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<meta name="DC.Language" content="en" />
<meta name="DC.Title" content="Cerebrovascular Reactivity during Prolonged Breath-Hold in Experienced Freedivers" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5790" />
<meta name="DC.Date" content="2018-10-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2018 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Experienced freedivers can endure prolonged breath-holds despite severe hypoxemia and are therefore ideal subjects to study apnea-induced cerebrovascular reactivity. This multiparametric study investigated CBF, the spatial coefficient of variation as a correlate of arterial transit time and brain metabolism, dynamics during prolonged apnea.

MATERIALS AND METHODS: Fifteen male freedivers (age range, 20–64 years; cumulative previous prolonged breath-holds &gt;2 minutes and 30 seconds: 4–79,200) underwent repetitive 3T pseudocontinuous arterial spin-labeling and 31P-/1H-MR spectroscopy before, during, and after a 5-minute breath-hold (split into early and late phases) and gave temporally matching venous blood gas samples. Correlation of temporal and regional cerebrovascular reactivity to blood gases and cumulative previous breath-holds of &gt;2 minutes and 30 seconds in a lifetime was assessed.

RESULTS: The spatial coefficient of variation of CBF (by arterial spin-labeling) decreased during the early breath-hold phase (−30.0%, P = .002), whereas CBF remained almost stable during this phase and increased in the late phase (+51.8%, P = .001). CBF differed between the anterior and the posterior circulation during all phases (eg, during late breath-hold: MCA, 57.3 ± 14.2 versus posterior cerebral artery, 42.7 ± 10.8 mL/100 g/min; P = .001). There was an association between breath-hold experience and lower CBF (1000 previous breath-holds reduced WM CBF by 0.6 mL/100 g/min; 95% CI, 0.15–1.1 mL/100 g/min; P = .01). While breath-hold caused peripheral lactate rise (+18.5%) and hypoxemia (oxygen saturation, −24.0%), cerebral lactate and adenosine diphosphate remained within physiologic ranges despite early signs of oxidative stress [−6.4% phosphocreatine / (adenosine triphosphate + adenosine diphosphate); P = .02].

CONCLUSIONS: This study revealed that the cerebral energy metabolism of trained freedivers withstands severe hypoxic hypercarbia in prolonged breath-hold due to a complex cerebrovascular hemodynamic response.

