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Chin KS, Holper S, Loveland P, Churilov L, Yassi N, Watson R. Prevalence of cerebral microbleeds in Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease dementia: A systematic review and meta-analysis. Neurobiol Aging 2024; 134:74-83. [PMID: 38006706 DOI: 10.1016/j.neurobiolaging.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/27/2023]
Abstract
Cerebral microbleeds (CMB) are often associated with vascular risk factors and/or cerebral amyloid angiopathy and are frequently identified in people with dementia. The present study therefore aimed to estimate the pooled prevalence and associations of CMB in Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), using meta-analytic methods. Sixty-five MRI studies were included after a systematic search on major electronic databases. We found that the prevalence of CMB was comparable across the three dementia subtypes (31-36%) and was highly influenced by the MRI techniques used. CMB in AD were associated with a history of hypertension and amyloid-β burden. In contrast, CMB in DLB, despite being predominantly lobar, were associated with hypertension, but not amyloid-β burden. These findings suggest that the underlying pathophysiology of CMB in DLB might differ from that of AD. There was substantially larger number of AD studies identified and more studies evaluating CMB in Lewy body dementias are warranted.
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Affiliation(s)
- Kai Sin Chin
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Aged Care, The Royal Melbourne Hospital, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
| | - Sarah Holper
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Paula Loveland
- Department of Aged Care, The Royal Melbourne Hospital, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Leonid Churilov
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Nawaf Yassi
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Rosie Watson
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Aged Care, The Royal Melbourne Hospital, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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2
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Magaki S, Chen Z, Severance A, Williams CK, Diaz R, Fang C, Khanlou N, Yong WH, Paganini-Hill A, Kalaria RN, Vinters HV, Fisher M. Neuropathology of microbleeds in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). J Neuropathol Exp Neurol 2023; 82:333-344. [PMID: 36715085 PMCID: PMC10025882 DOI: 10.1093/jnen/nlad004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Cerebral microbleeds (CMBs) detected on magnetic resonance imaging are common in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The neuropathologic correlates of CMBs are unclear. In this study, we characterized findings relevant to CMBs in autopsy brain tissue of 8 patients with genetically confirmed CADASIL and 10 controls within the age range of the CADASIL patients by assessing the distribution and extent of hemosiderin/iron deposits including perivascular hemosiderin leakage (PVH), capillary hemosiderin deposits, and parenchymal iron deposits (PID) in the frontal cortex and white matter, basal ganglia and cerebellum. We also characterized infarcts, vessel wall thickening, and severity of vascular smooth muscle cell degeneration. CADASIL subjects had a significant increase in hemosiderin/iron deposits compared with controls. This increase was principally seen with PID. Hemosiderin/iron deposits were seen in the majority of CADASIL subjects in all brain areas. PVH was most pronounced in the frontal white matter and basal ganglia around small to medium sized arterioles, with no predilection for the vicinity of vessels with severe vascular changes or infarcts. CADASIL subjects have increased brain hemosiderin/iron deposits but these do not occur in a periarteriolar distribution. Pathogenesis of these lesions remains uncertain.
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Affiliation(s)
- Shino Magaki
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Zesheng Chen
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Alyscia Severance
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Christopher K Williams
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Ramiro Diaz
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Chuo Fang
- Department of Neurology, University of California-Irvine School of Medicine, Irvine, California, USA
| | - Negar Khanlou
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - William H Yong
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Annlia Paganini-Hill
- Department of Neurology, University of California-Irvine School of Medicine, Irvine, California, USA
| | - Rajesh N Kalaria
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Harry V Vinters
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Department of Neurology, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Brain Research Institute, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Mark Fisher
- Department of Neurology, University of California-Irvine School of Medicine, Irvine, California, USA
- Department of Pathology and Laboratory Medicine, University of California-Irvine School of Medicine, Irvine, California, USA
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van Veluw SJ, Arfanakis K, Schneider JA. Neuropathology of Vascular Brain Health: Insights From Ex Vivo Magnetic Resonance Imaging-Histopathology Studies in Cerebral Small Vessel Disease. Stroke 2022; 53:404-415. [PMID: 35000425 PMCID: PMC8830602 DOI: 10.1161/strokeaha.121.032608] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sporadic cerebral small vessel disease (SVD) is a major contributor to vascular cognitive impairment and dementia in the aging human brain. On neuropathology, sporadic SVD is characterized by abnormalities to the small vessels of the brain predominantly in the form of cerebral amyloid angiopathy and arteriolosclerosis. These pathologies frequently coexist with Alzheimer disease changes, such as plaques and tangles, in a single brain. Conversely, during life, magnetic resonance imaging (MRI) only captures the larger manifestations of SVD in the form of parenchymal brain abnormalities. There appears to be a major knowledge gap regarding the underlying neuropathology of individual MRI-detectable SVD abnormalities. Ex vivo MRI in postmortem human brain tissue is a powerful tool to bridge this gap. This review summarizes current insights into the histopathologic correlations of MRI manifestations of SVD, their underlying cause, presumed pathophysiology, and associated secondary tissue injury. Moreover, we discuss the advantages and limitations of ex vivo MRI-guided histopathologic investigations and make recommendations for future studies.
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Affiliation(s)
- Susanne J. van Veluw
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, MA, USA,Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Konstantinos Arfanakis
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA,Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA,Departments of Pathology and Neurological Sciences, Rush University Medical Center, Chicago IL, USA
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Martin MDGM, Paes VR, Cardoso EF, Neto CEBP, Kanamura CT, Leite CDC, Otaduy MCG, Monteiro RADA, Mauad T, da Silva LFF, Castro LHM, Saldiva PHN, Dolhnikoff M, Duarte-Neto AN. Postmortem brain 7T MRI with minimally invasive pathological correlation in deceased COVID-19 subjects. Insights Imaging 2022; 13:7. [PMID: 35032223 PMCID: PMC8760871 DOI: 10.1186/s13244-021-01144-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/14/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Brain abnormalities are a concern in COVID-19, so we used minimally invasive autopsy (MIA) to investigate it, consisting of brain 7T MR and CT images and tissue sampling via transethmoidal route with at least three fragments: the first one for reverse transcription polymerase chain reaction (RT-PCR) analysis and the remaining fixed and stained with hematoxylin and eosin. Two mouse monoclonal anti-coronavirus (SARS-CoV-2) antibodies were employed in immunohistochemical (IHC) reactions. RESULTS Seven deceased COVID-19 patients underwent MIA with brain MR and CT images, six of them with tissue sampling. Imaging findings included infarcts, punctate brain hemorrhagic foci, subarachnoid hemorrhage and signal abnormalities in the splenium, basal ganglia, white matter, hippocampi and posterior cortico-subcortical. Punctate brain hemorrhage was the most common finding (three out of seven cases). Brain histological analysis revealed reactive gliosis, congestion, cortical neuron eosinophilic degeneration and axonal disruption in all six cases. Other findings included edema (5 cases), discrete perivascular hemorrhages (5), cerebral small vessel disease (3), perivascular hemosiderin deposits (3), Alzheimer type II glia (3), abundant corpora amylacea (3), ischemic foci (1), periventricular encephalitis foci (1), periventricular vascular ectasia (1) and fibrin thrombi (1). SARS-CoV-2 RNA was detected with RT-PCR in 5 out of 5 and IHC in 6 out 6 patients (100%). CONCLUSIONS Despite limited sampling, MIA was an effective tool to evaluate underlying pathological brain changes in deceased COVID-19 patients. Imaging findings were varied, and pathological features corroborated signs of hypoxia, alterations related to systemic critically ill and SARS-CoV-2 brain invasion.
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Affiliation(s)
- Maria da Graça Morais Martin
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, LIM44, Travessa da Rua Dr. Ovídio Pires de Campos, 75, São Paulo, SP, 05403-010, Brazil.
| | - Vitor Ribeiro Paes
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Ellison Fernando Cardoso
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, LIM44, Travessa da Rua Dr. Ovídio Pires de Campos, 75, São Paulo, SP, 05403-010, Brazil
| | | | | | - Claudia da Costa Leite
- Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo, LIM 44 HCFMUSP, São Paulo, Brazil
| | - Maria Concepcion Garcia Otaduy
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, LIM44, Travessa da Rua Dr. Ovídio Pires de Campos, 75, São Paulo, SP, 05403-010, Brazil
| | | | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Servico de Verificaçao de Óbitos de São Paulo (SVO), São Paulo, Brazil
| | | | | | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Instituto Adolfo Lutz, São Paulo, Brazil
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Humphreys CA, Smith C, Wardlaw JM. Correlations in post-mortem imaging-histopathology studies of sporadic human cerebral small vessel disease: A systematic review. Neuropathol Appl Neurobiol 2021; 47:910-930. [PMID: 34037264 DOI: 10.1111/nan.12737] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/29/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
AIMS Sporadic human cerebral small vessel disease (SVD) commonly causes stroke and dementia but its pathogenesis is poorly understood. There are recognised neuroimaging and histopathological features. However, relatively few studies have examined the relationship between the radiological and pathological correlates of SVD; better correlation would promote greater insight into the underlying biological changes. METHODS We performed a systematic review to collate and appraise the information derived from studies that correlated histological with neuroimaging-defined SVD lesions. We searched for studies describing post-mortem imaging and histological tissue examination in adults, extracted data from published studies, categorised the information and compiled this narrative. RESULTS We identified 38 relevant studies, including at least 1146 subjects, 342 of these with SVD: 29 studies focussed on neuroradiological white matter lesions (WML), six on microinfarcts and three on dilated perivascular spaces (PVS) and lacunes. The histopathology terminology was diverse with few robust definitions. Reporting and methodology varied widely between studies, precluding formal meta-analysis. PVS and 'oedema' were frequent findings in WML, being described in at least 94 and 18 radiological WML, respectively, in addition to myelin pallor. Histopathological changes extended beyond the radiological lesion margins in at least 33 radiological WML. At least 43 radiological lesions not seen pathologically and at least 178 histological lesions were not identified on imaging. CONCLUSIONS Histopathological assessment of human SVD is hindered by inconsistent methodological approaches and unstandardised definitions. The data from this systematic review will help to develop standardised definitions to promote consistency in human SVD research.
