Cerebrovascular reactivity mapping: an evolving standard for clinical functional imaging.
This review article explains the methodology of breath-hold cerebrovascular reactivity mapping, both in terms of acquisition and analysis, and reviews applications of this method to presurgical mapping, particularly with respect to blood oxygen level-dependent fMRI. Its main application in clinical fMRI is for the assessment of neurovascular uncoupling potential. Neurovascular uncoupling is potentially a major limitation of clinical fMRI, particularly in the setting of mass lesions in the brain such as brain tumors and intracranial vascular malformations that are associated with alterations in regional hemodynamics on either an acquired or congenital basis. As such, breath-hold cerebrovascular reactivity mapping constitutes an essential component of quality control analysis in clinical fMRI, particularly when performed for presurgical mapping of eloquent cortex. Exogenous carbon dioxide challenges used for cerebrovascular reactivity mapping will also be discussed, and their applications to the evaluation of cerebrovascular reserve and cerebrovascular disease will be described.
From the Division of Neuroradiology (J.J.P.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland jpillai1@jhmi.edu.
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Pillai
Department of Medical Imaging (D.J.M.), The University of Toronto, The University Health Network, The Toronto Western Hospital, Toronto, Ontario, Canada.
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Mikulis
D001931:Brain Mapping / Q000379:methods*; D062485:Breath Holding; D002245:Carbon Dioxide / Q000097:blood; D002540:Cerebral Cortex / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*
D002245:Carbon Dioxide