ATP
:   adenosine triphosphate
ASL
:   arterial spin-labeling
ASL-sCoV
:   spatial coefficient of variation of CBF (by ASL)
ATT
:   arterial transit time
CVR
:   cerebrovascular reactivity
HR
:   heart rate
Pi
:   inorganic phosphates
PCr
:   phosphocreatine
pO2
:   partial pressure of oxygen
SpO2
:   oxygen saturation" />
<meta name="DC.Contributor" content="V.C. Keil" />
<meta name="DC.Contributor" content="L. Eichhorn" />
<meta name="DC.Contributor" content="H.J.M.M. Mutsaerts" />
<meta name="DC.Contributor" content="F. Träber" />
<meta name="DC.Contributor" content="W. Block" />
<meta name="DC.Contributor" content="B. Mädler" />
<meta name="DC.Contributor" content="K. van de Ven" />
<meta name="DC.Contributor" content="J.C.W. Siero" />
<meta name="DC.Contributor" content="B.J. MacIntosh" />
<meta name="DC.Contributor" content="J. Petr" />
<meta name="DC.Contributor" content="R. Fimmers" />
<meta name="DC.Contributor" content="H.H. Schild" />
<meta name="DC.Contributor" content="E. Hattingen" />
<meta name="article:published_time" content="2018-10-01" />
<meta name="article:section" content="Adult Brain" />
<meta name="citation_title" content="Cerebrovascular Reactivity during Prolonged Breath-Hold in Experienced Freedivers" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Experienced freedivers can endure prolonged breath-holds despite severe hypoxemia and are therefore ideal subjects to study apnea-induced cerebrovascular reactivity. This multiparametric study investigated CBF, the spatial coefficient of variation as a correlate of arterial transit time and brain metabolism, dynamics during prolonged apnea.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Fifteen male freedivers (age range, 20–64 years; cumulative previous prolonged breath-holds &amp;gt;2 minutes and 30 seconds: 4–79,200) underwent repetitive 3T pseudocontinuous arterial spin-labeling and &lt;sup&gt;31&lt;/sup&gt;P-/&lt;sup&gt;1&lt;/sup&gt;H-MR spectroscopy before, during, and after a 5-minute breath-hold (split into early and late phases) and gave temporally matching venous blood gas samples. Correlation of temporal and regional cerebrovascular reactivity to blood gases and cumulative previous breath-holds of &amp;gt;2 minutes and 30 seconds in a lifetime was assessed.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The spatial coefficient of variation of CBF (by arterial spin-labeling) decreased during the early breath-hold phase (−30.0%, &lt;i&gt;P&lt;/i&gt; = .002), whereas CBF remained almost stable during this phase and increased in the late phase (+51.8%, &lt;i&gt;P&lt;/i&gt; = .001). CBF differed between the anterior and the posterior circulation during all phases (eg, during late breath-hold: MCA, 57.3 ± 14.2 versus posterior cerebral artery, 42.7 ± 10.8 mL/100 g/min; &lt;i&gt;P&lt;/i&gt; = .001). There was an association between breath-hold experience and lower CBF (1000 previous breath-holds reduced WM CBF by 0.6 mL/100 g/min; 95% CI, 0.15–1.1 mL/100 g/min; &lt;i&gt;P&lt;/i&gt; = .01). While breath-hold caused peripheral lactate rise (+18.5%) and hypoxemia (oxygen saturation, −24.0%), cerebral lactate and adenosine diphosphate remained within physiologic ranges despite early signs of oxidative stress [−6.4% phosphocreatine / (adenosine triphosphate + adenosine diphosphate); &lt;i&gt;P&lt;/i&gt; = .02].&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;This study revealed that the cerebral energy metabolism of trained freedivers withstands severe hypoxic hypercarbia in prolonged breath-hold due to a complex cerebrovascular hemodynamic response.&lt;/p&gt;" />
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<meta name="citation_volume" content="39" />
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<meta name="citation_author_institution" content="aFrom the Departments of Radiology (V.C.K., F.T., W.B., H.H.S., E.H.)" />
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<meta name="twitter:title" content="Cerebrovascular Reactivity during Prolonged Breath-Hold in Experienced Freedivers" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Experienced freedivers can endure prolonged breath-holds despite severe hypoxemia and are therefore ideal subjects to study apnea-induced cerebrovascular reactivity. This multiparametric study investigated CBF, the spatial coefficient of variation as a correlate of arterial transit time and brain metabolism, dynamics during prolonged apnea.

MATERIALS AND METHODS: Fifteen male freedivers (age range, 20–64 years; cumulative previous prolonged breath-holds &gt;2 minutes and 30 seconds: 4–79,200) underwent repetitive 3T pseudocontinuous arterial spin-labeling and 31P-/1H-MR spectroscopy before, during, and after a 5-minute breath-hold (split into early and late phases) and gave temporally matching venous blood gas samples. Correlation of temporal and regional cerebrovascular reactivity to blood gases and cumulative previous breath-holds of &gt;2 minutes and 30 seconds in a lifetime was assessed.

RESULTS: The spatial coefficient of variation of CBF (by arterial spin-labeling) decreased during the early breath-hold phase (−30.0%, P = .002), whereas CBF remained almost stable during this phase and increased in the late phase (+51.8%, P = .001). CBF differed between the anterior and the posterior circulation during all phases (eg, during late breath-hold: MCA, 57.3 ± 14.2 versus posterior cerebral artery, 42.7 ± 10.8 mL/100 g/min; P = .001). There was an association between breath-hold experience and lower CBF (1000 previous breath-holds reduced WM CBF by 0.6 mL/100 g/min; 95% CI, 0.15–1.1 mL/100 g/min; P = .01). While breath-hold caused peripheral lactate rise (+18.5%) and hypoxemia (oxygen saturation, −24.0%), cerebral lactate and adenosine diphosphate remained within physiologic ranges despite early signs of oxidative stress [−6.4% phosphocreatine / (adenosine triphosphate + adenosine diphosphate); P = .02].

CONCLUSIONS: This study revealed that the cerebral energy metabolism of trained freedivers withstands severe hypoxic hypercarbia in prolonged breath-hold due to a complex cerebrovascular hemodynamic response.

