Cerebral perfusion imaging: Hypoxia-induced deoxyhemoglobin or gadolinium?

Assessment of resting cerebrovascular perfusion measures (mean transit time, cerebral blood flow and cerebral blood volume) with magnetic resonance imaging currently requires the intravascular injection of the dynamic susceptibility contrast agent gadolinium. An initial comparison between hypoxia-induced deoxyhemoglobin and gadolinium was made for these measures in six healthy participants. A bolus of deoxyhemoglobin is generated in the lung via transient hypoxia induced by an available computer-controlled gas blender technology employing sequential gas delivery (RespirAct™). We hypothesised and confirmed perfusion measures from both susceptibility contrast agents would yield similar spatial patterns of cerebrovascular perfusion measures. We conclude that hypoxia-induced deoxyhemoglobin, an endogenously, non-invasively generated, non-allergenic, non-toxic, recyclable, environmentally innocuous molecule, may be suitable to become the first new magnetic resonance imaging susceptibility contrast agent introduction since gadolinium. ### Competing Interest Statement JAF and DJM contributed to the development of the automated end-tidal targeting device, RespirAct (Thornhill Research Inc., TRI) used in this study and have equity in the company. JAF, OS and JD receive salary support from TRI. TRI provided no other support for the study. All other authors have no disclosures.