Member Initiated Mini-Symposia

Cerebrovascular Reactivity Workshop: A New Clinical “Brain Stress Test”

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Overview
Cerebrovascular reserve is difficult to assess in patients with cerebrovascular steno-occlusive disease.  CT and MRI perfusion techniques measure resting blood flow but become increasingly less reliable as the degree and number of stenoses increase.  Measures of adequate baseline blood flow do not account for a possible shortfall in recruitable blood flow due to a drop in supply or an increased metabolic demand. Visualization of the temporal filling patterns with angiography may give some indication of the presence of collateral blood flow, but not its physiologic adequacy.

With the heart, the Cardiac Stress Test, is the bedrock in the assessment of vascular reserve in the prediction of MI.  Similarly, in the brain, hemodynamic reserve is the strongest known indicator of risk of stroke.  As such, we have developed a “Brain Stress Test” and studied more than 3000 patients with cerebrovascular disease over 20 years.  This test provides key data for:

• informing patient management decisions

• following the evolution of a known vascular lesions over time

• determining the effectiveness of a therapeutic intervention. 

Educational Objectives

Learn optimal performance and interpretation of the “brain stress test” via presentations with interactive question and answer, live demonstration, hands-on practice that includes control of automated gas blender, data analysis, and image interpretation.

Target Audience
Neuroradiologists, neurosurgeons, neurologists, MR scientists

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Faculty

• Joseph Fisher, MD, Toronto General Hospital and the University of Toronto, Toronto, ON

• David Mikulis, MD, Toronto Western Hospital and the University of Toronto, Toronto, ON

• Prasanna Vibhute, MD, Mayo Clinic Jacksonville, FL

• Andrea Para. MD, MSc, Toronto Western Hospital and the University of Toronto, Toronto, ON

Agenda

1:00 – 2:30     Presentations:

1:00     Welcome / Introduction

1:05     What is a “Brain Stress Test” and why do I need it? 

1:30     Breath Hold CVR Mapping - Don’t Hold Your Breath! The Good, The Bad, The Ugly

1:50     Measuring CVR: Is “Quick and Dirty” Good Enough?

2:05     Clinical Utility of the “Brain Stress Test”: Case Examples

2:30 - 3:00      Coffee Break

3:00 – 5:00     Small Group Learning Stations (30-minute rotations):

1. Development of a standardized CVR test for clinical utility

2. Hands on device and software use

3. CVR report and expanded case reporting

4. Discussion: Clinical Value for Patient Management