ATP
:   adenosine triphosphate
ASL
:   arterial spin-labeling
ASL-sCoV
:   spatial coefficient of variation of CBF (by ASL)
ATT
:   arterial transit time
CVR
:   cerebrovascular reactivity
HR
:   heart rate
Pi
:   inorganic phosphates
PCr
:   phosphocreatine
pO2
:   partial pressure of oxygen
SpO2
:   oxygen saturation" />
<meta name="og-title" property="og:title" content="Cerebrovascular Reactivity during Prolonged Breath-Hold in Experienced Freedivers" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/39/10/1839" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Experienced freedivers can endure prolonged breath-holds despite severe hypoxemia and are therefore ideal subjects to study apnea-induced cerebrovascular reactivity. This multiparametric study investigated CBF, the spatial coefficient of variation as a correlate of arterial transit time and brain metabolism, dynamics during prolonged apnea.

MATERIALS AND METHODS: Fifteen male freedivers (age range, 20–64 years; cumulative previous prolonged breath-holds &gt;2 minutes and 30 seconds: 4–79,200) underwent repetitive 3T pseudocontinuous arterial spin-labeling and 31P-/1H-MR spectroscopy before, during, and after a 5-minute breath-hold (split into early and late phases) and gave temporally matching venous blood gas samples. Correlation of temporal and regional cerebrovascular reactivity to blood gases and cumulative previous breath-holds of &gt;2 minutes and 30 seconds in a lifetime was assessed.

RESULTS: The spatial coefficient of variation of CBF (by arterial spin-labeling) decreased during the early breath-hold phase (−30.0%, P = .002), whereas CBF remained almost stable during this phase and increased in the late phase (+51.8%, P = .001). CBF differed between the anterior and the posterior circulation during all phases (eg, during late breath-hold: MCA, 57.3 ± 14.2 versus posterior cerebral artery, 42.7 ± 10.8 mL/100 g/min; P = .001). There was an association between breath-hold experience and lower CBF (1000 previous breath-holds reduced WM CBF by 0.6 mL/100 g/min; 95% CI, 0.15–1.1 mL/100 g/min; P = .01). While breath-hold caused peripheral lactate rise (+18.5%) and hypoxemia (oxygen saturation, −24.0%), cerebral lactate and adenosine diphosphate remained within physiologic ranges despite early signs of oxidative stress [−6.4% phosphocreatine / (adenosine triphosphate + adenosine diphosphate); P = .02].

CONCLUSIONS: This study revealed that the cerebral energy metabolism of trained freedivers withstands severe hypoxic hypercarbia in prolonged breath-hold due to a complex cerebrovascular hemodynamic response.