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Affiliation(s)
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute at The University of Edinburgh, Edinburgh, UK.,Row Fogo Centre for Research into Ageing and the Brain, Edinburgh, UK
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Post-Mortem 7.0-Tesla Magnetic Resonance Imaging of the Hippocampus in Progressive Supranuclear Palsy with and without Cerebral Amyloid Angiopathy. NEUROSCI 2020. [DOI: 10.3390/neurosci1020011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction and Purpose: Cerebral amyloid angiopathy (CAA) can be observed in patients with progressive supranuclear palsy (PSP), though to a lesser degree than in Alzheimer’s disease. The present post-mortem 7.0-tesla magnetic resonance imaging (MRI) evaluates whether CAA has an influence on the degree of hippocampal atrophy (HA) and on the incidence of associated micro-infarcts (HMIs) and cortical micro-bleeds (HMBs). Material and Methods: Eight brains with PSP-CAA were compared to 20 PSP brains without CAA. In addition to the neuropathological examination, the hippocampus was evaluated on the most representative coronal section with T2 and T2*-weighted MRI sequences. The average degree of HA was determined in both groups. The incidence of HMIs and HMBs was also compared as well as the frequency of cortical micro-infarcts (CoMIs) and cortical micro-bleeds (CoMBs) in the hemispheric neocortex. Results: The neuropathological examination showed a higher incidence of lacunar infarcts in the PSP-CAA brains compared to the PSP ones. With magnetic resonance imaging (MRI), the severity of HA and the incidence of HMIs and HMBs was similar between both groups. Additionally, the frequency of CoMIs and CoMBs in the neocortex was comparable. Conclusions: The association of CAA in PSP brains has no influence on the degree of HA and on the incidence of the small cerebrovascular lesions in the hippocampus as well as in the neocortex.
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Stringer MS, Lee H, Huuskonen MT, MacIntosh BJ, Brown R, Montagne A, Atwi S, Ramirez J, Jansen MA, Marshall I, Black SE, Zlokovic BV, Benveniste H, Wardlaw JM. A Review of Translational Magnetic Resonance Imaging in Human and Rodent Experimental Models of Small Vessel Disease. Transl Stroke Res 2020; 12:15-30. [PMID: 32936435 PMCID: PMC7803876 DOI: 10.1007/s12975-020-00843-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 12/29/2022]
Abstract
Cerebral small vessel disease (SVD) is a major health burden, yet the pathophysiology remains poorly understood with no effective treatment. Since much of SVD develops silently and insidiously, non-invasive neuroimaging such as MRI is fundamental to detecting and understanding SVD in humans. Several relevant SVD rodent models are established for which MRI can monitor in vivo changes over time prior to histological examination. Here, we critically review the MRI methods pertaining to salient rodent models and evaluate synergies with human SVD MRI methods. We found few relevant publications, but argue there is considerable scope for greater use of MRI in rodent models, and opportunities for harmonisation of the rodent-human methods to increase the translational potential of models to understand SVD in humans. We summarise current MR techniques used in SVD research, provide recommendations and examples and highlight practicalities for use of MRI SVD imaging protocols in pre-selected, relevant rodent models.
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Affiliation(s)
- Michael S Stringer
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Hedok Lee
- Department of Anesthesiology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Mikko T Huuskonen
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bradley J MacIntosh
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Rosalind Brown
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Axel Montagne
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sarah Atwi
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Joel Ramirez
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Maurits A Jansen
- Edinburgh Preclinical Imaging, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Ian Marshall
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Sandra E Black
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Berislav V Zlokovic
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Helene Benveniste
- Department of Anesthesiology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Joanna M Wardlaw
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. .,UK Dementia Research Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
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Magnetic Susceptibility in Normal Brains of Young Adults Based on Quantitative Susceptibility Mapping. J Craniofac Surg 2019; 30:1836-1839. [PMID: 31449218 DOI: 10.1097/scs.0000000000005597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To explore the changes of brain susceptibility of different sides and genders in healthy young adults using quantitative susceptibility mapping (QSM). METHODS Totally 42 healthy young right-handed adults underwent conventional brain magnetic resonance imaging and QSM scans, and the susceptibility maps were obtained by image post-processing software. Then the regions-of-interest (ROI) of bilateral frontal gray matter (FGM), frontal white matter (FWM), caudate (CA), globus pallidus (GP), putamen (PU), thalamus (TH), substantia nigra (SN), red nucleus (RN), dentate nucleus (DN), pons (PO), and corpus callosum (CC) were manually drawn to obtain magnetic susceptibility on the susceptibility maps. The magnetic susceptibility of each ROI was compared between 2 sides and genders by Wilcoxon rank sum test. RESULTS Magnetic susceptibility of bilateral ROI was the highest in GP, followed by SN, and the lowest in FWM. No statistically significant difference was found in susceptibility of bilateral FGM, FWM, CA, GP, PU, TH, SN, RN, DN, PO, or CC. Magnetic susceptibility in CA significantly different genders. CONCLUSION Brain magnetic susceptibility measured by QSM can be used to quantitatively assess brain iron concentrations.
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De Barros A, Arribarat G, Combis J, Chaynes P, Péran P. Matching ex vivo MRI With Iron Histology: Pearls and Pitfalls. Front Neuroanat 2019; 13:68. [PMID: 31333421 PMCID: PMC6616088 DOI: 10.3389/fnana.2019.00068] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/19/2019] [Indexed: 12/12/2022] Open
Abstract
Iron levels in the brain can be estimated using newly developed specific magnetic resonance imaging (MRI) sequences. This technique has several applications, especially in neurodegenerative disorders like Alzheimer's disease or Parkinson's disease. Coupling ex vivo MRI with histology allows neuroscientists to better understand what they see in the images. Iron is one of the most extensively studied elements, both by MRI and using histological or physical techniques. Researchers were initially only able to make visual comparisons between MRI images and different types of iron staining, but the emergence of specific MRI sequences like R2* or quantitative susceptibility mapping meant that quantification became possible, requiring correlations with physical techniques. Today, with advances in MRI and image post-processing, it is possible to look for MRI/histology correlations by matching the two sorts of images. For the result to be acceptable, the choice of methodology is crucial, as there are hidden pitfalls every step of the way. In order to review the advantages and limitations of ex vivo MRI correlation with iron-based histology, we reviewed all the relevant articles dealing with the topic in humans. We provide separate assessments of qualitative and quantitative studies, and after summarizing the significant results, we emphasize all the pitfalls that may be encountered.
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Affiliation(s)
- Amaury De Barros
- Toulouse NeuroImaging Center, University of Toulouse Paul Sabatier-INSERM, Toulouse, France.,Department of Anatomy, Toulouse Faculty of Medicine, Toulouse, France
| | - Germain Arribarat
- Toulouse NeuroImaging Center, University of Toulouse Paul Sabatier-INSERM, Toulouse, France
| | - Jeanne Combis
- Toulouse NeuroImaging Center, University of Toulouse Paul Sabatier-INSERM, Toulouse, France
| | - Patrick Chaynes
- Department of Anatomy, Toulouse Faculty of Medicine, Toulouse, France
| | - Patrice Péran
- Toulouse NeuroImaging Center, University of Toulouse Paul Sabatier-INSERM, Toulouse, France
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Dusek P, Madai VI, Huelnhagen T, Bahn E, Matej R, Sobesky J, Niendorf T, Acosta-Cabronero J, Wuerfel J. The choice of embedding media affects image quality, tissue R 2 * , and susceptibility behaviors in post-mortem brain MR microscopy at 7.0T. Magn Reson Med 2018; 81:2688-2701. [PMID: 30506939 DOI: 10.1002/mrm.27595] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/19/2018] [Accepted: 10/14/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE The quality and precision of post-mortem MRI microscopy may vary depending on the embedding medium used. To investigate this, our study evaluated the impact of 5 widely used media on: (1) image quality, (2) contrast of high spatial resolution gradient-echo (T1 and T2 * -weighted) MR images, (3) effective transverse relaxation rate (R2 * ), and (4) quantitative susceptibility measurements (QSM) of post-mortem brain specimens. METHODS Five formaldehyde-fixed brain slices were scanned using 7.0T MRI in: (1) formaldehyde solution (formalin), (2) phosphate-buffered saline (PBS), (3) deuterium oxide (D2 O), (4) perfluoropolyether (Galden), and (5) agarose gel. SNR and contrast-to-noise ratii (SNR/CNR) were calculated for cortex/white matter (WM) and basal ganglia/WM regions. In addition, median R2 * and QSM values were extracted from caudate nucleus, putamen, globus pallidus, WM, and cortical regions. RESULTS PBS, Galden, and agarose returned higher SNR/CNR compared to formalin and D2 O. Formalin fixation, and its use as embedding medium for scanning, increased tissue R2 * . Imaging with agarose, D2 O, and Galden returned lower R2 * values than PBS (and formalin). No major QSM offsets were observed, although spatial variance was increased (with respect to R2 * behaviors) for formalin and agarose. CONCLUSIONS Embedding media affect gradient-echo image quality, R2 * , and QSM in differing ways. In this study, PBS embedding was identified as the most stable experimental setup, although by a small margin. Agarose and Galden were preferred to formalin or D2 O embedding. Formalin significantly increased R2 * causing noisier data and increased QSM variance.
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Affiliation(s)
- Petr Dusek
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Praha, Czech Republic.,Department of Radiology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Praha, Czech Republic
| | - Vince Istvan Madai
- Department of Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitaetsmedizin, Berlin, Germany
| | - Till Huelnhagen
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Erik Bahn
- Institute of Neuropathology, University Medicine Göttingen, Göttingen, Germany
| | - Radoslav Matej
- Department of Pathology and Molecular Medicine, Thomayer Hospital, Praha, Czech Republic.,Department of Pathology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Praha, Czech Republic
| | - Jan Sobesky
- Department of Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitaetsmedizin, Berlin, Germany.,Experimental and Clinical Research Center (ECRC), Charité-Universitaetsmedizin and Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,Experimental and Clinical Research Center (ECRC), Charité-Universitaetsmedizin and Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Julio Acosta-Cabronero
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, University College London, London, United Kingdom.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Jens Wuerfel
- NeuroCure Clinical Research Center, Charité-Universitaetsmedizin, Berlin, Germany.,Medical Imaging Analysis Center AG, Basel, Switzerland.,Department of Biomedical Engineering, University Basel, Switzerland
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Niwa A, Ii Y, Shindo A, Matsuo K, Ishikawa H, Taniguchi A, Takase S, Maeda M, Sakuma H, Akatsu H, Hashizume Y, Tomimoto H. Comparative Analysis of Cortical Microinfarcts and Microbleeds using 3.0-Tesla Postmortem Magnetic Resonance Images and Histopathology. J Alzheimers Dis 2018; 59:951-959. [PMID: 28697558 PMCID: PMC5545920 DOI: 10.3233/jad-161242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Microvascular lesions including cortical microinfarctions (CMIs) and cerebral lobar microbleeds (CMBs) are usually caused by cerebral amyloid angiopathy (CAA) in the elderly and are correlated with cognitive decline. However, their radiological-histopathological coincidence has not been revealed systematically with widely used 3-Tesla (3T) magnetic resonance imaging (MRI). The purpose of the present study is to delineate the histopathological background corresponding to MR images of these lesions. We examined formalin-fixed 10-mm thick coronal brain blocks from 10 CAA patients (five were also diagnosed with Alzheimer's disease, three with dementia with Lewy bodies, and two with CAA only) with dementia and six non CAA patients with neurodegenerative disease. Using 3T MRI, both 3D-fluid attenuated inversion recovery (FLAIR) and 3D-double inversion recovery (DIR) were examined to identify CMIs, and T2* and susceptibility-weighted images (SWI) were examined to identify CMBs. These blocks were subsequently examined histologically and immunohistochemically. In CAA patients, 48 CMIs and 6 lobar CMBs were invariably observed in close proximity to degenerated Aβ-positive blood vessels. Moreover, 16 CMIs (33%) of 48 were detected with postmortem MRI, but none were seen when the lesion size was smaller than 1 mm. In contrast, only 1 undeniable CMI was founded with MRI and histopathology in 6 non CAA patients. Small, cortical high-intensity lesions seen on 3D-FLAIR and 3D-DIR images likely represent CMIs, and low-intensity lesions in T2* and SWI correspond to CMBs with in vivo MRI. Furthermore, a close association between amyloid-laden vessels and these microvascular lesions indicated the contribution of CAA to their pathogenesis.
