Original Research

Impact of Head-Down Position on Cerebral Blood Flow in Healthy Subjects: An Arterial Spin-Labeling MR Perfusion Study

Corresponding Author

Mehdi Mejdoubi MD, PhD

[email protected]

orcid.org/0000-0001-9422-9356

Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies, France

Address reprint requests to: M.M., Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies. E-mail: [email protected]Search for more papers by this author

Aude Pavilla PhD,

Aude Pavilla PhD

Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies, France

Search for more papers by this author

Sylvie Colombani MD,

Sylvie Colombani MD

Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies, France

Search for more papers by this author

Régis Duvauferrier MD, PhD,

Régis Duvauferrier MD, PhD

Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies, France

Search for more papers by this author

Yamilet Cepeda Ibarra MD,

Yamilet Cepeda Ibarra MD

Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies, France

Search for more papers by this author

Ian Seiller MD,

Ian Seiller MD

Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies, France

Search for more papers by this author

Mehdi Mejdoubi MD, PhD,

Corresponding Author

Mehdi Mejdoubi MD, PhD

[email protected]

orcid.org/0000-0001-9422-9356

Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies, France

Aude Pavilla PhD,

Aude Pavilla PhD

Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies, France

Search for more papers by this author

Sylvie Colombani MD,

Sylvie Colombani MD

Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies, France

Search for more papers by this author

Régis Duvauferrier MD, PhD,

Régis Duvauferrier MD, PhD

Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies, France

Search for more papers by this author

Yamilet Cepeda Ibarra MD,

Yamilet Cepeda Ibarra MD

Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies, France

Search for more papers by this author

Ian Seiller MD,

Ian Seiller MD

Department of Neuroradiology, Pierre-Zobda-Quitman Hospital, University Hospital of Martinique, French West Indies, France

Search for more papers by this author

First published: 09 May 2019

https://doi.org/10.1002/jmri.26783

Citations: 7

Share a link

Email
Wechat
Bluesky

Abstract

Background

A head-down (HD) position is used in some stroke centers to maintain cerebral perfusion (CP) in stroke patients.

Purpose

To assess CP in healthy volunteers in the supine and HD (–15°) positions.

Study Type

Prospective.

Population

Eighteen healthy subjects of 53 (±8) years old.

Field Strength/Sequence

1.5T / arterial spin-labeling (ASL) in the supine position and after 4 minutes of HD position.

Assessment

Regions of interest from reconstructed cerebral blood-flow (CBF) maps: subcortical nuclear gray matter (accumbens, amygdala, caudate, hippocampus, pallidum, putamen, thalamus), cortical gray matter (cGM), and white matter (WM). We also monitored hemodynamic parameters.

Statistical Tests

Shapiro–Wilk test, analysis of variance (ANOVA) tests, Student's t-tests, and Pearson correlation analysis.

Results

CBF was higher in women compared to men, whatever the position (mean difference of 17% in supine, and 13% in HD position). From supine to HD position, CBF was decreased in all regions (mean decrease of –7%). Simultaneously, mean arterial pressure and systolic blood pressure increased (respectively P = 0.004 and P < 0.001).

Data Conclusion

The CBF decrease, despite increased hemodynamic parameters, may indicate efficient cerebral autoregulation. Our results seem to reflect only early cerebral autoregulation stages but may open the way towards a more precise understanding of CP.

Level of Evidence: 1

Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:218–224.

