Cerebrovascular reactivity measured by functional magnetic resonance imaging during breath-hold challenge: A systematic review

- CVR is the cerebral hemodynamic response to a vasoactive stressor.
- Measuring CVR via MRI during breath hold (BH) is non-invasive and easy to implement.
- More than 50 studies have examined this method in non-neurological samples.
- CVR is generally higher among controls vs. patients with medical conditions.
- Ideal methods include ∼20 s BH, at end-expiration, and normalized to end-tidal CO2.

Cerebrovascular reactivity (CVR) is the cerebral hemodynamic response to a vasoactive substance. Breath-hold (BH) induced CVR has the advantage of being non-invasive and easy to implement during magnetic resonance imaging (MRI). We systematically reviewed the literature regarding MRI measurement of BH induced CVR. The literature was searched using MEDLINE with the search terms breath-hold; and MRI or cerebrovascular reactivity. The search yielded 2244 results and 54 articles were included. Between-group comparisons have found that CVR was higher among healthy controls than patients with various pathologies (e.g. sleep apnea, diabetes, hypertension etc.). However, counter-intuitive findings have also been reported, including higher CVR among smokers, sedentary individuals, and patients with schizophrenia vs. controls. Methodological studies have highlighted important measurement characteristics (e.g. normalizing signal to end-tidal CO2), and comparisons of BH induced CVR to non-BH methods. Future studies are warranted to address questions about group differences, treatment response, disease progression, and other salient clinical themes. Standardization of CVR and BH designs is needed to fully exploit the potential of this practical non-invasive method.