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Affiliation(s)
- Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Ko Matsuo
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Shinichi Takase
- Department of Radiology, Mie University Hospital, Mie, Japan
| | - Masayuki Maeda
- Department of Radiology, Mie University Hospital, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Mie, Japan
| | - Hiroyasu Akatsu
- Department of Neuropathology, Fukushimura Hospital, Aichi, Japan
| | - Yoshio Hashizume
- Department of Neuropathology, Fukushimura Hospital, Aichi, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
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12
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Guidoux C, Hauw JJ, Klein I, Labreuche J, Berr C, Duyckaerts C, Amarenco P. Amyloid Angiopathy in Brain Hemorrhage: A Postmortem Neuropathological-Magnetic Resonance Imaging Study. Cerebrovasc Dis 2018; 45:124-131. [DOI: 10.1159/000486554] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/28/2017] [Indexed: 02/06/2023] Open
Abstract
Background: Risk factors for intracerebral hemorrhage (ICH) include hypertension and cerebral amyloid angiopathy (CAA). The objective of this study was to determine the autopsy prevalence of CAA and the potential overlap with other risk factors among patients who died from ICH and also the correlation of CAA with cerebral microbleeds. Methods: We analyzed 81 consecutive autopsy brains from patients with ICH. Staining for CAA detection was performed. We used an age- and sex-matched control group of routine brain autopsies of nonneurological patients to determine the frequencies of CAA and hypertension. Postmortem 3D T2-weighted gradient-echo magnetic resonance imaging (MRI) with a 1.5-T magnet was performed in 11 brains with ICH (5 with CAA and 6 without) and histological correlation was performed when microbleeds were detected. Results: Hypertension and CAA were found in 69.1 and 24.7% of cases respectively. Among patients with CAA, 65.0% also had hypertension. The prevalence of CAA was similar among non-hypertensive cases and controls (33.3 and 23.1%; p = 0.54), whereas a significant difference was found between hypertensive cases vs. controls (28.9% vs. 0; p = 0.01). MRI documented 48 microbleeds and all 5 brains with CAA had ≥1 microbleed, compared to 3/6 brains without CAA. Among 48 microbleeds on MRI, 45 corresponded histologically to microbleeds surrounding microvessels (23 <200 µm in diameter, 19 between 200 µm and 2 mm, 3 were hemosiderin granules). Conclusions: Both hypertension and CAA frequently coexist in patients with ICH. MRI-detected microbleeds, proven by histological analysis, were twice as common in patients with CAA as in those with hypertensive ICH.
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13
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Topographic distribution of brain iron deposition and small cerebrovascular lesions in amyotrophic lateral sclerosis and in frontotemporal lobar degeneration: a post-mortem 7.0-tesla magnetic resonance imaging study with neuropathological correlates. Acta Neurol Belg 2017; 117:873-878. [PMID: 28988390 DOI: 10.1007/s13760-017-0832-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is associated with frontotemporal lobar degeneration (FTLD) in 15% of the cases. A neuropathological continuity between ALS and FTLD-TDP is suspected. The present post-mortem 7.0-tesla magnetic resonance imaging (MRI) study compares the topographic distribution of iron (Fe) deposition and the incidence of small cerebrovascular lesions in ALS and in FTLD brains. Seventy-eight post-mortem brains underwent 7.0-tesla MRI. The patients consisted of 12 with ALS, 38 with FTLD, and 28 controls. Three ALS brains had minor FTLD features. Three coronal sections of a cerebral hemisphere were submitted to T2 and T2* MRI sequences. The amount of Fe deposition in the deep brain structures and the number of small cerebrovascular lesions was determined in ALS and the subtypes of FTLD compared to control brains, with neuropathological correlates. A significant increase of Fe deposition was observed in the claustrum, caudate nucleus, globus pallidus, thalamus, and subthalamic nucleus of the FTLD-FUS and FTLD-TDP groups, while in the ALS one, the Fe increase was only observed in the caudate and the subthalamic nuclei. White matter changes were only significantly more severe in the FTLD compared to those in ALS and in controls brains. Cortical micro-bleeds were increased in the frontal and temporal lobes of FTLD as well as of ALS brains compared to controls. Cortical micro-infarcts were, on the other hand, more frequent in the control compared to the ALS and FTLD groups. The present study supports the assumption of a neuropathological continuity between ALS and FTLD and illustrates the favourable vascular risk profile in these diseases.
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De Reuck JL, Deramecourt V, Auger F, Durieux N, Maurage CA, Pasquier F, Cordonnier C, Leys D, Bordet R. Cerebrovascular Lesions in Mixed Neurodegenerative Dementia: A Neuropathological and Magnetic Resonance Study. Eur Neurol 2017; 78:1-5. [PMID: 28478439 DOI: 10.1159/000476032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/18/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND In elderly brains of demented patients, Alzheimer and Lewy body pathology (LBP) are frequently associated. Cortical microinfarcts (CoMIs) are more observed in Lewy body disease, even in the absence of cerebral amyloid angiopathy (CAA). The present neuropathological and 7.0-tesla MRI studies investigate whether CoMIs are also more frequent in mixed neurodegenerative dementia syndromes. SUMMARY Both examinations revealed that CoMIs are increased to different degrees in mixed dementia syndromes according to the severity of the LBP. They were mainly associated with a trend of older age and arterial hypertension in the patients with the most severe LBP. Messages: The increased number of CoMIs in mixed dementia syndromes with LBP is mainly due to the associated cerebrovascular pathology, even in the absence of CAA.
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Affiliation(s)
- Jacques L De Reuck
- Lille University, INSERM 1737 Degenerative and Vascular Cognitive Disorders, Lille, France
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15
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Abstract
Cerebrovascular disease (CVD) is the second leading cause of cognitive impairment in late life. Structural neuroimaging offers the most sensitive and specific biomarkers for hemorrhages and infarcts, but there are significant limitations in its ability to detect microvascular disease, microinfarcts, dynamic changes in the blood-brain barrier, and preclinical cerebrovascular disease. Autopsy studies disclose the common co-occurrence of vascular and neurodegenerative conditions, suggesting that in late life, a multifactorial approach to cognitive impairment may be more appropriate than traditional dichotomous classifications. Management of vascular risk factors remains a proven and practical approach to reducing acute and progressive cognitive impairment and dementia.
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Affiliation(s)
- Helena C Chui
- Department of Neurology, University of Southern California, 1540 Alcazar Street, CHP215, Los Angeles, CA 90033, USA.
| | - Liliana Ramirez Gomez
- Department of Neurology, University of California San Francisco, 400 Parnassus Avenue, A871, San Francisco, CA 94143, USA
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Sakiev K, Battakova S, Namazbaeva Z, Ibrayeva L, Otarbayeva M, Sabirov Z. Neuropsychological state of the population living in the Aral Sea region (zone of ecological crisis). INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2017; 23:87-93. [PMID: 29359636 PMCID: PMC6060854 DOI: 10.1080/10773525.2018.1425655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
Abstract
Background The Aral Sea crisis has led to harmful effects on human habitat. In recent years, mild cognitive impairment is a growing problem. Objectives This article provides the results of studying the neuropsychological state of residents living in the crisis zone of the Aral Sea region in the case of Shalkar city. We have provided an assessment of the neuropsychological state of examined population and determined the leading pathology in this region. Methods The survey sample included 344 persons of reproductive age from 21 to 45 years. We have obtained results in biochemical studies, indicating perturbations of proteometabolism and lipid metabolism. Results A correlation analysis showed dependence between a decrease of albumin and high-density lipoproteins, an increase of low-density lipoproteins and parameters of cognitive function. Conclusions The research suggests a high prevalence of cerebrovascular pathology among the population, changes in cognitive function parameters, long-term and short-term memory problems and high levels of depression.
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Affiliation(s)
- Kanat Sakiev
- Laboratory Occupational Physiology and Ergonomics Department, National Center of Labor Hygiene and Occupational Diseases, Karaganda, Kazakhstan
| | - Sharbanu Battakova
- Professional Laboratory of Neurology Department, National Center of Labor Hygiene and Occupational Diseases, Karaganda, Kazakhstan
| | - Zulkiya Namazbaeva
- Laboratory of Ecological Biochemistry, Biophysics and Genetics Department, National Center of Labor Hygiene and Occupational Diseases, Karaganda, Kazakhstan
| | - Lyazat Ibrayeva
- Department of Laboratory Eco-Industrial Diseases, National Center of Labor Hygiene and Occupational Diseases, Karaganda, Kazakhstan
| | - Maral Otarbayeva
- Service Management Research and Innovation Department, National Center of Labor Hygiene and Occupational Diseases, Karaganda, Kazakhstan
| | - Zhanbol Sabirov
- Laboratory of Ecological Biochemistry, Biophysics and Genetics Department, National Center of Labor Hygiene and Occupational Diseases, Karaganda, Kazakhstan
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17
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Radiologic-Histopathologic Correlation of Cerebral Microbleeds Using Pre-Mortem and Post-Mortem MRI. PLoS One 2016; 11:e0167743. [PMID: 27936213 PMCID: PMC5147972 DOI: 10.1371/journal.pone.0167743] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/20/2016] [Indexed: 12/23/2022] Open
Abstract
Introduction Cerebral microbleeds (CMB), also known as cerebral microhemorrhages, are small areas of susceptibility on brain magnetic resonance imaging (MRI), that are increasingly detected due to the higher availability of high-field MRI systems and dedicated pulse sequences. The prevalence of CMBs increases in cases with cognitive decline. The current investigation assessed the poorly investigated radiologic–histopathologic correlation of CMBs on MRI. Methods The local ethical committee approved the current investigation. We retrospectively assessed a consecutive series of 1303 autopsy cases hospitalized in Geneva University Hospitals between 2000–2014. Of 112 cases with pre-mortem T2* sequences, we included 25 cases (mean age 77.3 ± 9.6, 9 females) with at least one CMB. We compared pre-mortem CMBs with targeted histopathology and post-mortem MRI. Results 25 cases had 31 CMB lesions detected by pre-mortem MRI. 25 additional CMB were detected on histopathology. 4 CMBs on pre-mortem MRI were false positives, resulting in a total of 52 CMBs. 27 CMBs on pre-mortem MRI were confirmed on histopathology, corresponding to a sensitivity or true positive rate of 51.9% (95% CI 37.6–66.0%). The false negative rate of pre-mortem MRI was 48.1% (95% CI 34.0–62.4%). Post-mortem MRI showed only 3 cases with additional CMBs. Overall, pre-mortem MRI significantly underestimated CMBs (p = 0.0001). Conclusions Routine clinical brain MRI underestimates the prevalence of CMBs by approximately 50%, and 12% of radiologic pre-mortem MRI CMBs were false positives. Post-mortem MRI confirmed that this discordance is not explained by microbleeds occurring after the pre-mortem MRI.
