Evaluating the dependence of ADC-fMRI on haemodynamics in breath-hold and resting-state conditions

Apparent diffusion coefficient (ADC)-fMRI offers a promising functional contrast, capable of mapping neuronal activity directly in both grey and white matter. However, previous studies have shown that diffusion-weighted fMRI (dfMRI), from which ADC-fMRI derives, is influenced by BOLD effects, leading to a concern that the dfMRI contrast is still rooted in neurovascular rather than neuromorphological coupling. Mitigation strategies have been proposed to remove vascular contributions while retaining neuromorphological coupling, by: i) analysing ADC timecourses calculated from two interleaved diffusion-weightings, known as ADC-fMRI; ii) using b-values of at least 200 s mm−2 ; and iii) using a sequence compensated for cross-terms with fluctuating background field gradients associated with blood oxygenation. Respiration-induced haemodynamic fluctuations, which are dissociated from neural activity, are an excellent test-bed for the robustness of ADC-fMRI to vascular contributions. In this study, we investigate the association between end-tidal CO2 and ADC-fMRI, in comparison with dfMRI and BOLD, in both breath-hold and resting-state paradigms in the human brain. We confirm a strong dependence of the BOLD signal on respiration, and find a pattern of delayed haemodynamic response to respiration in regions comprising the default mode network. While dfMRI mitigates much of the vascular contribution, it retains some association with respiration, as expected. Conversely, ADC-fMRI is mostly unaffected by vascular contribution, exhibiting minimal correlation between expired CO2 and ADC timeseries, as well as low inter- and intra-subject reproducibility in correlation maps. These findings validate ADC-fMRI as a predominantly non-vascular contrast sensitive to microstructural dynamics, enabling whole-brain functional imaging unconstrained by vascular confounds.