Brain, Vol 121, Issue 7 1369-1379, Copyright © 1998 by Oxford University Press
P Schumann, O Touzani, AR Young, R Morello, JC Baron and ET MacKenzie
Local cerebral perfusion pressure (CPP), a crucial parameter that should
allow a better assessment of the haemodynamic compromise in cerebrovascular
diseases, is not currently measurable by non-invasive means. Experimental
and clinical studies have suggested that the regional ratio of cerebral
blood flow to cerebral blood volume (CBF:CBV), as measured by PET,
represents an index of local CPP in focal ischaemia. The present study was
designed to evaluate further the reliability of the CBF:CBV ratio during
manipulations of CPP by deliberately varying mean arterial pressure (MAP)
in the anaesthetized baboon. Cortical CBF, CBV, cerebral metabolic rate for
oxygen (CMRO2) and oxygen extraction fraction were measured by PET using
the (15)O steady-state technique in 10 anaesthetized baboons. Five baboons
(Group A) underwent four PET examinations at different levels of MAP: base
line (101 +/- 6 mmHg) followed by moderate hypotension (58 +/- 3 mmHg) and,
in a separate experiment, minor hypotension (72 +/- 3 mmHg) followed by
profound hypotension (34 +/- 5 mmHg). Trimetaphan was used to lower MAP to
minor and moderate levels while profound hypotension was achieved by the
combined effects of trimetaphan and lower-body negative pressure. Five
other baboons (Group B) were subjected to hypertension (121 +/- 2 mmHg)
induced by metaraminol and were compared with their base line state (81 +/-
10 mmHg). While CBF displayed significant changes with varying MAP, i.e.
decrease and increase with hypotension and hypertension, respectively (-11%
from base line to moderate hypotension compared with -20%, from minor to
profound hypotension and +31% from base line to hypertension), CBV was more
variable and did not significantly change, except with profound hypotension
when the increase was significant (+13%). The CBF:CBV ratio decreased
significantly at all stages of hypotension (-21 and -31%) and was
significantly increased during hypertension (+30%). Importantly, the
CBF:CBV ratio demonstrated a significant correlation with MAP (rho = 0.78,
Spearman's rank correlation coefficient, P < 0.01). No major changes in
CMRO2 were noted during either hypotension or hypertension. Our results
demonstrate that, under physiological conditions, cortical CBF:CBV is
significantly correlated with CPP, itself a function of MAP. In the
investigated range of MAP, the relationships between CBF:CBV and MAP appear
to be linear. These findings further argue for the reliability of CBF:CBV
as an index of CPP in situations where increases or decreases of MAP
without superimposed changes in cerebrovascular tone are encountered, and
they confirm the potential usefulness of this regional ratio for clinical
investigations and management in cerebrovascular diseases.
ARTICLES
Evaluation of the ratio of cerebral blood flow to cerebral blood volume as an index of local cerebral perfusion pressure [published erratum appears in Brain 1998 Oct;121(pt 10):2027]
University of Caen, CNRS UMR 6551, France. Schumann@cyceron.fr
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