Regional oxygen extraction predicts border zone vulnerability to stroke in sickle cell disease
Regional oxygen extraction predicts border zone vulnerability to stroke in sickle cell disease
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DOI：
10.1212/wnl.0000000000005194
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发表时间：
2018-03-27
期刊：
影响因子：
9.9
通讯作者：
Lee, Jin-Moo
中科院分区：
文献类型：
--
作者：
Fields, Melanie E.;Guilliams, Kristin P.;Lee, Jin-Moo
目的探讨镰状细胞病（SCD）局部脑梗死易感性的机制，通过测量体素脑血流量（CBF），氧摄取分数（OEF），和脑代谢率氧利用率（CMRO 2）在SCD儿童。MethodsParticipants进行脑MRI测量基于体素的CBF，OEF，和CMRO 2。一个梗死热图创建一个独立的儿科SCD队列无症状性梗死和前瞻性获得OEF maps. ResultsFifty六名参与者，36名儿童SCD和20名对照，完成了研究评估。SCD队列的全脑CBF（99.2 vs 66.3 mL/100 g/min，p < 0.001）、OEF（42.7% vs 28.8%，p < 0.001）和CMRO 2（3.7 vs 2.5 mL/100 g/min，p < 0.001）均高于对照组。在SCD队列的深层白色物质中确定了OEF峰值区域，通过平均SCD与对照OEF体素的比率图描绘。该区域的CMRO 2（包括CBF最低点）相对于所有白色物质较低（p < 0.001）。此外，这个峰值OEF区域共定位与来自一个独立的SCD cohol.ConclusionsElevated OEF在深白色的问题确定了一个签名的代谢应激脑组织中风风险增加的儿童SCD患者的最大梗死密度的区域。我们认为，边界区生理，加剧了慢性贫血性缺氧，解释了该地区的高风险。
ObjectiveTo determine mechanisms underlying regional vulnerability to infarction in sickle cell disease (SCD) by measuring voxel-wise cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen utilization (CMRO2) in children with SCD.MethodsParticipants underwent brain MRIs to measure voxel-based CBF, OEF, and CMRO2. An infarct heat map was created from an independent pediatric SCD cohort with silent infarcts and compared to prospectively obtained OEF maps.ResultsFifty-six participants, 36 children with SCD and 20 controls, completed the study evaluation. Whole-brain CBF (99.2 vs 66.3 mL/100 g/min, p < 0.001), OEF (42.7% vs 28.8%, p < 0.001), and CMRO2 (3.7 vs 2.5 mL/100 g/min, p < 0.001) were higher in the SCD cohort compared to controls. A region of peak OEF was identified in the deep white matter in the SCD cohort, delineated by a ratio map of average SCD to control OEF voxels. CMRO2 in this region, which encompassed the CBF nadir, was low relative to all white matter (p < 0.001). Furthermore, this peak OEF region colocalized with regions of greatest infarct density derived from an independent SCD cohort.ConclusionsElevated OEF in the deep white matter identifies a signature of metabolically stressed brain tissue at increased stroke risk in pediatric patients with SCD. We propose that border zone physiology, exacerbated by chronic anemic hypoxia, explains the high risk in this region.