References

1Aaslid R, Lindegaard KF, Sorteberg W, Nornes H. Cerebral autoregulation dynamics in humans. Stroke 1989; 20: 45–52.
10.1161/01.STR.20.1.45
CAS PubMed Web of Science® Google Scholar
2Cooke WH, Pellegrini GL, Kovalenko OA. Dynamic cerebral autoregulation is preserved during acute head-down tilt. J Appl Physiol 2003; 95: 1439–1445.
10.1152/japplphysiol.00524.2003
PubMed Web of Science® Google Scholar
3Van Beek AH, Claassen JA, Rikkert MG, Jansen RW. Cerebral autoregulation: An overview of current concepts and methodology with special focus on the elderly. J Cereb Blood Flow Metab 2008; 28: 1071–1085.
10.1038/jcbfm.2008.13
PubMed Web of Science® Google Scholar
4Bundgaard-Nielsen M, Sørensen H, Dalsgaard M, Rasmussen P, Secher NH. Relationship between stroke volume, cardiac output and filling of the heart during tilt. Acta Anaesthesiol Scand 2009; 53: 1324–1328.
10.1111/j.1399-6576.2009.02062.x
CAS PubMed Web of Science® Google Scholar
5Gelinas JC, Marsden KR, Tzeng YC, et al. Influence of posture on the regulation of cerebral perfusion. Aviat Space Environ Med 2012; 83: 751–757.
10.3357/ASEM.3269.2012
PubMed Web of Science® Google Scholar
6Lovell AT, Marshall AC, Elwell CE, Smith M, Goldstone JC. Changes in cerebral blood volume with changes in position in awake and anesthetized subjects. Anesth Analg 2000; 90: 372–376.
10.1097/00000539-200002000-00025
CAS PubMed Web of Science® Google Scholar
7Aries MJ, Bakker DC, Stewart RE, et al. Exaggerated postural blood pressure rise is related to a favorable outcome in patients with acute ischemic stroke. Stroke 2012; 43: 92–96.
10.1161/STROKEAHA.111.632349
PubMed Web of Science® Google Scholar
8Zhang Y, Rabinstein AA. Lower head of the bed position does not change blood flow velocity in subarachnoid hemorrhage. Neurocrit Care 2011; 14: 73–76.
10.1007/s12028-010-9444-0
PubMed Web of Science® Google Scholar
9Saeed NP, Horsfield MA, Panerai RB, Mistri AK, Robinson TG. Measurement of cerebral blood flow responses to the thigh cuff maneuver: A comparison of TCD with a novel MRI method. J Cereb Blood Flow Metab 2011; 31: 1302–1310.
10.1038/jcbfm.2010.225
PubMed Web of Science® Google Scholar
10Lucas SJ, Tzeng YC, Galvin SD, Thomas KN, Ogoh S, Ainslie PN. Influence of changes in blood pressure on cerebral perfusion and oxygenation. Hypertension 2010; 55: 698–705.
10.1161/HYPERTENSIONAHA.109.146290
CAS PubMed Web of Science® Google Scholar
11Ito H, Kanno I, Takahashi K, Ibaraki M, Miura S. Regional distribution of human cerebral vascular mean transit time measured by positron emission tomography. Neuroimage 2003; 19: 1163–1169.
10.1016/S1053-8119(03)00156-3
PubMed Web of Science® Google Scholar
12Grüner JM, Paamand R, Højgaard L, Law I. Brain perfusion CT compared with ¹⁵O-H₂O-PET in healthy subjects. EJNMMI Res 2011; 1: 28.
10.1186/2191-219X-1-28
PubMed Web of Science® Google Scholar
13Mejdoubi M, Calviere L, Dumas H. Value of CT perfusion for the diagnosis of early middle cerebral artery stroke. J Radiol 2010; 91: 555–660.
10.1016/S0221-0363(10)70087-1
CAS PubMed Web of Science® Google Scholar
14Carroll TJ, Teneggi V, Jobin M, et al. Absolute quantification of cerebral blood flow with magnetic resonance, reproducibility of the method, and comparison with H₂¹⁵O positron emission tomography. J Cereb Blood Flow Metab 2002; 22: 1149–1156.
10.1097/00004647-200209000-00013
PubMed Web of Science® Google Scholar
15Pfefferbaum A, Chanraud S, Pitel AL, et al. Volumetric cerebral perfusion imaging in healthy adults: Regional distribution, laterality, and repeatability of pulsed continuous arterial spin labeling (PCASL). Psychiatry Res 2010; 182: 266–273.
10.1016/j.pscychresns.2010.02.010
PubMed Web of Science® Google Scholar
16Sorond FA, Hollenberg NK, Panych LP, Fisher NDL. Brain blood flow and velocity: Correlations between magnetic resonance imaging and transcranial Doppler sonography. J Ultrasound Med 2010; 29: 1017–1022.
10.7863/jum.2010.29.7.1017
PubMed Web of Science® Google Scholar
17Wu WC, St Lawrence KS, Licht DJ, Wang DJ. Quantification issues in arterial spin labeling perfusion magnetic resonance imaging. Top Magn Reson Imaging 2010; 21: 65–73.
10.1097/RMR.0b013e31821e570a
PubMed Web of Science® Google Scholar
18Pavilla A, Arrigo A, Colombani S, Mejdoubi M. Absolute and regional cerebral perfusion assessment feasibility in head-down position with arterial spin-labeling magnetic resonance. A preliminary report on healthy subjects. J Neuroradiol 2016; 43: 392–397.
10.1016/j.neurad.2016.03.003
PubMed Web of Science® Google Scholar
19Nagatani K, Nawashiro H, Takeuchi S, Otani N, Wada K, Shima K. Effects of a head-down tilt on cerebral blood flow in mice during bilateral common carotid artery occlusion. Asian J Neurosurg 2012; 7: 171–173.
10.4103/1793-5482.106648
PubMed Google Scholar
20Wojner-Alexander AW, Garami Z, Chernyshev OY, Alexandrov AV. Heads down: Flat positioning improves blood flow velocity in acute ischemic stroke. Neurology 2005; 64: 1354–1357.
