Cerebrovascular pulsatility differs across vascular compartments and is altered by hypercapnic stimuli: a BOLD fMRI study

Abstract

Cerebral small vessel disease and neurodegenerative disorders have been associated with increased cerebrovascular pulsatility. Recently, BOLD fMRI-based methods have emerged for assessing pulsatility, however their interpretability is limited because the relation between estimated pulsatility indices (PI) and vascular anatomy and physiology remains poorly understood. To improve interpretability, we introduce a cardiac-specific BOLD fMRI- based PI, investigate its relationship to the cortical vasculature, and validate its sensitivity by introducing the known physiological vascular modulation of hypercapnia. Using high-resolution 7T BOLD fMRI with gradient-echo (GE) and spin-echo (SE) sequences, we disentangled macro- and microvascular contributions to the PI and quantified it across cortical depth. PI maps revealed anatomically plausible patterns, with elevated GE-PI near large veins and in white matter while SE-PI remained largely constant across cortical depth. GE-PI decreased during hypercapnia consistent with altered vascular tone, SE-PI on the other hand did not. PI correlated with cerebrovascular reactivity and venous blood volume suggesting sensitivity to vascular density and vessel mechanics. Our findings demonstrate that BOLD-derived PI provides a spatially and physiologically specific measure of vascular pulsatility. The BOLD fMRI-based PI method is readily applicable to existing datasets and has potential for assessing potential microvascular damage in cerebrovascular and neurodegenerative disease.