Motor cortex neurovascular coupling: inputs from ultra–high-frequency ultrasound imaging in humans

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OBJECTIVE

Neurovascular coupling reflects the link between neural activity and changes in cerebral blood flow. Despite many technical advances in functional exploration of the brain, including functional MRI, there are only a few reports of direct evidence of neurovascular coupling in humans. The authors aimed to explore, for the first time in humans, the local cerebral blood flow of the primary motor cortex using ultra–high-frequency ultrasound (UHF-US) Doppler imaging to detect low blood flow velocity (1 mm/sec).

METHODS

Four consecutive patients underwent awake craniotomy for glioma resection using cortical direct electrostimulation for brain mapping. The primary motor cortical area eliciting flexion of the contralateral forearm was identified. UHF-US color Doppler imaging of this cortical area was acquired at rest, during repeated spontaneous forearm flexion, and immediately after the movement’s termination. In each condition, the surface areas of the detectable vessels were measured after extraction of non–zero-velocity colored pixels and summed.

RESULTS

During movement, local cerebral blood flow increased significantly by 14.4% (range 5%–30%) compared with baseline. Immediately after the termination of movements, the local hyperemia decreased significantly by 8.6% (range 1.9%–15.7%).

CONCLUSIONS

To the authors’ knowledge, this study is the first to provide a real-time demonstration of the neurovascular coupling in the human cortex by ultrasound imaging. They assume that UHF-US may be used to gather original and advanced data on brain functioning, which could be used to help in the identification of functional cortical areas during brain surgery.

Clinical trial registration no.: NCT03179176 (clinicaltrials.gov)

ABBREVIATIONS BOLD = blood oxygen level–dependent; CBF = cerebral blood flow; DES = direct electrostimulation; fUS = functional US; mSA = median surface area; NVC = neurovascular coupling; TCD = transcranial Doppler; UHF-US = ultra–high-frequency US; US = ultrasound.
Article Information

Contributor Notes

Correspondence Fabien Almairac: Hôpital Pasteur 2, Nice, France. almairac.f@chu-nice.fr.INCLUDE WHEN CITING Published online November 9, 2018; DOI: 10.3171/2018.5.JNS18754.Disclosures Dr. Demarcy: employee of Oticon Medical.
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