Association of brain temperature increase and cerebrospinal fluid dynamics in chronic brain ischemia due to main trunk occlusion of cerebral arteries

• Project/Area Number: 21K09108
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 56010:Neurosurgery-related
• Research Institution: Iwate Medical University
• Principal Investigator: 小笠原 邦昭 岩手医科大学, 医学部, 教授 (00305989)
• Project Period (FY): 2021-04-01 – 2024-03-31
• Project Status: Granted (Fiscal Year 2022)
• Budget Amount: ¥4,030,000 (Direct Cost: ¥3,100,000、Indirect Cost: ¥930,000); Fiscal Year 2023: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000); Fiscal Year 2022: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000); Fiscal Year 2021: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
• Keywords: 性貧困灌流 / 脳脊髄液流動態 / 脳温度 / MRI / PET / ラジエーター効果 / 慢性貧困灌流 / ラジエータ効果 / 脳主幹動脈慢性閉塞狭窄 / 脳虚血 / 貧困灌流 / 脳脊髄液流

Outline of Research at the Start

本研究では、脳主幹動脈慢性閉塞狭窄性病変においてPETを用いて貧困灌流の有無を、3T MRI MRSを用いて脳温度マップを、7 Tesla MRIで取得した拡散強調画像で得られたIVIM解析にてCSF dynamicsを作成し、それぞれの関係を解析し、「慢性貧困灌流において低下した脳血流による不十分なラジエータ効果が存在するときに、脳脊髄液流が能動的にラジエータ効果を担っているのかどうか」を明らかにする。

Outline of Annual Research Achievements

本研究では、「慢性貧困灌流において低下した脳血流による不十分なラジエータ効果が存在するときに、脳脊髄液流が能動的にラジエータ効果を担っているのか
どうか」を明らかにする。2022年度は、脳主幹動脈慢性閉塞狭窄性病変の原因となる60歳代の動脈硬化性病変8例と40歳代の虚血発症もやもや病4例を対象とした。全例に術前に15OガスによるPETを用いて貧困灌流の有無を、3T MRI MRSを用いて脳温度マップを、7 Tesla MRIで取得した拡散強調画像で得られたIVIM解析にてCSF dynamicsを作成した。これらの症例に対して、上記の検査に加えて神経心理検査として、Wechsler adult intelligence scale-revised (WAIS-R)、Wechsler memory scalerevised (WMS-R)、Rey testを行い、認知機能を測定した。拡散強調画像から得られたIVIM解析は、以下の順で解析した。1)脳室・脳槽内脳脊髄液信号計測と信号減衰曲線を用いたIVIMパラメータ推定、2) 脳室・脳槽内脳脊髄液のIVIMパラメータの統計学的比較、3) 脳実質内脳脊髄液信号計測と信号減衰曲線を用いたIVIMパラメータ推定、4) 全脳脳脊髄液動態マップの作成。
2021年度と合わせた60歳代の動脈硬化性病変計18例と40歳代の虚血発症もやもや病9例から得られた現時点のデータでは、「1) 脳温度と脳脊髄液動態の関係は正の相関にある、2) 1)の関係は動脈硬化性病変より虚血発症もやもや病で強い、3) 1)の関係を認知機能低下例ほど、脳温度が高く、脳脊髄液動態の変化が強い。」というう結果になった。2023年度にはさらに症例を増やし、統計学的検討を行う予定である。

Current Status of Research Progress

2: Research has progressed on the whole more than it was originally planned.

Reason

予定症例数をクリアしており、またこれらの症例に対する検査も順調に行われている。解析も順調だが、症例数がまだ統解析するまでは至っておらず、施行していない。しかし、これは研究進捗としては予定通りである。

Strategy for Future Research Activity

えられた現時点のデータでは、「1) 脳温度と脳脊髄液動態の関係は正の相関にある、2) 1)の関係は動脈硬化性病変より虚血発症もやもや病で強い、3) 1)の関
係を認知機能低下例ほど、脳温度が高く、脳脊髄液動態の変化が強い。」傾向にある。2023年度このままの状況で症例をentryできれば、2023年度中盤には、最終結果がでる予定である。

