Wenjia Liu1, Bing Wu2, Dandan Zheng2, Xin Lou1, Yulin Wang1, Li Zheng3, Jie Liu4, and Lin Ma1
1Department of Radiology, PLA General Hospital, Beijing, China, People's Republic of, 2GE Healthcare, MR Research China, Beijing, Beijing, China, People's Republic of, 3Biomedical Engineering, Peking university, Beijing, China, People's Republic of, 4General Hospital of Tibetan Military Area Command, Lhasa, China, People's Republic of
Synopsis
Although cerebral blood flow(CBF) at high
altitude have been researched for years, most previous studies are limited by the
use of transcranial Doppler.
The conclusion of changes in CBF depend on the
assumption that the middle cerebral arterial diameter does not alter in
hypoxia, but recent studies suggesting that this is not the case. In our study,
CBF was measured by 3D arterial spin labeling (ASL) technique at sea level and
high altitude in order to seek the cerebrovascular response to altitude
environment.Purpose
It is well known that hypobaric hypoxia
occurs with acute exposure to high altitude, with commonly associated short
term symptoms including headache and short of breath. However, the exact
underlying physiological cause is still under debate
[1]. Furthermore, hypobaric hypoxia is also a concomitant with other diseases
such as ischemic stroke and epilepsy
[2], hence studying of
cerebrovascular response to hypoxia is of great clinical significance. Past
attempts include the use of transcranial Doppler (TCD) at high attitude or
measure of cerebral blood flow (CBF) in simulated hypoxia, both of which have methodological
shortcomings. In this work, 3D ASL at 3.0T was used to monitor the change of
CBF to further extend our understanding of hypobaric hypoxia.
Method
Ten healthy subjects [5 male; 5 female; 26±3 years old] were recruited for
this study after informed consent was obtained. Participants were nonsmokers,
physically fit, taking no medication, living at 20-60m and with no previous
exposure to high altitude (> 1500m). No alcohol, caffeine, or medication
that could affect CBF was consumed during the study period. On day one,
subjects flew from Peking to Lhasa (3658m) and spent five days in Lhasa, then
returned to Peking. Subjects underwent MRI for 8 times in total. The first,
seventh and eighth examinations were conducted in Peking before and after high
altitude exposure, while the rest of the examinations were conducted in Lhasa in
consecutive days at high altitude. The same 3.0T scanner (GE Discovery MR 750)
with an 8-channel head coil (in vivo) was used at the two sites. The MR
protocol included anatomical images as well as CBF measurement using 3D ASL. Spatially
matching 3D T1 image of was used to extract white matter, gray matter and CSF
region (Fig.1), which were then transferred to the CBF map to obtain respective
CBF measure for white matter, gray matter and global brain that include both
white matter and gray matter.
Results
The averaged CBF value of the global brain, white matter and gray matter
among the 10 participants at different time points are plotted in Fig.2.
Several observations can be made: CBF measurements in GB, WM and GM all had
obvious increase and reached their respective peak at the first day at high
altitude, and WM showed the largest percentage of increase; after the first day
at high altitude, the CBF measurements started to gradually decrease with a
small climb on the third day at high altitude; on the fifth day, the CBF returned
to that of sea level; it is interesting to note that, the CBF continued to drop
after returning to sea level, even below the that at sea level prior to
departure.
Discussion and conclusion
Previous researches on hypobaric
hypoxia either resorted to the use TCD or simulated high altitude hypoxia. It
has been recently reported that the assumption that the caliber of the artery
does not alter at high altitude may not hold
[3]; whereas simulated
hypoxia can only achieve short term effects that derivate from reality that
long term exposure to hypoxia takes place, either due to high altitude or pathological
changes. To our knowledge, this is the first attempt that consistent imaging
setup was used for direct CBF measure using 3D ASL is conducted. Our initial
findings agree with previous reports that there is an initial increase in CBF
at high altitude, and it soon dissipated; also WM showed a larger increase as
compared to GM, which could be due to the fact that high altitude edema is
primarily located to WM
[4]. On contrary to
previous understanding, it was observed that the CBF stayed at a lower level
after returning to sea level even after a week, which is hypothesized to be due
to Hypocapnic cerebral vasoconstriction and changes of hematocrit. An extension
of the temporal axis in this longitudinal study would be needed to further
investigate this observation.
Acknowledgements
No acknowledgement found.References
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