ATP
:   adenosine triphosphate
ASL
:   arterial spin-labeling
ASL-sCoV
:   spatial coefficient of variation of CBF (by ASL)
ATT
:   arterial transit time
CVR
:   cerebrovascular reactivity
HR
:   heart rate
Pi
:   inorganic phosphates
PCr
:   phosphocreatine
pO2
:   partial pressure of oxygen
SpO2
:   oxygen saturation" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node63388--5" data-node-nid="63388" id="top-node-63388--61375826361" data-pisa="ajnr;39/10/1839" data-pisa-master="ajnr;ajnr.A5790" data-apath="/ajnr/39/10/1839.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Adult Brain</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Cerebrovascular Reactivity during Prolonged Breath-Hold in Experienced Freedivers</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">V.C. Keil</span>, <span class="highwire-citation-author" data-delta="1">L. Eichhorn</span>, <span class="highwire-citation-author" data-delta="2">H.J.M.M. Mutsaerts</span>, <span class="highwire-citation-author" data-delta="3">F. Träber</span>, <span class="highwire-citation-author" data-delta="4">W. Block</span>, <span class="highwire-citation-author" data-delta="5">B. Mädler</span>, <span class="highwire-citation-author" data-delta="6">K. van de Ven</span>, <span class="highwire-citation-author" data-delta="7">J.C.W. Siero</span>, <span class="highwire-citation-author" data-delta="8">B.J. MacIntosh</span>, <span class="highwire-citation-author" data-delta="9">J. Petr</span>, <span class="highwire-citation-author" data-delta="10">R. Fimmers</span>, <span class="highwire-citation-author" data-delta="11">H.H. Schild</span> and <span class="highwire-citation-author" data-delta="12">E. Hattingen</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2018,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1839-1847; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5790 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-63388--61375826361" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">V.C. Keil </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (V.C.K., F.T., W.B., H.H.S., E.H.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=V.C.%2BKeil%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Keil%20V&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AV.C.%2BKeil%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8699-3506" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for V.C. Keil</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">L. Eichhorn </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Anesthesiology and Intensive Care Medicine (L.E.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.%2BEichhorn%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Eichhorn%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AL.%2BEichhorn%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9769-0639" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L. Eichhorn</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">H.J.M.M. Mutsaerts </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Radiology (H.J.M.M.M.), Academic Medical Center, Amsterdam, the Netherlands</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Sunnybrook Research Institute (H.J.M.M.M., B.J.M.), University of Toronto, Toronto, Ontario, Canada</div><div class='author-affiliation'><span class='nlm-sup'>f</span>Department of Radiology (H.J.M.M.M., J.C.W.S.), University Medical Center Utrecht, Utrecht, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.J.M.M.%2BMutsaerts%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Mutsaerts%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AH.J.M.M.%2BMutsaerts%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-0894-0307" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H.J.M.M. Mutsaerts</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">F. Träber </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (V.C.K., F.T., W.B., H.H.S., E.H.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BTr%C3%A4ber%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Tr%C3%A4ber%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.%2BTr%25C3%25A4ber%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9713-3445" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. Träber</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">W. Block </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (V.C.K., F.T., W.B., H.H.S., E.H.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=W.%2BBlock%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Block%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AW.%2BBlock%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-3095-6356" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for W. Block</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">B. Mädler </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>g</span>Philips GmbH (B.M), Bonn, Germany</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.%2BM%C3%A4dler%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=M%C3%A4dler%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.%2BM%25C3%25A4dler%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-1465-2961" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B. Mädler</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">K. van de Ven </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>h</span>Philips Healthcare (K.v.d.V.), Best, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2Bvan%2Bde%2BVen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=van%20de%20Ven%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.%2Bvan%2Bde%2BVen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-2751-6213" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. van de Ven</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">J.C.W. Siero </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>Department of Radiology (H.J.M.M.M., J.C.W.S.), University Medical Center Utrecht, Utrecht, the Netherlands</div><div class='author-affiliation'><span class='nlm-sup'>i</span>Spinoza Centre for Neuroimaging (J.C.W.S.), Amsterdam, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.C.W.%2BSiero%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Siero%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.C.W.%2BSiero%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5079-2868" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.C.W. Siero</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">B.J. MacIntosh </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Sunnybrook Research Institute (H.J.M.M.M., B.J.M.), University of Toronto, Toronto, Ontario, Canada</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.J.%2BMacIntosh%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=MacIntosh%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.J.%2BMacIntosh%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7300-2355" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B.J. MacIntosh</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">J. Petr </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>j</span>Helmholtz Center Dresden-Rossendorf, Institute for Radiopharmaceutic Cancer Research (J.P.), PET Center, Dresden-Rossendorf, Germany.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BPetr%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Petr%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BPetr%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3201-6002" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Petr</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">R. Fimmers </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Institut für Medizinische Biometrie, Informatik und Epidemiologie (R.F.), University Hospital Bonn, Bonn, Germany</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BFimmers%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fimmers%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.%2BFimmers%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7485-6803" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. 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Schild </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (V.C.K., F.T., W.B., H.H.S., E.H.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.H.%2BSchild%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Schild%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AH.H.%2BSchild%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4264-0121" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H.H. Schild</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">E. 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 39</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 10 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Oct 2018 </div></div>
      
      
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1839-1847; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5790 </span></div>
  
  
  
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      <div class="highwire-cite-title">Cerebrovascular Reactivity during Prolonged Breath-Hold in Experienced Freedivers</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">V.C.</span> <span class="nlm-surname">Keil</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Eichhorn</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">H.J.M.M.</span> <span class="nlm-surname">Mutsaerts</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Träber</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">W.</span> <span class="nlm-surname">Block</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Mädler</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">K.</span> <span class="nlm-surname">van de Ven</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">J.C.W.</span> <span class="nlm-surname">Siero</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">B.J.</span> <span class="nlm-surname">MacIntosh</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Petr</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Fimmers</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">H.H.</span> <span class="nlm-surname">Schild</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Hattingen</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1839-1847; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5790 </span></div>
  
  
  
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