@article{f38dabea20384c0691e50f89badcc90f,
title = "Hemodynamic impairment measured by positron-emission tomography is regionally associated with decreased cortical thickness in moyamoya phenomenon",
abstract = "BACKGROUND AND PURPOSE: Impaired cerebrovascular reactivity has been associated with decreased cortical thickness in patients with arterial occlusive diseases. This study tests the hypothesis that severe hemodynamic impairment, indicated by increased oxygen extraction fraction ratios on positron-emission tomography with 15O tracers, is associated with decreased cortical thickness in patients with Moyamoya phenomenon. MATERIALS AND METHODS: Patients with unilateral or bilateral idiopathic Moyamoya phenomenon were recruited. Oxygen extraction fraction ratio maps were generated from cerebral images of O[15O] counts divided by H2[15O] counts with normalization by corresponding cerebellar counts. The normal range of the oxygen extraction fraction ratio was estimated from historically available healthy control subjects. Cortical thickness was estimated from T1-weighted MR imaging and FreeSurfer. Regional samples of oxygen extraction fraction ratios and cortical thicknesses were drawn using FreeSurfer parcellations, retaining only parcellations from the vascular territory of the middle cerebral artery. RESULTS: Complete MR imaging and PET datasets were available in 35 subjects, including 23 women; the mean age at scanning was 44 years. Patients with Moyamoya phenomenon had a significantly increased regional oxygen extraction fraction ratio compared with 15 healthy control subjects (P<.001). Regional oxygen extraction fraction ratio and age were significant predictors of cortical thickness (P 10101 < .001 for each) in a generalized linear mixed-effects model. Using hemisphere averages and patient averages, we found that only age was a significant predictor of cortical thickness (P < .001). CONCLUSIONS: Chronic hemodynamic impairment, as indicated by a higher regional oxygen extraction fraction ratio, was significantly predictive of reduced cortical thickness in mixed-effects analysis of FreeSurfer regions. This phenomenon may be related to reversible metabolic down-regulation.",
author = "Lee, {J. J.} and Shimony, {J. S.} and H. Jafri and Zazulia, {A. R.} and Dacey, {R. G.} and Zipfel, {G. R.} and Derdeyn, {C. P.}",
note = "Funding Information: Received February 12, 2018; accepted after revision August 6. From the Mallinckrodt Institute of Radiology (J.J.L., J.S.S., H.J., A.R.Z.) and Departments of Neurology (A.R.Z., G.R.Z.) and Neurosurgery (R.G.D., G.R.Z.), Washington University, St Louis, Missouri; and Department of Radiology (C.P.D.), University of Iowa, Iowa City, Iowa. This work was supported by the National Institute of Neurological Disorders and Stroke RO1 NS051631 (C.P.D.). Support for the research imaging center where the MR studies were performed was provided by UL1 RR024992-01, TL1 RR024995-01, and KL2 RR 024994-01 from the National Center for Research Resources, a component of the National Institutes of Health, and the National Center for Research Resources Roadmap for Medical Research, P30NS048056. J.S.S. was also supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number U54 HD087011 to the Intellectual and Developmental Disabilities Research Center at Washington University. Funding Information: Disclosures: John J. Lee—RELATED: Grant: National Institutes of Health, Comments: Supported by National Institute of Neurological Disorders and Stroke RO1 NS051631. Support for the research imaging center where the MR imaging studies were performed was provided by 1 UL1 RR024992-01, 1 TL1 RR024995-01, and 1 KL2 RR 024994-01 from the National Center for Research Resources, a component of the National Institutes of Health, and the National Institutes of Health Roadmap for Medical Research and P30NS048056*. Joshua S. Shimony—UNRELATED: Expert Testimony: expert testimony in regard to the use of DTI in the diagnosis of traumatic brain injury; Grants/Grants Pending: National Institutes of Health *. Gregory R. Zipfel— UNRELATED: Consultancy: Gerson Lehrman Group, Comments: consulting on a medical topic outside that discussed in the present article; Expert Testimony: Wais, Vogelstein, Forman and Offutt; Darby & Gaza; Zeigler Cohen & Koch; Hyde, Love, and Overby; Boyle Brasher LLC, Comments: expert witness for a variety of medical conditions; Grants/Grants Pending: National Institutes of Health.* *Money paid to institution. Publisher Copyright: {\textcopyright} 2018 by the American Society of Neuroradiology.",
year = "2018",
month = nov,
day = "1",
doi = "10.3174/ajnr.A5812",
language = "English",
volume = "39",
pages = "2037--2044",
journal = "American Journal of Neuroradiology",
issn = "0195-6108",
number = "11",
}