Vascular space occupancy (VASO) cerebral blood volume-weighted MRI identifies hemodynamic impairment in patients with carotid artery disease

Purpose To assess the role of vascular space occupancy (VASO) magnetic resonance imaging (MRI), a noninvasive cerebral blood volume (CBV)‐weighted technique, for evaluating CBV reactivity in patients with internal carotid artery (ICA) stenosis. Materials and Methods VASO reactivity, defined as a signal change in response to hypercapnic stimulus (4‐second exhale, 14‐second breath‐hold), was measured in the left and right ICA flow territories in patients (n = 10) with varying degrees of unilateral and bilateral ICA stenosis and in healthy volunteers (n = 10). Results Percent VASO reactivity was more negative (P < 0.01) bilaterally in patients (ipsilateral: −3.6 ± 1.5%; contralateral: −3.4 ± 1.2%) compared with age‐matched controls (left: −1.9 ± 0.6%; right: −1.9 ± 0.8%). Owing to the nature of the VASO contrast mechanism, this more negative VASO reactivity was attributed to autoregulatory CBV effects in patients. A postbreath‐hold overshoot, which was absent in healthy volunteers, was observed unilaterally in a subset of patients. Conclusion More negative VASO reactivity was observed in patients with ICA stenosis and may be a marker of autoregulatory effects. Furthermore, the postbreath‐hold overshoot observed in patients is consistent with compensatory microvascular vasoconstriction and may be a marker of hemodynamic impairment. Based on the results of this feasibility study, VASO should be useful for identifying CBV adjustments in patients with steno‐occlusive disease of the ICA. J. Magn. Reson. Imaging 2009;29:718–724. © 2009 Wiley‐Liss, Inc.