Cerebrovascular Reserve in Moyamoya Disease: Relation to Cerebral Blood Flow, Capillary Dysfunction, Oxygenation, and Energy Metabolism."

Exciting New Study! Gaining Deeper Insights into Moyamoya Disease with Cercare Medical's Neurosuite (CMN)!

Scientific Report

The study investigated the association of cerebrovascular reserve (CVR) with various cerebral hemodynamic and energy metabolic parameters in Moyamoya disease (MMD), using perfusion imaging (contrast-based MR and arterial spin label magnetic resonance imaging (ASL-MRI) before and after acetazolamide administration.

  • The progressive nature of MMD warrants monitoring of the patient’s cerebral hemodynamics to evaluate treatment efficacy and the possible need for surgical intervention

  • However, the cerebral hemodynamics in MMD is intricate and involves interactions between macrovascular and microvascular blood flow, oxygenation, and energy metabolism.

  • Cerebrovascular Reserve (CVR) and CBF: Homeostasis is initially preserved via autoregulation but over time the ability to avoid ischemia via vessel dilation when cerebral blood flow (CBF) decreases in both the anterior cerebral artery (ACA) and middle cerebral artery (MCA) territories is lost. A CVR test using ASL can be used to evaluate the integrity of this mechanism.

  • Capillary Dysfunction: Lower CVR in the ACA territory is linked to elevated capillary transit time heterogeneity (CTH), indicating microvascular dysfunction and inefficient oxygen delivery.

  • Oxygenation and Energy Metabolism: Decreased CVR in the ACA territory is strongly associated with higher oxygen extraction fraction (OEFmax), suggesting increased oxygen extraction to compensate for lower CBF.

  • CMRO2 and CBF in MCA Territory: Lower CVR in the MCA territory is associated with lower CBF and higher cerebral metabolic rate of oxygen (CMRO2), indicating increased energy consumption in response to ischemic insults.

The Game-Changer: Cercare Medical Neurosuite

Gain deeper insights into the patient's cerebral hemodynamics and energy metabolism, with the power of Cercare Medical's cutting-edge software. This groundbreaking tool allowed us to non-invasively assess capillary transit time heterogeneity (CTH), oxygen extraction fraction (OEFmax), and cerebral metabolic rate of oxygen (CMRO2max).

Key Findings:

Analysis revealed a reduced cerebrovascular reserve (CVR) in both anterior cerebral artery (ACA) and middle cerebral artery (MCA) territories. Additionally, we observed lower baseline CBF, elevated CTH, and increased OEFmax in the ACA territory, and lower CVR in the MCA territory was associated with reduced CBF and higher CMRO2max.

New scientific report from Uppsala
Read the Full article: https://www.frontiersin.org/articles/10.3389/fneur.2023.1190309/full

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CLINICAL USE CASES AND TECHNICAL HIGHLIGHTS


CLINICAL USE CASES
  • Assess outcomes post-intervention: detect missed stenoses, distal occlusions, or microvascular disturbances.
  • Guide complementary therapies on the spot based on perfusion status.
  • May detect the no-reflow phenomenon — providing insight into cases where recovery may fail despite successful thrombectomy.
  • Potentially enables direct-to-angio workflows.

TECHNICAL HIGHLIGHTS
  • Full set of perfusion markers: CBF, CBV, MTT.
  • Advanced oxygen metabolism imaging: OEF, CMRO₂.
  • Reliable results with as few as 5 CBCT acquisitions (bolus injection timing protocol very important).
  • Integrated with Siemens and Philips systems; GE/Canon under evaluation.

CBCT Imaging

Side-by-side comparison: The left-hand side is the raw CBCT data, while the right-hand side panel is the pre-processed data.
Using CMN software in the angio suite delivers results comparable to conventional CT/MR perfusion.

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