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Abstract #1219

The reactivity penumbra as a novel metric of ischemic symptomatology in patients with intracranial cerebrovascular disease

Caleb Han1, Wesley T. Richerson1, Maria Garza1, Melanie Leguizamon1, Murli Mishra1, Larry Taylor Davis1,2, Matthew Fusco2,3, Rohan Chitale2,3, Lori C. Jordan1,2,4, and Manus J. Donahue1,5,6
1Neurology, Vanderbilt University Medical Center, Nashville, TN, United States, 2Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States, 3Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States, 4Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States, 5Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States, 6Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, United States

Synopsis

Keywords: Stroke, Ischemia, cerebrovascular reactivity, moyamoya, magnetic resonance imaging

Motivation: Quantitation of cerebrovascular reactivity (CVR) impairment from hypercapnic MRI stimuli is complicated by differences in imaging parameters, stimuli, and vendors.

Goal(s): To evaluate if the volume of CVR impairment represents a reactivity penumbra that correlates directly with recent ischemic symptoms.

Approach: Time-regression cerebrovascular reactivity analyses and subsequent area-under-the-curve analyses were applied separately in brain hemispheres of 91 moyamoya participants with versus without focal neurological symptoms in the past six months.

Results: The parenchymal volumes of impaired reactivity were significantly higher in the flow territory of ischemic symptoms than in asymptomatic hemispheres.

Impact: Cerebrovascular reactivity (CVR) metrics, assessed from fixed-inspired hypercapnic stimuli, differ in brain hemispheres with versus without recent ischemic symptoms; furthermore, the volume of CVR impairment, relative to asymptomatic hemispheres, and the CVR measurements themselves are related to recent ischemic symptomatology.

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Keywords