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Introduction - A Comprehensive Review of MRI Biomarkers for Detection and Evaluation of Hypoxia

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Hypoxia is referred to the low oxygen level in the body tissue of a person which causes signs and symptoms like “restlessness, headache, difficulty in breathing, quick heart rate, bluish skin texture, confusion or baffling” or with more symptoms. Hypoxia can also be seen in a person at higher altitudes and this may put the person at risk and can be life threatening since it has been seen to cause lung or chronic heart conditions. Many cases were studied based on hypoxia found in them, especially in people having tumors or cancer, or even in brain injury. Now, “MRI (Magnetic Resonance Imaging)” is a biomedical device used as an imaging technique on the ground of computer auto-generated radio waves and magnetic fields. According to the give case scenario, it’s effective to create a very detailed structure of images of the tissues or the organs in the human body and helps to detect the issue. In addition, to treat hypoxia here the discussion will be on MRI biomarkers approach.


Reports showed that, when the lungs or heart does not function properly, due to some cellular issue or because of low oxygen in the body, hypoxia is quickly fatal. In the context of tumor or brain injury, few case studies showed that in a hypoxic model the "StO2-MRI '' was successful in detecting hypoxia (O'Connor et al. 2019). There can be few causes of hypoxia-like “ventilation-perfusion mismatch”, which means not enough oxygen flow into the lungs.

Similarly, “right to left shunting”, which means that without being oxygenated the blood enters directly to the left side of the heart is also seen. “Diffusion impairment” means that the oxygen shows impaired movement which goes into the bloodstream from lungs, can be detected using MRI biomarkers (Hillestad et al. 2020). As many case studies on different ways of detecting acute and chronic diseases through CT resulted in an average outcome, it also tried to use MRI as a new detection device which proved to be quite more sensitive and superior in analyzing and detecting hypoxic lesions (Sun et al. 2019). However, the specificity based on the behavior of the signals needed the differentiation of acute and chronic alterations, which can be improved further in MRI biomarkers to predict the prognostic outcome. Hence, here in this critical review, the focus will be on aim on discovering the approach of using MRI to detect hypoxia (Bernauer et al. 2021).


As per the previous discussion in the context section, many case studies of hypoxia described the results and findings of using MRI, especially from patients in hypoxic coma. The findings of MRI in patients with hypoxic brain injury and damage are found to be highly complex and severe but they are distinctive (Stadlbauer et al. 2019)

A standard MRI fails to provide a detailed or even a distinct good image of blood flow or the blood vessels. But studies showed that BOLD MRI (“Blood Oxygen Level-dependent MRI”) found to be quite an appropriate and suitable solution that can efficiently and effectively track the very minute details of the oxygen levels and changes in the neurological system of the human body (Weiss et al. 2019). Thus, it can be taken as an accurate or appropriate fitting technique to detect or assess the “neural tumor hypoxia” examination (Little et al. 2018). MRI is effective use, also because it can show the lesions in the brain which cannot be visible in CT (Computed Tomography) including "cortical luminal necrosis”, “diffuse axonal injury after traumatic brain damage”, “early cytotoxic oedema after ischemic stroke” or even “neurological cardiac arrest" (Chacko et al. 2020). Thus, it can be said that MRI has the efficacy and capability to increase the accuracy of its device to detect the neurological diagnosis or treatment in severe patients or critical conditions in the patients (Goswami et al. 2020).

A few roles of the anatomical structure, which involve awareness and arousal, are avenue and discussed further in this research review of the case study. Detecting strokes via MRI at the early stage of any disease for diagnosis can provide valuable information to the patients who can even go to mechanical ventilation (Salas et al. 2020). Studies provide enough evidence for MRI (Xiu et al. 2020). Several sequences of MRI are seen to be used which explore the structures, functions and metabolism of the brain. As a result, it can be said that the MRI technique can be used to predict and detect neurological outcomes on a long-term basis (Marcu et al. 2020).