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18
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Heiss WD, Rosenberg GA, Thiel A, Berlot R, de Reuck J. Neuroimaging in vascular cognitive impairment: a state-of-the-art review. BMC Med 2016; 14:174. [PMID: 27806705 PMCID: PMC5094143 DOI: 10.1186/s12916-016-0725-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 10/25/2016] [Indexed: 01/07/2023] Open
Abstract
Imaging is critical in the diagnosis and treatment of dementia, particularly in vascular cognitive impairment, due to the visualization of ischemic and hemorrhagic injury of gray and white matter. Magnetic resonance imaging (MRI) and positron emission tomography (PET) provide structural and functional information. Clinical MRI is both generally available and versatile - T2-weighted images show infarcts, FLAIR shows white matter changes and lacunar infarcts, and susceptibility-weighted images reveal microbleeds. Diffusion MRI adds another dimension by showing graded damage to white matter, making it more sensitive to white matter injury than FLAIR. Regions of neuroinflammatory disruption of the blood-brain barrier with increased permeability can be quantified and visualized with dynamic contrast-enhanced MRI. PET shows metabolism of glucose and accumulation of amyloid and tau, which is useful in showing abnormal metabolism in Alzheimer's disease. Combining MRI and PET allows identification of patients with mixed dementia, with MRI showing white matter injury and PET demonstrating regional impairment of glucose metabolism and deposition of amyloid. Excellent anatomical detail can be observed with 7.0-Tesla MRI. Imaging is the optimal method to follow the effect of treatments since changes in MRI scans are seen prior to those in cognition. This review describes the role of various imaging modalities in the diagnosis and treatment of vascular cognitive impairment.
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Affiliation(s)
- Wolf-Dieter Heiss
- Max Planck Institute for Metabolism Research, Gleueler str. 50, D-50931, Cologne, Germany.
| | - Gary A Rosenberg
- Department of Neurology, UNM Memory and Aging Center, MSC 11 6035, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Alexander Thiel
- Department of Neurology & Neurosurgery, McGill University at SMBD Jewish General Hospital and Lady Davis Institute for Medical Research, Montreal, H3T 1E2, Québec, Canada
| | - Rok Berlot
- Department of Neurology (R.B.), University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia
| | - Jacques de Reuck
- INSERM U1171, Degenerative and Vascular Cognitive Disorders, Université Lille 2, Lille, France
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19
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Castellani RJ, Mojica G, Perry G. The Role of the Iron Stain in Assessing Intracranial Hemorrhage. Open Neurol J 2016; 10:136-142. [PMID: 27857815 PMCID: PMC5090778 DOI: 10.2174/1874205x01610010136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/07/2016] [Accepted: 07/26/2016] [Indexed: 11/22/2022] Open
Abstract
The timing of the breakdown of red blood cells and organization of hemorrhage has significance in the catabolism of heme and the processing of iron, but also has a practical application in terms of assigning, or attempting to assign, a time course with respect to traumatic events (e.g. contusions and hemorrhages). Attempts to date contusions, however, have generally been unsuccessful by macroscopic observation, whereas the microscopic observations provide broad data but are also anatomically imprecise as a function of time. Intracranial lesions are of particular significance with respect to the timing of organizing hemorrhage given the acute, and often life-threatening nature of the hemorrhages, and the medicolegal investigation into potential crimes. Of concern is that the Prussian Blue reaction for iron, a relatively straightforward histochemical reaction that has been in use for over 150 years, is sometimes suggested as a diagnostic test for chronicity. Therefore, this study examined the utility of the Prussian Blue iron stain in living patients with intracranial hemorrhages and well-defined symptom onset, to test whether the presence of Prussian Blue reactivity could be correlated with chronicity. It was found that out of 12 cases with intracranial hemorrhage, eight cases showed at least focal iron reactivity. The duration from symptom onset to surgery in those eight cases ranged from < 24 hours to more than 3 days. Of those cases with no iron reactivity, the duration from symptom onset to surgery ranged from < 24 hours to six days. In conclusion, the Prussian Blue reaction was unreliable as an indicator of timing in intracranial hemorrhage. The use of the Prussian blue reaction as an independent indicator of chronicity is therefore not valid and can be misleading. Caution is indicated when employing iron staining for timing purposes, as its only use is to highlight, as opposed to identify, pre-existing lesions. With respect to brain lesions, the Prussian blue reaction should not be used in place of the clinical timing of the neurologic decline, or clinical data that is otherwise more accurate and less susceptible to false positive results.
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Affiliation(s)
- Rudy J Castellani
- University of Maryland School of Medicine, Baltimore, Maryland, USA; Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | | | - George Perry
- College of Sciences, University of Texas, San Antonio, Texas, USA
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20
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De Reuck J, Cordonnier C, Deramecourt V, Auger F, Durieux N, Leys D, Pasquier F, Maurage CA, Bordet R. Lobar intracerebral haematomas: Neuropathological and 7.0-tesla magnetic resonance imaging evaluation. J Neurol Sci 2016; 369:121-125. [PMID: 27653876 DOI: 10.1016/j.jns.2016.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 07/29/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE The Boston criteria for cerebral amyloid angiopathy (CAA) need validation by neuropathological examination in patients with lobar cerebral haematomas (LCHs). In "vivo" 1.5-tesla magnetic resonance imaging (MRI) is unreliable to detect the age-related signal changes in LCHs. This post-mortem study investigates the validity of the Boston criteria in brains with LCHs and the signal changes during their time course with 7.0-tesla MRI. MATERIALS AND METHODS Seventeen CAA brains including 26 LCHs were compared to 13 non-CAA brains with 14 LCHs. The evolution of the signal changes with time was examined in 25 LCHs with T2 and T2* 7.0-tesla MRI. RESULTS In the CAA group LCHs were predominantly located in the parieto-occipital lobes. Also white matter changes were more severe with more cortical microinfarcts and cortical microbleeds. On MRI there was a progressive shift of the intensity of the hyposignal from the haematoma core in the acute stage to the boundaries later on. During the residual stage the hyposignal mildly decreased in the boundaries with an increase of the superficial siderosis and haematoma core collapse. CONCLUSIONS Our post-mortem study of LCHs confirms the validity of the Boston criteria for CAA. Also 7.0-tesla MRI allows staging the age of the LCHs.
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Affiliation(s)
- Jacques De Reuck
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France.
| | - Charlotte Cordonnier
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Vincent Deramecourt
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Florent Auger
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Nicolas Durieux
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Didier Leys
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Florence Pasquier
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Claude-Alain Maurage
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Regis Bordet
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
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21
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McAleese KE, Alafuzoff I, Charidimou A, De Reuck J, Grinberg LT, Hainsworth AH, Hortobagyi T, Ince P, Jellinger K, Gao J, Kalaria RN, Kovacs GG, Kövari E, Love S, Popovic M, Skrobot O, Taipa R, Thal DR, Werring D, Wharton SB, Attems J. Post-mortem assessment in vascular dementia: advances and aspirations. BMC Med 2016; 14:129. [PMID: 27600683 PMCID: PMC5011905 DOI: 10.1186/s12916-016-0676-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 08/19/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cerebrovascular lesions are a frequent finding in the elderly population. However, the impact of these lesions on cognitive performance, the prevalence of vascular dementia, and the pathophysiology behind characteristic in vivo imaging findings are subject to controversy. Moreover, there are no standardised criteria for the neuropathological assessment of cerebrovascular disease or its related lesions in human post-mortem brains, and conventional histological techniques may indeed be insufficient to fully reflect the consequences of cerebrovascular disease. DISCUSSION Here, we review and discuss both the neuropathological and in vivo imaging characteristics of cerebrovascular disease, prevalence rates of vascular dementia, and clinico-pathological correlations. We also discuss the frequent comorbidity of cerebrovascular pathology and Alzheimer's disease pathology, as well as the difficult and controversial issue of clinically differentiating between Alzheimer's disease, vascular dementia and mixed Alzheimer's disease/vascular dementia. Finally, we consider additional novel approaches to complement and enhance current post-mortem assessment of cerebral human tissue. CONCLUSION Elucidation of the pathophysiology of cerebrovascular disease, clarification of characteristic findings of in vivo imaging and knowledge about the impact of combined pathologies are needed to improve the diagnostic accuracy of clinical diagnoses.
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Affiliation(s)
- Kirsty E McAleese
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Irina Alafuzoff
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | | | - Lea T Grinberg
- Departments of neurology and Pathology, University of California, San Francisco, USA.,Department of Pathology - LIM-22, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Atticus H Hainsworth
- Institute of Cardiovascular and Cell Sciences, St George's University of London, London, UK
| | - Tibor Hortobagyi
- Department of Neuropathology, University of Debrecen, Debrecen, Hungary
| | - Paul Ince
- Sheffield Institute for Translational Neuroscience, Sheffield, UK
| | | | - Jing Gao
- Neurological Department, Peking Union Medical College Hospital, Beijing, China
| | - Raj N Kalaria
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Gabor G Kovacs
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Enikö Kövari
- Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland
| | - Seth Love
- Clincial Neurosciences, University of Bristol, Bristol, UK
| | - Mara Popovic
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Olivia Skrobot
- Clincial Neurosciences, University of Bristol, Bristol, UK
| | - Ricardo Taipa
- Unit of Neuropathology, Centro Hospitalar do Porto, University of Porto, Porto, Portugal
| | - Dietmar R Thal
- Department of Neuroscience, KU-Leuven and Department of Pathology, UZ-Leuven, Leuven, Belgium
| | - David Werring
- Institute of Neurology, University College London, London, UK
| | | | - Johannes Attems
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
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Evaluating the Role of Reduced Oxygen Saturation and Vascular Damage in Traumatic Brain Injury Using Magnetic Resonance Perfusion-Weighted Imaging and Susceptibility-Weighted Imaging and Mapping. Top Magn Reson Imaging 2016; 24:253-65. [PMID: 26502307 DOI: 10.1097/rmr.0000000000000064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The cerebral vasculature, along with neurons and axons, is vulnerable to biomechanical insult during traumatic brain injury (TBI). Trauma-induced vascular injury is still an underinvestigated area in TBI research. Cerebral blood flow and metabolism could be important future treatment targets in neural critical care. Magnetic resonance imaging offers a number of key methods to probe vascular injury and its relationship with traumatic hemorrhage, perfusion deficits, venous blood oxygen saturation changes, and resultant tissue damage. They make it possible to image the hemodynamics of the brain, monitor regional damage, and potentially show changes induced in the brain's function not only acutely but also longitudinally following treatment. These methods have recently been used to show that even mild TBI (mTBI) subjects can have vascular abnormalities, and thus they provide a major step forward in better diagnosing mTBI patients.
