The Regulation of Vasomotor and Cardiorespiratory Pulsations Is Disrupted in Primary Central Nervous System Lymphoma: A Case-Control fMRI Study.

Primary central nervous system lymphoma (PCNSL) alters (peri)vascular structures while increasing vasomotor and cardiorespiratory pulsations within the brain. Vasomotor pulsations may arise from amplitude modulations of respiratory (RPE) and cardiovascular (CHE) pulsations while cardiovascular fluctuations may be modulated by respiration through cardiorespiratory amplitude modulation (CREM). In this study, we examined glymphatic cerebrospinal fluid convection in brains of PCNSL patients by assessing these waves. Thirty PCNSL patients (median 66y; 9 females) and 40 healthy age-matched controls (median 62y; 29 females) were scanned using an fMRI-based MREGBOLD sequence. Respective MREGBOLD fluctuation amplitudes (AFRPE; AFCHE; AFCREM) were compared between groups using nonparametric permutation. Regional amplitudes were compared using Mann-Whitney analysis and Cox survival analysis. Subject-specific pulsations were analyzed through Z-score mapping. AFCREM and AFRPE were significantly elevated across PCNSL brains, with lesser increases in AFCHE. However, only significant increases in AFRPE remained after correcting for sex and head displacement. AFRPE showed a link to mortality as it was markedly elevated in deceased patients. While elevations in all pulsations were present within (peri)tumoral regions, AFRPE elevations extended into extra-tumoral white matter and grey matter. Thus, altered cardiorespiratory fluctuations give rise to dysfunctional vasomotor and CSF pulsations in PCNSL, predicting impaired glymphatic function.
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Poltojainen Poltojainen, Järvelä Järvelä, Keinänen Keinänen, Bode Bode, Isokangas Isokangas, Kuitunen Kuitunen, Nikkinen Nikkinen, Korhonen Korhonen, Huotari Huotari, Raitamaa Raitamaa, Kananen Kananen, Helakari Helakari, Korhonen Korhonen, Tetri Tetri, Kuittinen Kuittinen, Kiviniemi Kiviniemi
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