Interested readers

The readers who can be interested in learning more about the new approach of using MRI biomarkers in hypoxia are the people from an R&D background, Doctors or medical workers, nurses, medical representatives, laboratory technicians who are into using the MRI pieces of equipment. They collect data collector analyze the data from MRI Biomarker, the people who are suffering from hypoxia they also can be considered as the interested reader of this review (Doman et al. 2018). The above-mentioned people can be benefited to read this review or article related to this where discussion on the new approach of MRI biomarkers in treating, scanning, or detecting hypoxia in a person (Reiss et al. 2019). However, this review paper can assure that if the MRI biomarker approach is taken to detect hypoxia it can result in a better diagnosis than what is done for a long time by using CT (Computed Tomography).

Main body

The radiation oncologists tried to overcome the problem of tumor hypoxia or other related issues of hypoxia by obtaining a tool which is known as SIB IMRT ("Simultaneous Integrated boost intensity-modulated Radiation Therapy") which activates a booster dose that delivers to the malignant tumor within in a small target of the radiation (Lemyre & Chau, 2018).

The BOLD MRI (“Blood Oxygen Level-dependent Magnetic Resonance Imaging ”) which is a little more advanced than the standard MRI assesses and detects the hypoxic level in a person who is dealing with Acute or Chronic alterations. There are four makers; “NAA (N-acetylated_aspartate), Creatine, Choline and Lactate” are studied for assessing the metabolism of the brain in vivo (Doman et al. 2018). NAA is an amino acid that reflects the neural tissue's presence in neurons and its status (Sun et al. 2019). Creatinine is considered a stable amino acid and serves as the reference point, which is found in the neurons and in glia. Choline reflects on the proliferation of the glial membrane or its breakdown. It serves as a component of the cell membrane, which is constitutive (Hillestad et al. 2020). The last marker is lactate, which serves as a marker in anaerobic metabolism specifically.

Imaging by transferring the magnetization is a principle in MRI where the sequence is structured-bound and undergoes the Proton T1 coupling in an adequate phase (O'Connor et al. 2019). This principle is a relaxation coupling of protons in the macromolecules that exchange the saturated portion in longitudinal magnetization leading to the signal intensity to reduce to an extent (Marcu et al. 2020).

The focus is kept on the standard Magnetic resonance imaging (MRI) or the conventional MRI to treat or detect traumatic brain damage or other hypoxic issues and it showed the lesions superiorly to what Computed Tomography (CT) could show and provide. However, the distinctiveness is not present (Snyder et al. 2020). In addition, that can only be achieved if the use of advanced methodologies and equipment of MRI is popularized. There are findings that were analyzed from the case study, and a few things are considered as a factor of achievement to use MRI biomarkers in hypoxic conditions. The first finding was that MRI could successfully identify more lesions in the human brain that had gone through a traumatic brain injury in compared to Computed tomography (CT). The next findings were that TBI was found to more common after the lesions in the brain shown during MRI. In addition, the last finding was on the patients who regained consciousness showed no lesions after they put into deep structuring in their brain through imaging. All these states approach using MRI as a biomarker in hypoxia


To conclude this literature review on using MRI biomarkers in detecting Hypoxia, this MRI tool is going to be an effective and efficient one. The patients dealing with hypoxic tumours especially which includes hypoxia in patients going through cancer in lungs, hearts, brain, breast, skin, blood etc. Along with other patients who are suffering through acute or chronic hypoxia, or people suffering from hypoxia in higher altitudes, are the main focus of concern. Adapting a completely new level of intensive and sensitive medical care is a big challenge for the neurological care department to use for a better outcome for the neurological system in the human body. This paper discussed all the possibilities of adopting the MRI approach in hypoxia, explaining its effectiveness, its challenges and all the positive and negative sides of it. Keeping an open ending on this review, it promises to provide accurate predictions and result in the neurological outcome if it has manufactured and developed a little more in certain aspects.


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