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CBF alterations have been identified in BD, but studies to date have been small and inconclusive. We aimed to determine cortical gray matter CBF (GM\u2010CBF) differences between BD and healthy controls (HC) and to identify relationships between CBF and clinical or cognitive measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cortical GM\u2010CBF maps were generated using Pseudo\u2010Continuous Arterial Spin Labeling (pCASL) for 109 participants (BD, n\u00a0=\u00a061; HC, n\u00a0=\u00a048). We used SnPM13 to perform non\u2010parametric voxel\u2010wise two\u2010sample t\u2010tests comparing CBF between groups. We performed multiple linear regression to relate GM\u2010CBF with clinical and cognitive measures. Analysis was adjusted for multiple comparisons with 10,000 permutations. Significance was set at a voxel level threshold of <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001 followed by AlphaSim cluster\u2010wise correction of <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.05.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to HCs, BD patients had greater GM\u2010CBF in the left lateral occipital cortex, superior division and lower CBF in the right lateral occipital, angular and middle temporal gyrus. Greater GM\u2010CBF in the left lateral occipital cortex correlated with worse working memory, verbal memory, attention and speed of processing. We found using voxel\u2010wise regression that decreased gray matter CBF in the bilateral thalamus and cerebellum, and increased right fronto\u2010limbic CBF were associated with worse working memory. No clusters were associated with clinical variables after FDR correction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Cortical GM\u2010CBF alterations are seen in BD and may be related to cognitive function, which suggest neurovascular unit dysfunction as a possible pathophysiologic mechanism.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12966","type":"journal-article","created":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T02:19:10Z","timestamp":1593051550000},"page":"130-140","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Altered cerebral perfusion in bipolar disorder: A pCASL MRI study"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2901-4057","authenticated-orcid":false,"given":"Victor","family":"Zeng","sequence":"first","affiliation":[{"name":"Psychiatry Beth Israel Deaconess Medical Center Boston MA 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