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23
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De Reuck J, Auger F, Durieux N, Cordonnier C, Deramecourt V, Pasquier F, Maurage CA, Leys D, Bordet R. Topographic distribution of white matter changes and lacunar infarcts in neurodegenerative and vascular dementia syndromes: A post-mortem 7.0-tesla magnetic resonance imaging study. Eur Stroke J 2016; 1:122-129. [PMID: 31008274 DOI: 10.1177/2396987316650780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 04/27/2016] [Indexed: 12/11/2022] Open
Abstract
Background White matter changes and lacunar infarcts are regarded as linked to the same underlying small-vessel pathology. On magnetic resonance imaging, white matter changes are frequently observed, while the number of lacunar infarcts is probably underestimated. The present study post-mortem 7.0-tesla magnetic resonance imaging study compares the severity and the distribution of white matter changes and lacunar infarcts in different neurodegenerative and vascular dementia syndromes in order to determine their impact on the disease evolution. Patients and methods Eighty-four post-mortem brains consisting of 15 patients with pure Alzheimer's disease and 12 with associated cerebral amyloid angiopathy, 14 patients with frontotemporal lobar degeneration, 7 with Lewy body dementia, 10 with progressive supranuclear palsy, 14 with vascular dementia and 12 control brains were examined. Six hemispheric coronal sections of each brain underwent 7.0-tesla magnetic resonance imaging. Location and severity of white matter changes and lacunar infarcts were evaluated semi-quantitatively in each section separately. Results White matter changes predominated in the prefrontal and frontal sections of frontotemporal lobar degeneration and in the post-central section of associated cerebral amyloid angiopathy brains, while overall increased in vascular dementia cases. Lacunar infarcts were more frequent in the vascular dementia brains and mainly increased in the centrum semiovale. Conclusions White matter changes have a different topographic distribution in neurodegenerative diseases and are most severe and extended in vascular dementia. Lacunar infarcts predominate in the deep white matter of vascular dementia compared to the neurodegenerative diseases. Vascular cognitive impairment is mainly linked to white matter changes due to chronic ischaemia as well as to lacunar infarcts due to small-vessel occlusion.
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Affiliation(s)
| | | | | | | | | | | | | | - Didier Leys
- Université Lille 2, INSERM U 1171, Lille, France
| | - Regis Bordet
- Université Lille 2, INSERM U 1171, Lille, France
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Birkl C, Langkammer C, Golob-Schwarzl N, Leoni M, Haybaeck J, Goessler W, Fazekas F, Ropele S. Effects of formalin fixation and temperature on MR relaxation times in the human brain. NMR IN BIOMEDICINE 2016; 29:458-465. [PMID: 26835664 DOI: 10.1002/nbm.3477] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 06/05/2023]
Abstract
Post-mortem MRI of the brain is increasingly applied in neuroscience for a better understanding of the contrast mechanisms of disease induced tissue changes. However, the influence of chemical processes caused by formalin fixation and differences in temperature may hamper the comparability with results from in vivo MRI. In this study we investigated how formalin fixation and temperature affect T1, T2 and T2* relaxation times of brain tissue. Fixation effects were examined with respect to changes in water content and crosslinking. Relaxometry was performed in brain slices from five deceased subjects at different temperatures. All measurements were repeated after 190 days of formaldehyde immersion. The water content of unfixed and fixed tissue was determined using the wet-to-dry ratio following drying. Protein weight was determined with sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Fixation caused a strong decrease of all relaxation times, the strongest effect being seen on T1, with a reduction of up to 76%. The temperature coefficient of T1 was lower in the fixed than unfixed tissue, which was in contrast to T2, where an increase of the temperature coefficient was observed following fixation. The reduction of the water content after fixation was in the range of 1-6% and thus not sufficient to explain the changes in relaxation time. Results from SDS-PAGE indicated a strong increase of the protein size above 260 kDa in all brain structures examined. Our results suggest that crosslinking induced changes of the macromolecular matrix are responsible for T1 shortening and a decreased temperature dependency. The relaxation times provided in this work should allow optimization of post-mortem MRI protocols for the brain.
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Affiliation(s)
- Christoph Birkl
- Department of Neurology, Medical University of Graz, Austria
| | - Christian Langkammer
- Department of Neurology, Medical University of Graz, Austria
- MGH Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Nicole Golob-Schwarzl
- Department of Neuropathology, Institute of Pathology, Medical University of Graz, Austria
| | - Marlene Leoni
- Department of Neuropathology, Institute of Pathology, Medical University of Graz, Austria
| | - Johannes Haybaeck
- Department of Neuropathology, Institute of Pathology, Medical University of Graz, Austria
| | - Walter Goessler
- Institute of Chemistry, Analytical Chemistry, University of Graz, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Austria
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25
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Esin RG, Esin OR, Khairullin IK. [Discirculatory encephalopathy and small vessel disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2016. [PMID: 28635746 DOI: 10.17116/jnevro201611681109-113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The report examines the practicability of the term 'discirculatory encephalopathy' used in the Russian Federation to designate the chronic cerebral ischemia of different origin. The authors discuss the state of small vessel disease which manifests itself through slowly progressive cerebral changes. On the basis of their own research results and literature review the authors conclude that a standardized extract of Ginkgo biloba EGb761 (tanakan) can be effectively used in patients with small vessel disease.
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Affiliation(s)
- R G Esin
- Kazan State Medical Academy, Kazan, Russia; Kazan Federal University, Kazan, Russia
| | - O R Esin
- Kazan Federal University, Kazan, Russia
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Shams S, Wahlund LO. Cerebral microbleeds as a biomarker in Alzheimer's disease? A review in the field. Biomark Med 2015; 10:9-18. [PMID: 26641942 DOI: 10.2217/bmm.15.101] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cerebral microbleeds (CMBs) are a marker of small vessel disease, increasingly recognized as being of importance in the Alzheimer's disease (AD) process. CMBs influence in AD, and its longitudinal impact on disease progression is however still unknown. CMBs show several associations with AD across studies, are associated with decreased cerebrospinal fluid amyloid levels and are related with the ApoE ϵ4 allele, as well as other imaging manifestations typical for small vessel disease. CMBs, in addition to other markers of small vessel disease, are important to discover further in order to discern possible AD phenotypes.
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Affiliation(s)
- Sara Shams
- Department of Clinical Science, Intervention & Technology, Division of Medical Imaging & Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Olof Wahlund
- Department of Neurobiology, Care Sciences & Society, Karolinska Institutet, Stockholm, Sweden. Division of Clinical Geriatrics, Karolinska University Hospital, Stockholm, Sweden
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De Reuck J, Auger F, Durieux N, Deramecourt V, Cordonnier C, Pasquier F, Maurage CA, Leys D, Bordet R. Topography of Cortical Microbleeds in Alzheimer's Disease with and without Cerebral Amyloid Angiopathy: A Post-Mortem 7.0-Tesla MRI Study. Aging Dis 2015; 6:437-43. [PMID: 26618045 DOI: 10.14336/ad.2015.0429] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/29/2015] [Indexed: 11/01/2022] Open
Abstract
Cortical microbleeds (CMBs) detected on T2*-weighted gradient-echo (GRE) magnetic resonance imaging (MRI) are considered as a possible hallmark of cerebral amyloid angiopathy (CAA). The present post-mortem 7.0-tesla MRI study investigates whether topographic differences exist in Alzheimer's brains without (AD) and with CAA (AD-CAA). The distribution of CMBs in thirty-two post-mortem brains, consisting of 12 AD, 8 AD-CAA and 12 controls, was mutually compared on T2*-GRE MRI of six coronal sections of a cerebral hemisphere. The mean numbers of CMBs were determined in twenty-two different gyri. As a whole there was a trend of more CMBs on GRE MRI in the prefrontal section of the AD, the AD-CAA as well as of the control brains. Compared to controls AD brains had significantly more CMBs in the superior frontal, the inferior temporal, the rectus and the cinguli gyrus, and in the insular cortex. In AD-CAA brains CMBs were increased in all gyri with exception of the medial parietal gyrus and the hippocampus. AD-CAA brains showed a highly significant increase of CMBs in the inferior parietal gyrus (p value: 0.001) and a significant increase in the precuneus and the cuneus (p value: 0.01) compared to the AD brains. The differences in topographic distribution of CMBs between AD and AD-CAA brains should be further investigated on MRI in clinically suspected patients.
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Affiliation(s)
- J De Reuck
- Université de Lille 2, INSERM U1171, F-59000 Lille, France
| | - F Auger
- Université de Lille 2, INSERM U1171, F-59000 Lille, France
| | - N Durieux
- Université de Lille 2, INSERM U1171, F-59000 Lille, France
| | - V Deramecourt
- Université de Lille 2, INSERM U1171, F-59000 Lille, France
| | - C Cordonnier
- Université de Lille 2, INSERM U1171, F-59000 Lille, France
| | - F Pasquier
- Université de Lille 2, INSERM U1171, F-59000 Lille, France
| | - C A Maurage
- Université de Lille 2, INSERM U1171, F-59000 Lille, France
| | - D Leys
- Université de Lille 2, INSERM U1171, F-59000 Lille, France
| | - R Bordet
- Université de Lille 2, INSERM U1171, F-59000 Lille, France
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Kövari E, Charidimou A, Herrmann FR, Giannakopoulos P, Bouras C, Gold G. No neuropathological evidence for a direct topographical relation between microbleeds and cerebral amyloid angiopathy. Acta Neuropathol Commun 2015; 3:49. [PMID: 26268348 PMCID: PMC4535376 DOI: 10.1186/s40478-015-0228-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 02/02/2023] Open
Abstract
Introduction Cerebral microbleeds correspond to blood breakdown products, including hemosiderin-containing macrophages around small vessels on histological examination. Superficial lobar cerebral microbleeds are increasingly recognized on MRI as a biomarker of cerebral amyloid angiopathy but the direct association between amyloid-laden vessels burden and cerebral microbleeds has yet to be validated neuropathologically. To address this issue, we examined the frequency of histopathologically-defined cerebral microbleeds in different brain regions and their relationship with cerebral amyloid angiopathy in a large autopsy population. Results The frontal, parietal and occipital cortex as well as the adjacent white matter and basal ganglia of 113 consecutive autopsies were examined. Cerebral microbleedss were identified on haematoxylin-eosin-stained histological slides, cerebral amyloid angiopathy using anti-amyloid antibody. Cerebral microbleeds were present in 92.9 % of the cases and cerebral amyloid angiopathy in 44.3 % of them. Cerebral microbleeds were more frequent in parietal and frontal lobes followed by the occipital region and basal ganglia. In contrast, cerebral amyloid angiopathy was most frequent in the occipital lobe. There was no significant topographical association between cerebral amyloid angiopathy presence or severity and cerebral microbleeds in any brain region. In lobar areas, cerebral amyloid angiopathy was found in the cortex, predominantly affecting pial arteries and their superficial cortical branches, in contrast to microbleeds which were mainly in the white matter and occurred around deeper arteries and arterioles, including the subcortical segment of long penetrating branches of pial vessels. Conclusions Our study does not support a direct relation between cerebral microbleeds and cerebral amyloid angiopathy burden at the neuropathological level, raising intriguing questions on the potential pathophysiological mechanisms of cerebral microbleeds in the context of cerebral amyloid angiopathy or other small vessel disease pathology.
