Improving the Assessment of Breath-Holding Induced Cerebral Vascular Reactivity Using a Multiband Multi-echo ASL/BOLD Sequence

Breath holding (BH) is a viable vasodilatory stimulus for calculating functional MRI-derived cerebral vascular reactivity (CVR). The BH technique suffers from reduced repeatability compared with gas inhalation techniques; however, extra equipment is needed to perform gas inhalation techniques, and this equipment is not available at all institutions. This study aimed to determine the sensitivity and repeatability of BH activation and CVR using a multiband multi-echo simultaneous arterial spin labelling/blood oxygenation level dependent (ASL/BOLD) sequence. Whole-brain images were acquired in 14 volunteers. Ten subjects returned for repeat imaging. Each subject performed four cycles of 16 s BH on expiration interleaved with paced breathing. Following standard preprocessing, the echoes were combined using a T2*-weighted approach. BOLD and ASL BH activation was computed, and CVR was then determined as the percent signal change related to the activation. The M parameter from the Davis Model was also computed by incorporating the ASL signal. Our results showed higher BH activation strength, volume, and repeatability for the combined multi-echo (MEC) data compared with the single-echo data. MEC CVR also had higher repeatability, sensitivity, specificity, and reliability compared with the single-echo BOLD data. These data support the usefulness of an MBME ASL/BOLD acquisition for BH CVR and M measurements.