Iterative delay correction improves breath-hold cerebrovascular reactivity mapping in clinical populations.

Cerebrovascular reactivity (CVR), the ability of cerebral blood vessels to dilate or constrict in response to a vasoactive stimulus, is an important measure of cerebrovascular health. Accurate CVR estimation requires accounting for the time required for the vasoactive stimulus to reach each brain region and the time it takes for local arterioles to modulate cerebral blood flow. The temporal search range used to calculate this spatially varying offset can substantially impact CVR estimates, and the appropriate search range may vary across populations, acquisition protocols, and even brain regions. Here, we present an iterative approach for automatically determining the appropriate maximum shift, using breath-hold fMRI data acquired in a cohort of stroke survivors. This approach selectively expands the delay search range only for voxels with estimated delays at the boundary (i.e., near the minimum or maximum shift) until the estimated delay is no longer at the boundary or a predefined value is reached. In the context of stroke, among voxels initially at the boundary, this approach significantly increased the number of voxels with statistically significant CVR (i.e., having a relationship between end-tidal CO