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Assessment of MR blood-oxygen-level-dependent cerebrovascular reactivity under general anaesthesia in children with moyamoya

Assessment of MR blood-oxygen-level-dependent cerebrovascular reactivity under general anaesthesia in children with moyamoya
Assessment of MR blood-oxygen-level-dependent cerebrovascular reactivity under general anaesthesia in children with moyamoya
Background: Moyamoya is a progressive arteriopathy condition characterized by steno-occlusion of the arteries of the circle of Willis. MRI performed with hypercapnic challenge can image blood-oxygen-level-dependent cerebrovascular reactivity (BOLD-CVR) thereby assessing cerebrovascular reserve. MRI studies of children <7 years of age, or with significant behavioural challenges require anesthesia. The purpose of this study was to validate the use of ventilator-induced hypercapnic challenge under general anaesthesia (GA).

Methods: Children with moyamoya underwent two BOLD-CVR imaging in the same session under GA (GA-CVR). Differences in CVR estimates and intraclass correlation coefficient (ICC) between repeated scans were examined to determine repeatability across grey and white matter tissue and vascular territories. Bland-Altman plots were used to visulaize the overall variation between the scans. The associations with age, moyamoya types, and stroke presentation were also examined. Qualitative scoring by visual inspection was also conducted by trained neurologists.

Results: Thirty-two paired GA-CVR studies (sixty-four scans in total) were analyzed (mean age: 7.07 (2.74 -17.95) years, 13 females). Forty-one percent (41%) were under 7 and 77%, under 10. No significant differences between repeated scans were found for any of the CVR estimates, when summarized by tissue and vascular territory. Of the paired studies, repeatability (ICC) for the whole-brain CVR estimates was excellent (≥0.74) in 14 (43.8%), good (≤0.59, >0.74) in 7 (21.9%), fair (≤0.41, >0.59) in 6 (18.8%) and poor (<0.41) in 5 (15.6%). Bland-Altman plots illustrated the overall variation of whole-brain CVR within 95% confidence interval level. Repeatability indices were not affected by children’s age and other clinical factors. On qualitative scoring, the Cohen weighted kappa showed substantial agreement in both right (0.75) and left (0.81) hemispheres.

Conclusion: Our study support the clinical use of GA-CVR across all ages and disease conditions. The GA-CVR provides a feasible, repeatable, and reliably interpretable tool for the assessment of cerebrovascular reserve of very young and behaviourally challenged children with moyamoya.
0039-2499
Choi, Eun Jung
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Logan, William
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Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Robertson, Amanda
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Muthusami, Prakash
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Shroff, Manohar
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Moharir, Mahendranath D.
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Dirks, Peter
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MacGregor, Daune
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Slim, Mahmoud
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Pulcine, Elizabeth
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Bhathal, Ishvinder
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Kaseka, Matsanga Leyila
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Levin, David
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Kassner, Andrea
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Deveber, Gabrielle A.
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Dlamini, Nomazulu
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Choi, Eun Jung
cb669c08-8e16-4923-b585-e0580a5b261e
Logan, William
83d4929e-2157-4135-925f-b5746e5607b3
Kirkham, Fenella J.
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Robertson, Amanda
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Muthusami, Prakash
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Shroff, Manohar
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Moharir, Mahendranath D.
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Dirks, Peter
fc8502cb-260b-4981-be77-f25c640ce905
MacGregor, Daune
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Slim, Mahmoud
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Pulcine, Elizabeth
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Bhathal, Ishvinder
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Kaseka, Matsanga Leyila
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Levin, David
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Kassner, Andrea
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Deveber, Gabrielle A.
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Dlamini, Nomazulu
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Choi, Eun Jung, Logan, William, Kirkham, Fenella J., Robertson, Amanda, Muthusami, Prakash, Shroff, Manohar, Moharir, Mahendranath D., Dirks, Peter, MacGregor, Daune, Slim, Mahmoud, Pulcine, Elizabeth, Bhathal, Ishvinder, Kaseka, Matsanga Leyila, Levin, David, Kassner, Andrea, Deveber, Gabrielle A. and Dlamini, Nomazulu (2022) Assessment of MR blood-oxygen-level-dependent cerebrovascular reactivity under general anaesthesia in children with moyamoya. Stroke, 53. (doi:10.1161/str.53.suppl_1.65).

Record type: Meeting abstract

Abstract

Background: Moyamoya is a progressive arteriopathy condition characterized by steno-occlusion of the arteries of the circle of Willis. MRI performed with hypercapnic challenge can image blood-oxygen-level-dependent cerebrovascular reactivity (BOLD-CVR) thereby assessing cerebrovascular reserve. MRI studies of children <7 years of age, or with significant behavioural challenges require anesthesia. The purpose of this study was to validate the use of ventilator-induced hypercapnic challenge under general anaesthesia (GA).

Methods: Children with moyamoya underwent two BOLD-CVR imaging in the same session under GA (GA-CVR). Differences in CVR estimates and intraclass correlation coefficient (ICC) between repeated scans were examined to determine repeatability across grey and white matter tissue and vascular territories. Bland-Altman plots were used to visulaize the overall variation between the scans. The associations with age, moyamoya types, and stroke presentation were also examined. Qualitative scoring by visual inspection was also conducted by trained neurologists.

Results: Thirty-two paired GA-CVR studies (sixty-four scans in total) were analyzed (mean age: 7.07 (2.74 -17.95) years, 13 females). Forty-one percent (41%) were under 7 and 77%, under 10. No significant differences between repeated scans were found for any of the CVR estimates, when summarized by tissue and vascular territory. Of the paired studies, repeatability (ICC) for the whole-brain CVR estimates was excellent (≥0.74) in 14 (43.8%), good (≤0.59, >0.74) in 7 (21.9%), fair (≤0.41, >0.59) in 6 (18.8%) and poor (<0.41) in 5 (15.6%). Bland-Altman plots illustrated the overall variation of whole-brain CVR within 95% confidence interval level. Repeatability indices were not affected by children’s age and other clinical factors. On qualitative scoring, the Cohen weighted kappa showed substantial agreement in both right (0.75) and left (0.81) hemispheres.

Conclusion: Our study support the clinical use of GA-CVR across all ages and disease conditions. The GA-CVR provides a feasible, repeatable, and reliably interpretable tool for the assessment of cerebrovascular reserve of very young and behaviourally challenged children with moyamoya.

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More information

Published date: February 2022
Venue - Dates: International Stroke Conference 2022 Oral Abstracts, , Orleans, United States, 2022-02-09 - 2022-02-11

Identifiers

Local EPrints ID: 470207
URI: http://eprints.soton.ac.uk/id/eprint/470207
ISSN: 0039-2499
PURE UUID: c07cb1af-2c8c-47d4-beb0-73bc194e2e74
ORCID for Fenella J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 04 Oct 2022 16:49
Last modified: 05 Oct 2022 01:38

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Contributors

Author: Eun Jung Choi
Author: William Logan
Author: Amanda Robertson
Author: Prakash Muthusami
Author: Manohar Shroff
Author: Mahendranath D. Moharir
Author: Peter Dirks
Author: Daune MacGregor
Author: Mahmoud Slim
Author: Elizabeth Pulcine
Author: Ishvinder Bhathal
Author: Matsanga Leyila Kaseka
Author: David Levin
Author: Andrea Kassner
Author: Gabrielle A. Deveber
Author: Nomazulu Dlamini

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