Cerebrovascular reactivity (CVR) is a widely used estimation of hemodynamic stress and ischemic stroke risk but its semi-quantitative nature relegates it primarily to estimations of relative change by comparison to putatively normal territories. Diagnostic and prognostic utility is thus attenuated in commonly encountered patients with bihemispheric disease, thus we have tested approaches for identification of candidate healthy voxels accompanying perfusion imaging or inline calibration of BOLD temporal shift, optimized in a cohort of subjects with strictly unilateral macrovascular disease. Excellent agreement with normative CVR values was observed, suggesting its applicability in patients with multi-focal or ambiguous vascular disease patterns.
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