10.1212/01.WNL.0000158284.41705.A5
PubMed Web of Science® Google Scholar
21Marshall-Goebel K, Ambarki K, Eklund A, et al. Effects of short-term exposure to head-down tilt on cerebral hemodynamics: A prospective evaluation of a spaceflight analog using phase-contrast MRI. J Appl Physiol (1985) 2016; 120: 1466–1473.
10.1152/japplphysiol.00841.2015
CAS PubMed Web of Science® Google Scholar
22Ishida S, Miyati T, Ohno N, et al. MRI-based assessment of acute effect of head-down tilt position on intracranial hemodynamics and hydrodynamics. J Magn Reson Imaging 2018; 47: 565–571.
10.1002/jmri.25781
PubMed Web of Science® Google Scholar
23Kramer LA, Hasan KM, Sargsyan AE, et al., SPACECOT Investigators Group. Quantitative MRI volumetry, diffusivity, cerebrovascular flow, and cranial hydrodynamics during head-down tilt and hypercapnia: The SPACECOT study. J Appl Physiol (1985). 2017; 122: 1155–1166.
10.1152/japplphysiol.00887.2016
CAS PubMed Web of Science® Google Scholar
24Rodriguez G, Warkentin S, Risberg J, Rosadini G. Sex differences in regional cerebral blood flow. J Cereb Blood Flow Metab 1988; 8: 783–789.
10.1038/jcbfm.1988.133
CAS PubMed Web of Science® Google Scholar
25Liu Y, Zhu X, Feinberg D, et al. Arterial spin labeling MRI study of age and gender effects on brain perfusion hemodynamics. Magn Reson Med 2012; 68: 912–922.
10.1002/mrm.23286
CAS PubMed Web of Science® Google Scholar
26Hasan KM, Ali H, Shad MU. Atlas-based and DTI-guided quantification of human brain cerebral blood flow: Feasibility, quality assurance, spatial heterogeneity and age effects. Magn Reson Imaging 2013; 31: 1445–1452.
10.1016/j.mri.2013.04.010
PubMed Web of Science® Google Scholar
27Tarumi T, Shah F, Tanaka H, Haley AP. Association between central elastic artery stiffness and cerebral perfusion in deep subcortical gray and white matter. Am J Hypertens 2011; 24: 1108–1113.
10.1038/ajh.2011.101
CAS PubMed Web of Science® Google Scholar
28Zhang R, Behbehani K, Levine BD. Dynamic pressure-flow relationship of the cerebral circulation during acute increase in arterial pressure. J Physiol 2009; 587: 2567–2577.
10.1113/jphysiol.2008.168302
CAS PubMed Web of Science® Google Scholar
29Schwertfeger N, Neu P, Schlattmann P, Lemke H, Heuser I, Bajbouj M. Cerebrovascular reactivity over time course in healthy subjects. J Neurol Sci 2006; 249: 135–139.
10.1016/j.jns.2006.06.009
CAS PubMed Web of Science® Google Scholar
30Petersen LG, Petersen JC, Andresen M, Secher NH, Juhler M. Postural influence on intracranial and cerebral perfusion pressure in ambulatory neurosurgical patients. Am J Physiol Regul Integr Comp Physiol 2016; 310: R100–104.
10.1152/ajpregu.00302.2015
CAS PubMed Web of Science® Google Scholar
31Harms MP, van Lieshout JJ, Jenstrup M, Pott F, Secher NH. Postural effects on cardiac output and mixed venous oxygen saturation in humans. Exp Physiol 2003; 88: 611–616.
10.1113/eph8802580
PubMed Web of Science® Google Scholar
32Diserens K, Moreira T, Hirt L, Faouzi M, Grujic J, Bieler G et al. Early mobilization out of bed after ischaemic stroke reduces severe complications but not cerebral blood flow: A randomized controlled pilot trial. Clin Rehabil 2012; 26: 451–459.
10.1177/0269215511425541
PubMed Web of Science® Google Scholar
33Faraci FM, Heistad DD. Regulation of large cerebral arteries and cerebral microvascular pressure. Circ Res 1990; 66: 8–17.
10.1161/01.RES.66.1.8
CAS PubMed Web of Science® Google Scholar
34Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of body position on intracranial pressure and cerebral perfusion in patients with large hemispheric stroke. Stroke 2002; 33: 497–501.
10.1161/hs0202.102376
PubMed Web of Science® Google Scholar
35Favilla CG, Mesquita RC, Mullen M, et al. Optical bedside monitoring of cerebral blood flow in acute ischemic stroke patients during head-of–bed manipulation. Stroke 2014; 45: 1269–1274.
10.1161/STROKEAHA.113.004116
PubMed Web of Science® Google Scholar
36Durduran T, Zhou C, Edlow BL, et al. Transcranial optical monitoring of cerebrovascular hemodynamics in acute stroke patients. Opt Express 2009; 17: 3884–3902.
10.1364/OE.17.003884
CAS PubMed Web of Science® Google Scholar
37Gauthier A, Gérardin P, Renou P, et al. Trendelenburg positioning in large vessel ischaemic stroke: A pre-post observational study using propensity score matching. Cerebrovasc Dis 2018; 46: 24–32.
10.1159/000490423
PubMed Web of Science® Google Scholar

Citing Literature

Volume51, Issue1

January 2020

Pages 218-224

Impact of Head-Down Position on Cerebral Blood Flow in Healthy Subjects: An Arterial Spin-Labeling MR Perfusion Study

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Impact of Head-Down Position on Cerebral Blood Flow in Healthy Subjects: An Arterial Spin-Labeling MR Perfusion Study

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

References

Citing Literature

References

Related

Information