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European Radiology
Published in: European Radiology 10/2019

Open Access 01-10-2019 | Neuro

Cortical cerebral blood flow in ageing: effects of haematocrit, sex, ethnicity and diabetes

Authors: Lorna A. Smith, Andrew Melbourne, David Owen, M. Jorge Cardoso, Carole H. Sudre, Therese Tillin, Magdalena Sokolska, David Atkinson, Nish Chaturvedi, Sebastien Ourselin, Alun D. Hughes, Frederik Barkhof, H. R. Jäger

Published in: European Radiology | Issue 10/2019

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Abstract

Objectives

Cerebral blood flow (CBF) estimates from arterial spin labelling (ASL) show unexplained variability in older populations. We studied the impact of variation of haematocrit (Hct) on CBF estimates in a tri-ethnic elderly population.

Materials and methods

Approval for the study was obtained from the Fulham Research Ethics Committee and participants gave written informed consent. Pseudo-continuous arterial spin labelling was performed on 493 subjects (age 55–90) from a tri-ethnic community-based cohort recruited in London. CBF was estimated using a simplified Buxton equation, with and without correction for Hct measured from blood samples. Differences in perfusion were compared, stratified by sex, ethnicity and diabetes. Results of Student’s t tests were reported with effect size.

Results

Hct adjustment decreased CBF estimates in all categories except white European men. The decrease for women was 2.7 (3.0, 2.4) mL/100 g/min) (mean (95% confidence interval (CI)), p < 0.001 d = 0.38. The effect size differed by ethnicity with estimated mean perfusion in South Asian and African Caribbean women found to be lower by 3.0 (3.6, 2.5) mL/100 g/min, p < 0.001 d = 0.56 and 3.1 (3.6, 2.5) mL/100 g/min), p < 0.001 d = 0.48, respectively. Estimates of perfusion in subjects with diabetes decreased by 1.8 (2.3, 1.4) mL/100 g/min, p < 0.001 d = 0.23) following Hct correction. Correction for individual Hct altered sample frequency distributions of CBF values, especially in women of non-European ethnicity.

Conclusion

ASL-derived CBF values in women, non-European ethnicities and individuals with diabetes are overestimated if calculations are not appropriately adjusted for individual Hct.

Key Points

• CBF quantification from ASL using a fixed Hct of 43.5%, as recommended in the ISMRM white paper, may lead to erroneous CBF estimations particularly in non-European and female subjects.
• Individually measured Hct values improve the accuracy of CBF estimation and, if these are not available, an adjusted value according to gender, ethnicity or diabetes status should be considered.
• Hct-corrected ASL could be potentially important for CBF threshold decision making in the fields of neurodegenerative disease and neuro-oncology.
Appendix
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Metadata
Title
Cortical cerebral blood flow in ageing: effects of haematocrit, sex, ethnicity and diabetes
Authors
Lorna A. Smith
Andrew Melbourne
David Owen
M. Jorge Cardoso
Carole H. Sudre
Therese Tillin
Magdalena Sokolska
David Atkinson
Nish Chaturvedi
Sebastien Ourselin
Alun D. Hughes
Frederik Barkhof
H. R. Jäger
Publication date
01-10-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06096-w

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