Research Products

• [Journal Article] Effect of the addition of 123I-iomazenil single-photon emission computed tomography to brain perfusion single-photon emission computed tomography on the detection accuracy of misery perfusion in adult patients with ischemic moyamoya disease. (2023)
  • Author(s): Ogasawara K, Takahashi T, Igarashi S, Yabuki M, Omori D, Akamatsu Y, Chida K, Kobayashi M, Fujiwara S, Terasaki K.
  • Journal Title: Ann Nucl Med Volume: In press Issue: 5 Pages: 280-288
  • DOI: 10.1007/s12149-023-01825-0
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Symptomatic subdural hemorrhage following heart valve surgery: a retrospective cohort study. (2023)
  • Author(s): Oshida S, Tsuboi J, Kin H, Okabayashi H, Komoribayashi N, Akamatsu Y, Fujiwara S, Ogasawara K.
  • Journal Title: J Neurosurg Volume: In press Issue: 3 Pages: 741-747
  • DOI: 10.3171/2023.1.jns222059
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Prediction of cerebral hyperperfusion following carotid endarterectomy using intravoxel incoherent motion magnetic resonance imaging. (2023)
  • Author(s): Takahashi T, Uwano I, Akamatsu Y, Chida K, Kobayashi M, Yoshida K, Fujiwara S, Kubo Y, Sasaki M, Ogasawara K.
  • Journal Title: J Stroke Cerebrovasc Dis Volume: 32 Issue: 2 Pages: 106909-106909
  • DOI: 10.1016/j.jstrokecerebrovasdis.2022.106909
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Changes in periventricular anastomosis after indirect revascularization surgery alone for adult patients with misery perfusion due to ischemic moyamoya disease. (2022)
  • Author(s): Kobayashi M, Akamatsu Y, Chida K, Uchida S, Fujiwara S, Yoshida K, Koji T, Kubo Y, Ogasawara K.
  • Journal Title: Neurosurg Rev Volume: 45 Issue: 6 Pages: 3665-3673
  • DOI: 10.1007/s10143-022-01861-w
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Development of cerebral microbleeds and its impact on cognitive function in adult patients receiving medical management alone for ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort. (2022)
  • Author(s): Yabuki M, Kubo Y, Kitakami K, Oomori D, Fujiwara S, Yoshida K, Kobayashi M, Ogasawara K.
  • Journal Title: Neurol Res Volume: 44 Issue: 12 Pages: 1104-1112
  • DOI: 10.1080/01616412.2022.2112375
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Outcomes of Medical Management Alone for Adult Patients with Cerebral Misery Perfusion Due to Ischemic Moyamoya Disease. (2022)
  • Author(s): Ogasawara K, Uchida S, Akamatsu Y, Chida K, Kobayashi M, Yoshida K, Fujiwara S, Terasaki K, Kubo Y.
  • Journal Title: J Stroke Cerebrovasc Dis Volume: 31 Pages: 106588-106588
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Recovery of Cortical Neurotransmitter Receptor Function and Its Impact on Cognitive Improvement after Indirect Revascularization Surgery Alone for Adult Patients with Ischemic Moyamoya Disease: 123I-Iomazenil Single-Photon Emission Computed Tomography Study. (2022)
  • Author(s): Yasuda S, Katakura Y, Kubo Y, Dobashi K, Kimura K, Fujiwara S, Chida K, Akamatsu Y, Kobayashi M, Yoshida K, Terasaki K, Ogasawara K.
  • Journal Title: World Neurosurg Volume: 164
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Delayed development of cerebral atrophy after cerebral hyperperfusion following arterial bypass for adult patients with ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort (2022)