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Wardlaw JM, Valdés Hernández MC, Muñoz-Maniega S. What are white matter hyperintensities made of? Relevance to vascular cognitive impairment. J Am Heart Assoc 2015; 4:001140. [PMID: 26104658 PMCID: PMC4599520 DOI: 10.1161/jaha.114.001140] [Citation(s) in RCA: 519] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Joanna M Wardlaw
- Division of Neuroimaging Sciences and Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (J.M.W., M.C.V.H., S.M.M.)
| | - Maria C Valdés Hernández
- Division of Neuroimaging Sciences and Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (J.M.W., M.C.V.H., S.M.M.)
| | - Susana Muñoz-Maniega
- Division of Neuroimaging Sciences and Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (J.M.W., M.C.V.H., S.M.M.)
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30
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De Reuck JL, Deramecourt V, Auger F, Durieux N, Cordonnier C, Devos D, Defebvre L, Moreau C, Capparos-Lefebvre D, Pasquier F, Leys D, Maurage CA, Bordet R. The Significance of Cortical Cerebellar Microbleeds and Microinfarcts in Neurodegenerative and Cerebrovascular Diseases. Cerebrovasc Dis 2015; 39:138-43. [DOI: 10.1159/000371488] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 12/10/2014] [Indexed: 11/19/2022] Open
Abstract
Background: As cortical microbleeds and microinfarcts in neurodegenerative and cerebrovascular diseases have been studied predominantly at the level of the cerebral hemispheres and linked to the presence of cerebral amyloid angiopathy (CAA), we aimed at determining with 7.0-tesla magnetic resonance imaging (MRI) whether the causes and the frequency of cortical cerebellar microbleeds (CCeMBs) and microinfarcts (CCeMIs) are the same. Materials and Methods: Hundred and four postmortem brains, composed of 29 with pure Alzheimer's disease (AD), 9 with AD associated to CAA, 10 with frontotemporal lobar degeneration, 9 with amyotrophic lateral sclerosis, 10 with Lewy body disease, 12 with progressive supranuclear palsy, 9 with vascular dementia (VaD), and 16 controls, were examined. On a horizontal section of a cerebellar hemisphere examined with 7.0-tesla MRI, the number CCeMBs and CCeMIs were compared between the different disease groups and the control group. The MRI findings were also compared with the corresponding mean values observed on histological examination of a separate standard horizontal section of a cerebellar hemisphere, used for diagnostic purpose. Results: CCeMBs and CCeMIs were only significantly increased in the VaD group. When comparing the diseased patients with and without CAA mutually and with those with arterial hypertension and severe atherosclerotic cerebrovascular disease, only in the latter an increase of CCeMBs and CCeMIs was observed. There was an excellent correlation between the MRI and the neuropathological findings. Conclusions: CCeMBs and CCeMIs are mainly due to atherosclerotic cerebrovascular disease and not due to CAA. Their increased presence cannot be included to the Boston diagnostic criteria for CAA.
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31
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Post-mortem 7.0-tesla magnetic resonance study of cortical microinfarcts in neurodegenerative diseases and vascular dementia with neuropathological correlates. J Neurol Sci 2014; 346:85-9. [DOI: 10.1016/j.jns.2014.07.061] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 07/19/2014] [Accepted: 07/29/2014] [Indexed: 11/18/2022]
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32
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Akoudad S, Ikram MA, Koudstaal PJ, Hofman A, Niessen WJ, Greenberg SM, van der Lugt A, Vernooij MW. Cerebral microbleeds are associated with the progression of ischemic vascular lesions. Cerebrovasc Dis 2014; 37:382-8. [PMID: 24970709 DOI: 10.1159/000362590] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 04/01/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite their different appearance on imaging, hemorrhagic and ischemic vascular lesions frequently co-occur in the brain and are hypothesized to progress concurrently. Although silent hemorrhagic and ischemic vascular brain lesions are highly prevalent in the general population, the concomitant progression of these lesions has only been studied to a limited extent in this population. We therefore aimed to investigate whether pre-existing and incident cerebral microbleeds (CMBs) are related to the progression of ischemic lesions in the general population. METHODS In the prospective population-based Rotterdam Scan Study, 803 individuals aged ≥60 years underwent magnetic resonance imaging at baseline and after an average interval of 3.4 years. The presence of microbleeds and lacunes was visually rated by trained research physicians, and white matter lesions (WMLs) were automatically segmented at both time points. Logistic regression was used to investigate the association of microbleeds with incident lacunes, and linear regression was used to investigate the relation between microbleeds and progression of WML volume. All analyses were adjusted for age, sex and the time interval between baseline and follow-up scanning. The analyses were repeated after additional adjustments for cardiovascular risk factors: blood pressures; total and high-density lipoprotein cholesterol; smoking; diabetes mellitus; lipid lowering, antihypertensive and antiplatelet medications, and apolipoprotein E ε4. The analyses involving WMLs were also adjusted for intracranial volume. RESULTS We found that pre-existing microbleeds in any location of the brain were related to a higher incidence of lacunes (odds ratio [OR] adjusted for age, sex and scan interval: 4.67; 95% confidence interval [CI]: 1.84-11.85). Pre-existing microbleeds were not related to progression of WML volume (mean difference in WML volume increase: -0.03; 95% CI: -0.15 to 0.09). Additional adjustments for cardiovascular risk factors did not change the results considerably. Incident microbleeds in any location of the brain were associated with a higher incidence of lacunes (OR: 9.18; 95% CI: 3.61-23.35), whereas only incident microbleeds located in cortico-subcortical regions were related to progression of WML volume (mean difference in WML volume increase: 0.41; 95% CI: 0.21-0.62). Again, adjustments for cardiovascular risk factors did not change the results significantly. CONCLUSIONS Our findings suggest that in the general population, CMBs serve as a predictor of ischemic brain lesions and may represent an imaging marker of active vasculopathy. These results support the hypothesis of a common underlying pathway in the development of ischemic and hemorrhagic brain lesions.
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Affiliation(s)
- Saloua Akoudad
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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33
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De Reuck JL, Deramecourt V, Auger F, Durieux N, Cordonnier C, Devos D, Defebvre L, Moreau C, Caparros-Lefebvre D, Leys D, Maurage CA, Pasquier F, Bordet R. Iron deposits in post-mortem brains of patients with neurodegenerative and cerebrovascular diseases: a semi-quantitative 7.0 T magnetic resonance imaging study. Eur J Neurol 2014; 21:1026-31. [PMID: 24698410 DOI: 10.1111/ene.12432] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/06/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE Accumulation of iron (Fe) is often detected in brains of people suffering from neurodegenerative diseases. However, no studies have compared the Fe load between these disease entities. The present study investigates by T2*-weighted gradient-echo 7.0 T magnetic resonance imaging (MRI) the Fe content in post-mortem brains with different neurodegenerative and cerebrovascular diseases. METHODS One hundred and fifty-two post-mortem brains, composed of 46 with Alzheimer's disease (AD), 37 with frontotemporal lobar degeneration (FTLD), 11 with amyotrophic lateral sclerosis, 13 with Lewy body disease, 14 with progressive supranuclear palsy, 16 with vascular dementia (VaD) and 15 controls without a brain disease, were examined. The Fe load was determined semi-quantitatively on T2*-weighted MRI serial brain sections in the claustrum, caudate nucleus, putamen, globus pallidus, thalamus, subthalamic nucleus, hippocampus, mamillary body, lateral geniculate body, red nucleus, substantia nigra and dentate nucleus. The disease diagnosis was made on subsequent neuropathological examination. RESULTS The Fe load was significantly increased in the claustrum, caudate nucleus and putamen of FTLD brains and to a lesser degree in the globus pallidus, thalamus and subthalamic nucleus. In the other neurodegenerative diseases no Fe accumulation was observed, except for a mild increase in the caudate nucleus of AD brains. In VaD brains no Fe increase was detected. CONCLUSIONS Only FTLD displays a significant Fe load, suggesting that impaired Fe homeostasis plays an important role in the pathogenesis of this heterogeneous disease entity.
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Affiliation(s)
- J L De Reuck
- Université Lille Nord de France, UDSL, EA 1046, Lille, France
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McAleese KE, Firbank M, Hunter D, Sun L, Hall R, Neal JW, Mann DMA, Esiri M, Jellinger KA, O'Brien JT, Attems J. Magnetic resonance imaging of fixed post mortem brains reliably reflects subcortical vascular pathology of frontal, parietal and occipital white matter. Neuropathol Appl Neurobiol 2014; 39:485-97. [PMID: 23075072 DOI: 10.1111/j.1365-2990.2012.01310.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/12/2012] [Indexed: 11/28/2022]
Abstract
AIMS Subcortical vascular pathology of the white and deep grey matter (WM and DGM) is associated with cognitive impairment. Routine neuropathological assessment of subcortical vascular pathology is based on semiquantitative scoring of characteristic lesions in a limited number of histological slides from selected WM and DGM areas. Clinically, WM and DGM lesions are visualized as hyper-intensities on magnetic resonance imaging (MRI). The aim of this study was to evaluate the feasibility of MRI on fixed post mortem brain hemispheres to complement routine neuropathological assessment of subcortical vascular pathology. METHODS We assessed subcortical vascular pathology in 40 post mortem brain hemispheres from demented (n = 26) and nondemented (n = 14) individuals (mean age 83.2 ± 14.8 years; 62.5% female) using (i) routine histological assessment; (ii) extensive histological assessment of the entire hemisphere at 7-mm intervals; and (iii) full T2-weighted MRI performed on fixed post mortem brain hemispheres. RESULTS In both WM and DGM routine histological scores for subcortical vascular pathology were significantly lower (P < 0.01) than the corresponding scores obtained by extensive histological assessment. In contrast, no significant differences were seen between scores obtained by MRI and extensive histological assessment in frontal, parietal and occipital lobes while MRI scores were significantly lower in the temporal WM and DGM (P < 0.01). CONCLUSIONS The results of our study indicate that routine histological assessment underrates subcortical vascular pathology and we conclude that MRI could be used in addition to complement neuropathological post mortem assessment of subcortical vascular pathology of the WM.
