Clinical and anatomical consequences of impaired cerebrovascular reserve as detectable by ...

227 Pages·2012·10.95 MB·English

by  Jorn Fierstra

Clinical and anatomical consequences of impaired
cerebrovascular reserve as detectable by quantitative
functional MR imaging

Jorn Fierstra
Clinical and anatomical consequences of impaired cerebrovascular
reserve as detectable by quantitative functional MR imaging
PhD thesis, Utrecht University, The Netherlands

Copyright © 2012 J. Fierstra, Utrecht, The Netherlands.
The copyright of some of the published chapters has been transferred to the respective
journals.

ISBN: 978-90-393-5726-2
Cover: Jorn Fierstra & Julien Poublanc
Cover Image: Axial image of BOLD-MRI cerebrovascular reactivity map of patient
with unilateral impaired cerebrovascular reserve (indicated in blue)
related to steno-occlusive disease.
Lay-out: Jorn Fierstra
Printed by: Proefschriftmaken.nl
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Clinical and anatomical consequences of impaired
cerebrovascular reserve as detectable by quantitative
functional MR imaging

Klinische en anatomische consequenties van gestoorde cerebrovasculaire
reserve detecteerbaar met kwantitatieve functionele MR beeldvorming

(met een samenvatting in het Nederlands)

Proefschrift

ter verkrijging van de graad van doctor aan de Universiteit Utrecht op
gezag van de rector magnificus, prof.dr. G.J. van der Zwaan, ingevolge
het besluit van het college voor promoties in het openbaar te verdedigen
op donderdag 1 maart 2012 des middags te 4.15 uur

door

Jorn Fierstra

geboren op 15 mei 1983 te Leeuwarden
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Promotoren: Prof.dr. L.P.E. Regli
Prof.dr. M. Tymianski

Co-promotoren: Dr. D.J. Mikulis
Dr. J.A. Fisher

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Oer ús skynt deselde sinne,
hwer’t wy op de wrâld ek binne

Upon us shines the same sun,
wherever we are in the world

For my family

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Table of Contents

Abstract 9
Organisation of Thesis 13
Definition of Terms 19
Chapter 1 Background & Introduction 23
1.1 Brain anatomy 25
1.2 Brain vasculature 25
1.3 Physiology 28
1.4 Chronic cerebrovascular diseases 29
1.5 Examining the integrity of cerebrovascular 39
autoregulation
1.6 Structural versus functional neurovascular MR imaging 45
in chronic cerebrovascular disease
1.7 Introduction 53
1.7.1 Main hypothesis 55
Part 1: MRI studies in human subjects
Chapter 2 Sequential standardized fMRI assessment of 59
cerebrovascular reserve in chronic intracranial steno-
occlusive disease with two illustrative case studies
Chapter 3 Steal physiology is spatially associated with cerebral 73
cortical thinning
Chapter 4 Surgical revascularization reverses cerebral cortical 83
thinning in patients with severe cerebrovascular steno-
occlusive disease
Chapter 5 Impaired peri-nidal cerebrovascular reserve in seizure 97
patients with brain arteriovenous malformations
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Part 2: Experimental animal models
Chapter 6 End-inspiratory rebreathing reduces the end-tidal to 115
arterial PCO gradient in mechanically ventilated pigs
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Chapter 7 Non-invasive accurate measurement of PaCO in a 129
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pediatric animal model

Chapter 8 Discussion 143
8.1 Future research avenues 159
8.2 Summary 161
Addendum
Chapter I Impaired cerebrovascular reactivity with steal 165
phenomenon is associated with increased diffusion in
white matter of patients with moyamoya disease
Chapter II Mapping white matter diffusion and cerebrovascular 175
reactivity in carotid occlusive disease

Bibliography 185
Nederlandse samenvatting 207
Acknowledgments 211
List of publications 217
Curriculum Vitae 223

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Abstract

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