  • Author(s): Katakura Y, Kubo Y, Dobashi K, Kimura K, Fujiwara S, Chida K, Kobayashi M, Yoshida K, Terasaki K, Ogasawara K
  • Journal Title: Acta Neurochir (Wien) Volume: 164 Issue: 4 Pages: 1037-1045
  • DOI: 10.1007/s00701-022-05141-w
  • Peer Reviewed
• [Journal Article] De Novo Cerebral Microbleeds and Cognitive Decline in Cerebral Hyperperfusion After Direct Revascularization for Adult Moyamoya Disease. (2022)
  • Author(s): Dobashi K, Kubo Y, Kimura K, Katakura Y, Chida K, Kobayashi M, Yoshida K, Fujiwara S, Terasaki K, Ogasawara K.
  • Journal Title: J Stroke Cerebrovasc Dis. Volume: 31(1) Issue: 1 Pages: 106166-106166
  • DOI: 10.1016/j.jstrokecerebrovasdis.2021.106166
  • Peer Reviewed
• [Journal Article] Five-Year Outcomes of Medical Management Alone for Adult Patients with Ischemic Moyamoya Disease without Cerebral Misery Perfusion. (2022)
  • Author(s): Kitakami K, Kubo Y, Yabuki M, Oomori D, Takahashi T, Igarashi S, Fujiwara S, Yoshida K, Kobayashi M, Terasaki K, Ogasawara K.
  • Journal Title: Cerebrovasc Dis. Volume: 51(2) Issue: 2 Pages: 158-164
  • DOI: 10.1159/000518725
  • Peer Reviewed
• [Journal Article] Angiographic, Cerebral Hemodynamic, and Cognitive Outcomes of Indirect Revascularization Surgery Alone for Adult Patients With Misery Perfusion due to Ischemic Moyamoya Disease. (2021)
  • Author(s): Kimura K, Kubo Y, Dobashi K, Katakura Y, Chida K, Kobayashi M, Yoshida K, Fujiwara S, Terasaki K, Kawamura T, Ogasawara K.
  • Journal Title: Neurosurgery Volume: 23 Issue: 6 Pages: 676-683
  • DOI: 10.1227/neu.0000000000001907
  • Peer Reviewed / Open Access
• [Journal Article] Optimal timing for measuring cerebral blood flow after acetazolamide administration to detect preexisting cerebral hemodynamics and metabolism in patients with bilateral major cerebral artery steno-occlusive diseases: 15O positron emission tomography studies (2021)
  • Author(s): Kobayashi M, Igarashi S, Takahashi T, Fujiwara S, Chida K, Terasaki K, Kubo Y, Ogasawara K
  • Journal Title: Am J Nucl Med Mol Imaging Volume: 11 Pages: 507-518
  • Peer Reviewed / Open Access
• [Journal Article] Long-Term Cognitive Changes after Revascularization Surgery in Adult Patients with Ischemic Moyamoya Disease. (2021)
  • Author(s): Uchida S., Kubo Y., Oomori D., Yabuki M., Kitakami K., Fujiwara S., Yoshida K., Kobayashi M., Terasaki K., Ogasawara K.
  • Journal Title: Cerebrovasc Dis Extra. Volume: 11(3) Issue: 3 Pages: 145-154
  • DOI: 10.1159/000521028
  • Peer Reviewed / Open Access
• [Journal Article] Angiographic disease progression in medically treated adult patients with ischemic moyamoya disease without cerebral misery perfusion: supplementary analysis of a 5-year prospective cohort. (2021)
  • Author(s): Oomori D, Kubo Y, Yabuki M, Kitakami K, Fujiwara S, Yoshida K, Kobayashi M, Terasaki K, Ogasawara K.
  • Journal Title: Neurosurg Rev. Volume: 23 Issue: 2 Pages: 1553-1561
  • DOI: 10.1007/s10143-021-01677-0
  • Peer Reviewed / Open Access
• [Journal Article] Superb Microvascular Imaging Ultrasound for Cervical Carotid Artery Stenosis for Prediction of the Development of Microembolic Signals on Transcranial Doppler during Carotid Exposure in Endarterectomy (2021)
  • Author(s): Chiba T, Fujiwara S, Oura K, Oikawa K, Chida K, Kobayashi M, Yoshida K, Kubo Y, Maeda T, Itabashi R, Ogasawara K