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Affiliation(s)
- K E McAleese
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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35
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Valdés Hernández MDC, Glatz A, Kiker AJ, Dickie DA, Aribisala BS, Royle NA, Muñoz Maniega S, Bastin ME, Deary IJ, Wardlaw JM. Differentiation of calcified regions and iron deposits in the ageing brain on conventional structural MR images. J Magn Reson Imaging 2013; 40:324-33. [PMID: 24923620 DOI: 10.1002/jmri.24348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/26/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE In the human brain, minerals such as iron and calcium accumulate increasingly with age. They typically appear hypointense on T2*-weighted MRI sequences. This study aims to explore the differentiation and association between calcified regions and noncalcified iron deposits on clinical brain MRI in elderly, otherwise healthy subjects. MATERIALS AND METHODS Mineral deposits were segmented on co-registered T1- and T2*-weighted sequences from 100 1.5 Tesla MRI datasets of community-dwelling individuals in their 70s. To differentiate calcified regions from noncalcified iron deposits we developed a method based on their appearance on T1-weighted images, which was validated with a purpose-designed phantom. Joint T1- and T2*-weighted intensity histograms were constructed to measure the similarity between the calcified and noncalcified iron deposits using a Euclidean distance based metric. RESULTS We found distinct distributions for calcified regions and noncalcified iron deposits in the cumulative joint T1- and T2*-weighted intensity histograms across all subjects (correlations ranging from 0.02 to 0.86; mean = 0.26 ± 0.16; t = 16.93; P < 0.001) consistent with differences in iron and calcium signal in the phantom. The mean volumes of affected tissue per subject for calcified and noncalcified deposits were 236.74 ± 309.70 mm(3) and 283.76 ± 581.51 mm(3); respectively. There was a positive association between the mineral depositions (β = 0.32, P < 0.005), consistent with existing literature reports. CONCLUSION Calcified mineral deposits and noncalcified iron deposits can be distinguished from each other by signal intensity changes on conventional 1.5T T1-weighted MRI and are significantly associated in brains of elderly, otherwise healthy subjects.
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Affiliation(s)
- Maria del C Valdés Hernández
- Brain Research Imaging Centre, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom; SINAPSE (Scottish Imaging Network, A Platform for Scientific Excellence) collaboration, Scotland, United Kingdom
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Deramecourt V. Vascular neuropathology and cognitive decline. Rev Neurol (Paris) 2013; 169:765-71. [DOI: 10.1016/j.neurol.2013.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/02/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
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Murao K, Rossi C, Cordonnier C. Intracerebral haemorrhage and cognitive decline. Rev Neurol (Paris) 2013; 169:772-8. [DOI: 10.1016/j.neurol.2013.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 07/22/2013] [Accepted: 07/22/2013] [Indexed: 01/27/2023]
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Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, Lindley RI, O'Brien JT, Barkhof F, Benavente OR, Black SE, Brayne C, Breteler M, Chabriat H, DeCarli C, de Leeuw FE, Doubal F, Duering M, Fox NC, Greenberg S, Hachinski V, Kilimann I, Mok V, Oostenbrugge RV, Pantoni L, Speck O, Stephan BCM, Teipel S, Viswanathan A, Werring D, Chen C, Smith C, van Buchem M, Norrving B, Gorelick PB, Dichgans M. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013; 12:822-38. [PMID: 23867200 PMCID: PMC3714437 DOI: 10.1016/s1474-4422(13)70124-8] [Citation(s) in RCA: 3478] [Impact Index Per Article: 316.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cerebral small vessel disease (SVD) is a common accompaniment of ageing. Features seen on neuroimaging include recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain atrophy. SVD can present as a stroke or cognitive decline, or can have few or no symptoms. SVD frequently coexists with neurodegenerative disease, and can exacerbate cognitive deficits, physical disabilities, and other symptoms of neurodegeneration. Terminology and definitions for imaging the features of SVD vary widely, which is also true for protocols for image acquisition and image analysis. This lack of consistency hampers progress in identifying the contribution of SVD to the pathophysiology and clinical features of common neurodegenerative diseases. We are an international working group from the Centres of Excellence in Neurodegeneration. We completed a structured process to develop definitions and imaging standards for markers and consequences of SVD. We aimed to achieve the following: first, to provide a common advisory about terms and definitions for features visible on MRI; second, to suggest minimum standards for image acquisition and analysis; third, to agree on standards for scientific reporting of changes related to SVD on neuroimaging; and fourth, to review emerging imaging methods for detection and quantification of preclinical manifestations of SVD. Our findings and recommendations apply to research studies, and can be used in the clinical setting to standardise image interpretation, acquisition, and reporting. This Position Paper summarises the main outcomes of this international effort to provide the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE).
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Affiliation(s)
- Joanna M Wardlaw
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Correspondence to: Prof Joanna M Wardlaw, Division of Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Eric E Smith
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary and Seaman Family MR Research Centre, Calgary, AL, Canada
| | - Geert J Biessels
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, UMC Utrecht, Utrecht, Netherlands
| | | | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Richard Frayne
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary and Seaman Family MR Research Centre, Calgary, AL, Canada
| | - Richard I Lindley
- University of Sydney and George Institute for Global Health, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, Netherlands
| | - Oscar R Benavente
- Department of Medicine, Division of Neurology, Brain Research Centre, University of British Columbia, Vancouver, BC, Canada
| | | | - Carol Brayne
- Cambridge Institute of Public Health, School of Clinical Medicine, Cambridge, UK
| | | | - Hugues Chabriat
- Service de Neurologie, Hopital Lariboisiere, INSERM, Université Denis Diderot, Paris, France
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, Sacramento, CA, USA
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Fergus Doubal
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - Marco Duering
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Nick C Fox
- Department of Neurodegeneration, Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Steven Greenberg
- Massachusetts General Hospital, Stroke Research Center, Boston, MA, USA
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE) Rostock and Greifswald, Rostock, Germany
| | - Vincent Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Robert van Oostenbrugge
- Department of Neurology, School of Mental Health and Neuroscience, and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Leonardo Pantoni
- Azienda Universitario Ospedaliera Careggi, Department of Neuroscience, Pharmacology and Child's Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Oliver Speck
- Department of Biomedical Magnetic Resonance, Faculty for Natural Sciences, Institute for Experimental Physics, Otto-von-Guericke UniversityMagdeburg, Magdeburg, Germany
| | | | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE) Rostock and Greifswald, Rostock, Germany
| | - Anand Viswanathan
- Massachusetts General Hospital, Stroke Research Center, Boston, MA, USA
| | - David Werring
- Stroke Research Group, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - Christopher Chen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mark van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Skåne University Hospital, Lund, Sweden
| | - Philip B Gorelick
- Saint Mary's Health Care, Hauenstein Neuroscience Center, Grand Rapids, MI, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Prof M Dichgans, Institute for Stroke and Dementia Research, Klinikum der Universität, Munich, Germany
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Kleinig TJ. Associations and implications of cerebral microbleeds. J Clin Neurosci 2013; 20:919-27. [DOI: 10.1016/j.jocn.2012.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/27/2012] [Accepted: 12/01/2012] [Indexed: 10/26/2022]
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Glatz A, Valdés Hernández MC, Kiker AJ, Bastin ME, Deary IJ, Wardlaw JM. Characterization of multifocal T2*-weighted MRI hypointensities in the basal ganglia of elderly, community-dwelling subjects. Neuroimage 2013; 82:470-80. [PMID: 23769704 PMCID: PMC3776225 DOI: 10.1016/j.neuroimage.2013.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/05/2013] [Indexed: 12/29/2022] Open
Abstract
Multifocal T2*-weighted (T2*w) hypointensities in the basal ganglia, which are believed to arise predominantly from mineralized small vessels and perivascular spaces, have been proposed as a biomarker for cerebral small vessel disease. This study provides baseline data on their appearance on conventional structural MRI for improving and automating current manual segmentation methods. Using a published thresholding method, multifocal T2*w hypointensities were manually segmented from whole brain T2*w volumes acquired from 98 community-dwelling subjects in their early 70s. Connected component analysis was used to derive the average T2*w hypointensity count and load per basal ganglia nucleus, as well as the morphology of their connected components, while nonlinear spatial probability mapping yielded their spatial distribution. T1-weighted (T1w), T2-weighted (T2w) and T2*w intensity distributions of basal ganglia T2*w hypointensities and their appearance on T1w and T2w MRI were investigated to gain further insights into the underlying tissue composition. In 75/98 subjects, on average, 3 T2*w hypointensities with a median total volume per intracranial volume of 50.3 ppm were located in and around the globus pallidus. Individual hypointensities appeared smooth and spherical with a median volume of 12 mm3 and median in-plane area of 4 mm2. Spatial probability maps suggested an association between T2*w hypointensities and the point of entry of lenticulostriate arterioles into the brain parenchyma. T1w and T2w and especially the T2*w intensity distributions of these hypointensities, which were negatively skewed, were generally not normally distributed indicating an underlying inhomogeneous tissue structure. Globus pallidus T2*w hypointensities tended to appear hypo- and isointense on T1w and T2w MRI, whereas those from other structures appeared iso- and hypointense. This pattern could be explained by an increased mineralization of the globus pallidus. In conclusion, the characteristic spatial distribution and appearance of multifocal basal ganglia T2*w hypointensities in our elderly cohort on structural MRI appear to support the suggested association with mineralized proximal lenticulostriate arterioles and perivascular spaces. A rater segmented focal hypointensities on T2*w brain MRI from 98 elderly subjects. On average 3 focal hypointensities were found in the basal ganglia of 75 subjects. Their spatial distribution suggests an association with lenticulostriate arterioles. Signal intensity distributions suggest an underlying inhomogeneous tissue structure.
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Affiliation(s)
- Andreas Glatz
- Brain Research Imaging Centre (BRIC), Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
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van Veluw SJ, Zwanenburg JJM, Engelen-Lee J, Spliet WGM, Hendrikse J, Luijten PR, Biessels GJ. In vivo detection of cerebral cortical microinfarcts with high-resolution 7T MRI. J Cereb Blood Flow Metab 2013; 33:322-9. [PMID: 23250109 PMCID: PMC3587820 DOI: 10.1038/jcbfm.2012.196] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cerebrovascular disease has an important role in cognitive decline and dementia. In this context, cerebral microinfarcts are attracting increasing attention, but these lesions could thus far not be detected in vivo. The aim of this study was to try to identify possible cortical microinfarcts on high-resolution 7T in vivo magnetic resonance imaging (MRI) and to perform a histopathologic validation study on similar appearing lesions on 7T ex vivo MRI of postmortem brain tissue. The study population consisted of 22 elderly subjects, who underwent 7T MRI. The fluid attenuated inversion recovery, T(2), and T(1) weighted scans of these subjects were examined for possible cortical microinfarcts. In the ex vivo MRI study, 15 formalin-fixed coronal brain slices of 6 subjects with Alzheimer and vascular pathology were examined and subjected to histopathologic verification. On the in vivo scans, 15 cortical lesions could be identified that were likely to be microinfarcts in 6 subjects. In the postmortem tissue, 6 similar appearing lesions were identified of which 5 were verified as cortical microinfarcts on histopathology. This study provides strong evidence that cortical microinfarcts can be detected in vivo, which will be of great value in further studies into the role of vascular disease in cognitive decline and dementia.
