specificity = 93%). Additionally, the PD patients with MAPT H1/H1 haplotype had decreased perfusion than the ones with H1/H2 haplotype at the posterior areas of the visual network (VN), default mode network (DMN), and dorsal attention network (DAN). The PH-type pattern in ASL-MRI could be employed as a biomarker of both current cognitive impairment and future cognitive decline in PD.