  • Journal Title: Cerebrovasc Dis Extra Volume: 11 Issue: 2 Pages: 61-68
  • DOI: 10.1159/000516426
  • Peer Reviewed / Open Access
• [Journal Article] Diagnostic Accuracy of Screening Arterial Spin-Labeling MRI Using Hadamard Encoding for the Detection of Reduced CBF in Adult Patients with Ischemic Moyamoya Disease (2021)
  • Author(s): Setta K, Matsuda T, Sasaki M, Chiba T, Fujiwara S, Kobayashi M, Yoshida K, Kubo Y, Suzuki M, Yoshioka K, Ogasawara K
  • Journal Title: AJNR Am J Neuroradiol Volume: 42 Issue: 8 Pages: 1403-1409
  • DOI: 10.3174/ajnr.a7167
  • Peer Reviewed
• [Journal Article] Development of cerebral microbleeds in patients with cerebral hyperperfusion following carotid endarterectomy and its relation to postoperative cognitive decline (2021)
  • Author(s): Igarashi S, Ando T, Takahashi T, Yoshida J, Kobayashi M, Yoshida K, Terasaki K, Fujiwara S, Kubo Y, Ogasawara K
  • Journal Title: J Neurosurg Volume: in press Issue: 4 Pages: 0-0
  • DOI: 10.3171/2020.7.jns202353
  • Peer Reviewed / Open Access
• [Presentation] 虚血発症成人もやもや病に対する間接血行再建術単独におけるperiventricular anastomosisへの効果 (2023)
  • Author(s): 小笠原邦昭
  • Organizer: STROKE2023(第52回日本脳卒中の外科学会学術集会)
  • Invited
• [Presentation] 虚血発症成人もやもや病に対する治療戦略～自験前向き研究の結果から～ (2022)
  • Author(s): 小笠原邦昭
  • Organizer: STROKE2022（第51回日本脳卒中の外科学会学術集会）
• [Presentation] 貧困灌流を伴う虚血発症成人もやもや病に対する間接血行再建術単独の認知機能への効果 -大脳皮質神経受容体機能からの検討- (2022)
  • Author(s): 小笠原邦昭
  • Organizer: 第45回日本脳神経CI学会総会
  • Invited
• [Presentation] 慢性脳虚血に対する血行再建術後認知機能変化 (2022)
  • Author(s): 小笠原邦昭
  • Organizer: 第6回日本脳神経外科認知症学会学術総会
  • Invited
• [Presentation] Cerebral white matter abnormalities can affect cognitive improvement after carotid endarterectomy in patients with carotid artery steno-occlusive disease. (2022)
  • Author(s): Yoshida J., Yamashita F., Sasaki M., Yoshioka K., Fujiwara S., Kobayashi M., Yoshida K., Kubo Y., Ogasawara K.
  • Organizer: The 7th Annual Scientific Meeting of the ISMRM Japanese Chapter (ISMRM JPC 2022)
  • Int'l Joint Research
• [Presentation] Vasodilation-related dynamic susceptibility changes on quantitative susceptibility mapping with acetazolamide administration at 7T. (2022)
  • Author(s): Fujimoto K, Ogasawara K
  • Organizer: The 7th Annual Scientific Meeting of the ISMRM Japanese Chapter (ISMRM JPC 2022)
  • Int'l Joint Research
• [Presentation] Feasibility of a hadamard encoding-based arterial spin-labeling MRI for detecting CBF reduction in adult patients with ischemic moyamoya disease. (2022)
  • Author(s): Setta K., Matsuda T., Sasaki M., Chiba T., Fujiwara S., Kobayashi M., Yoshida K., Kubo Y., Suzuki M., Yoshioka K., Ogasawara K.
  • Organizer: 10th European-Japanese Cerebrovascular Congress
  • Int'l Joint Research
• [Presentation] Cerebral white matter abnormalities can affect cognitive improvement after carotid endarterectomy in patients with carotid artery steno-occlusive disease. (2022)
  • Author(s): Yoshida J., Yamashita F., Sasaki M., Yoshioka K., Fujiwara S., Kobayashi M., Yoshida K., Kubo Y., Ogasawara K.
  • Organizer: 10th European-Japanese Cerebrovascular Congress
  • Int'l Joint Research
• [Presentation] 虚血発症成人もやもや病に対する治療戦略～自験前向き研究の結果から～ (2022)
  • Author(s): 小笠原邦昭
  • Organizer: 第51回日本脳卒中の外科学会
• [Presentation] 成人虚血発症もやもや病における直接血行再建術後認知 機能変化のメカニズム (2021)
  • Author(s): 小笠原邦昭
  • Organizer: 日本脳神経外科学会第80回学術総会