Simultaneous MRI and laser Doppler Flowmetry: Assessing cerebral Macro- and microcirculation in neurointensive care

• The first study of simultaneous MRI and LDF monitoring of cerebral circulation in humans. • Longitudinal measurements were achieved in four critically brain-injured patients. • Total inflow, global and regional CBF, and local perfusion were quantified. • Patient safety and data quality were maintained during simultaneous measurements. • This approach highlights both macro- and microcirculation in neurocritical care. Subarachnoid hemorrhage (SAH) patients are monitored in the neurointensive care unit (NICU) to avoid additional brain injuries, yet methods for monitoring cerebral blood flow (CBF) are limited. The aim was to investigate the feasibility of simultaneous MRI, using arterial spin labeling (ASL) and 2D-flow MRI, and probe-based laser Doppler flowmetry (LDF) in NICU patients. Four SAH patients, three of whom received optical probes during routine surgery, were included. Compatibility of simultaneous LDF and MRI was evaluated before performing MRI 3–4 times over several days per patient. The methods were compared using mean CBF in grey matter obtained from the absolute ASL CBF-maps, the total inflow calculated from 2D-flow MRI, and local average LDF perfusion. Additionally, regional mean CBF from ASL and each arterial flowrate was compared for each hemisphere. Twelve MRI measurements were successfully performed, eight of which included simultaneous LDF. With careful routines and the MR scanner uniquely located in the NICU, neither patient safety nor data quality was compromised, demonstrating the feasibility of concurrent measurements. All methods showed longitudinal dynamic changes, following the same increasing or decreasing trends. In three patients, ASL and 2D-flow data were closely related, with dynamic changes within 10 %. This novel approach offers longitudinal, simultaneous estimates of macro- and microcirculatory components locally, regionally, and globally in the human brain. This concept has potential to provide insights into the interplay of different aspects of CBF in NICU patients and thereby aid in prevention of secondary brain injuries.