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Affiliation(s)
- Susanne J van Veluw
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
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De Reuck J, Deramecourt V, Cordonnier C, Auger F, Durieux N, Pasquier F, Bordet R, Defebvre L, Caparros-Lefebvre D, Maurage C, Leys D. Superficial Siderosis of the Central Nervous System: A Post-Mortem 7.0-Tesla Magnetic Resonance Imaging Study with Neuropathological Correlates. Cerebrovasc Dis 2013; 36:412-7. [DOI: 10.1159/000355042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022] Open
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Abstract
Magnetic resonance imaging (MRI) enables a noninvasive in vivo quantification of iron in various organs. Several techniques have been developed that detect signal alterations derived mainly from the magnetic properties of ferritin and hemosiderin, the major iron storage compounds. High magnetic susceptibility of ferritin shortens the transversal relaxation time of nearby water protons and thus induces a focal signal extinction of iron-rich areas in T2-weighted (T2w) MRI. T2w tissue contrast is additionally influenced by other factors such as water content, myelin density, and the presence of other metals. Therefore, more specific methods are needed with higher specificity to iron. These in vivo techniques can be divided into three groups: relaxometry, magnetic field correlation imaging and phase-based contrast covering susceptibility-weighted imaging, and quantitative susceptibility mapping. The differential diagnosis of various neurological disorders is aided by characteristic patterns of iron depositions. Reliable estimates of cerebral tissue iron concentration are equally important in studying physiological age-related as well as pathological conditions in neurodegenerative, neuroinflammatory, and vascular diseases. In the future, monitoring changes in iron storage and content may serve as sensitive biomarker for diagnosis as well as treatment monitoring.
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Affiliation(s)
- Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Institut für interventionelle und diagnostische Neuroradiologie, Universitätsmedizin Göttingen, Göttingen, Germany.
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Thal DR, Grinberg LT, Attems J. Vascular dementia: different forms of vessel disorders contribute to the development of dementia in the elderly brain. Exp Gerontol 2012; 47:816-24. [PMID: 22705146 PMCID: PMC3470831 DOI: 10.1016/j.exger.2012.05.023] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 05/27/2012] [Accepted: 05/30/2012] [Indexed: 01/22/2023]
Abstract
The diagnosis of vascular dementia (VaD) describes a group of various vessel disorders with different types of vascular lesions that finally contribute to the development of dementia. Most common forms of VaD in the elderly brain are subcortical vascular encephalopathy, strategic infarct dementia, and the multi infarct encephalopathy. Hereditary forms of VaD are rare. Most common is the cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Sporadic forms of VaD are caused by degenerative vessel disorders such as atherosclerosis, small vessel disease (SVD) including small vessel arteriosclerosis, arteriolosclerosis, and lipohyalinosis, and cerebral amyloid angiopathy (CAA). Less frequently inflammatory vessel disorders and tumor-associated vessel lesions (e.g. angiocentric T-cell or angiotropic large cell lymphoma) can cause symptoms of dementia. Here, we review and discuss the impact of vessel disorders to distinct vascular brain tissue lesions and to the development of dementia in elderly individuals. The impact of coexisting neurodegenerative pathology in the elderly brain to VaD as well as the correlation between SVD and CAA expansion in the brain parenchyma with that of Alzheimer's disease (AD)-related pathology is highlighted. We conclude that "pure" VaD is rare and most frequently caused by infarctions. However, there is a significant contribution of vascular lesions and vessel pathology to the development of dementia that may go beyond tissue damage due to vascular lesions. Insufficient blood blow and alterations of the perivascular drainage mechanisms of the brain may also lead to a reduced protein clearance from extracellular space and subsequent increase of proteins in the brain parenchyma, such as the amyloid β-protein, and foster, thereby, the development of AD-related neurodegeneration. As such, it seems to be important for clinical practice to consider treatment of potentially coexisting AD pathology in cognitively impaired patients with vascular lesions.
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Affiliation(s)
- Dietmar Rudolf Thal
- Institute of Pathology, Laboratory of Neuropathology, University of Ulm, Ulm, Germany.
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van der Kolk AG, Hendrikse J, Luijten PR. Ultrahigh-field magnetic resonance imaging: the clinical potential for anatomy, pathogenesis, diagnosis, and treatment planning in brain disease. Neuroimaging Clin N Am 2012; 22:343-62, xii. [PMID: 22548936 DOI: 10.1016/j.nic.2012.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this review, current (clinical) applications and possible future directions of ultrahigh-field (≥7 T) magnetic resonance (MR) imaging in the brain are discussed. Ultrahigh-field MR imaging can provide contrast-rich images of diverse pathologies and can be used for early diagnosis and treatment monitoring of brain disease. These images may provide increased sensitivity and specificity. Several limitations need to be overcome before worldwide clinical implementation can be commenced. Current literature regarding clinically based ultrahigh-field MR imaging is reviewed, and limitations and promises of this technique are discussed, as well as some practical considerations for the implementation in clinical practice.
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Affiliation(s)
- Anja G van der Kolk
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Postbox 85500, 3508 GA Utrecht, The Netherlands.
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Kinno R, Yamamoto M, Yamazaki T, Owan Y, Fukui T, Kinugasa E. Cerebral microhemorrhage in Marchiafava-Bignami disease detected by susceptibility-weighted imaging. Neurol Sci 2012; 34:545-8. [PMID: 22777568 DOI: 10.1007/s10072-012-1147-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 06/22/2012] [Indexed: 10/28/2022]
Abstract
Marchiafava-Bignami disease (MBD) is a rare alcohol-associated disorder. Clinical features include not only disturbed consciousness, dysarthria, tetraparesis, astasia-abasia, and symptoms of interhemispheric disconnection as initial symptoms but also cognitive deficits as clinical outcomes. The clinical significance of cerebral microhemorrhage (CMH) has been recognized in patients with cognitive deficits; however, the presence of CMH in patients with MBD has not been emphasized. The aim of the present study was to clarify the relationship between CMH and MBD. For this purpose, we report four patients with MBD, who showed asymmetrical hypointense areas in multiple cortico-subcortical regions on susceptibility-weighted imaging (SWI). All cases had a history of chronic alcohol abuse and symmetrical lesions in the entire corpus callosum. These patients' clinical symptoms included not only coma, dysarthria, and astasia-abasia as initial symptoms but also dementia as a clinical outcome. SWI showed asymmetrical hypointense areas in the multiple cortico-subcortical regions, indicating the presence of CMH. Compared with patients with normal cognitive function, demented patients showed higher severity of CMH. Our report would indicate that CMH is an important factor indicating the severity of dementia in patients with MBD.
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Affiliation(s)
- Ryuta Kinno
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki, Yokohama, Kanagawa 224-8503, Japan.
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Abstract
Several types of cerebrovascular lesions are associated with cognitive decline, but the role of each type in dementia manifestation has yet to be determined. One of the greatest barriers of conducting clinicopathological studies in vascular dementia concerns the overlapping of nomenclature for these lesions. The aim of the present review was to discuss current nomenclature for cerebrovascular lesions and suggest modifications to allow better diagnostic reproducibility in this field.
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Affiliation(s)
- Lea Tenenholz Grinberg
- Department of Neurology, University of California San Francisco - 675 Nelson Rising Lane, San Francisco - CA - 94158 - USA. Departamento de Patologia da FMUSP - Av. Dr. Arnaldo,455 / sala 1353 - 01246903 São Paulo SP, Brazil
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Valdés Hernández MDC, Maconick LC, Tan EMJ, Wardlaw JM. Identification of mineral deposits in the brain on radiological images: a systematic review. Eur Radiol 2012; 22:2371-81. [PMID: 22688125 DOI: 10.1007/s00330-012-2494-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 03/29/2012] [Accepted: 04/04/2012] [Indexed: 01/11/2023]
Abstract
OBJECTIVES MRI has allowed the study of mineral deposition in the brain throughout life and in disease. However, studies differ in their reporting of minerals on MRI for reasons that are unclear. METHODS We conducted a systematic review from 1985 to July 2011 to determine the appearance of iron, calcium, copper and manganese on MRI and CT and their reliability. We assessed which imaging investigations provided the most consistent results compared with histology. RESULTS Of 325 papers on minerals imaging, we included 46 studies that confirmed findings either directly or indirectly using a non-imaging method such as histology. Within this group, there was inconsistency in the identification of iron probably because of changes in its paramagnetic properties during its degradation. Iron appeared consistently hypointense only on T2*-weighted MRI, and along with calcified areas, hyperattenuated on CT. Appearance of copper, calcium and manganese, although consistently reported as hyperintense on T1-weighted MRI, was confirmed histologically in few studies. On T2-weighted imaging, calcified areas were always reported as hypointense, while the appearance of iron depended on the concentration, location and degradation stage. CONCLUSIONS More work is required to improve the reliability of imaging methods to detect and differentiate brain mineral deposition accurately. KEY POINTS There is inconsistency in reporting the appearance of minerals on radiological images. • Only 46 studies confirmed mineral appearance using a non-imaging method. • Iron is the mineral more widely studied, consistently hypointense on T2*-weighted MRI. • T1-weighted MRI consistently reported copper, calcium and manganese hyperintense. • Calcium is consistently reported hypointense on T2-weighted MRI and hyperattenuating on CT.
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De Reuck J, Deramecourt V, Cordonnier C, Auger F, Durieux N, Bordet R, Maurage CA, Leys D, Pasquier F. Detection of microbleeds in post-mortem brains of patients with frontotemporal lobar degeneration: a 7.0-Tesla magnetic resonance imaging study with neuropathological correlates. Eur J Neurol 2012; 19:1355-60. [DOI: 10.1111/j.1468-1331.2012.03776.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 04/24/2012] [Indexed: 11/30/2022]
Affiliation(s)
- J. De Reuck
- Université Lille Nord de France, UDSL; EA 1046; Lille France
| | - V. Deramecourt
- Université Lille Nord de France, UDSL; EA 1046; Lille France
- Memory Clinic; Lille University Hospital; Lille France
- Department of Pathology; Lille University Hospital; Lille France
- INSERM U837; Lille France
| | - C. Cordonnier
- Université Lille Nord de France, UDSL; EA 1046; Lille France
- Neurovascular Department; Lille University Hospital; Lille France
| | - F. Auger
- Université Lille Nord de France, UDSL; EA 1046; Lille France
- Imaging Platform Research Pole; Lille University Hospital; Lille France
| | - N. Durieux
- Université Lille Nord de France, UDSL; EA 1046; Lille France
- Imaging Platform Research Pole; Lille University Hospital; Lille France
| | - R. Bordet
- Université Lille Nord de France, UDSL; EA 1046; Lille France
- Department of Pharmacology; Lille University Hospital; Lille France
| | - C. A. Maurage
- Université Lille Nord de France, UDSL; EA 1046; Lille France
- Department of Pathology; Lille University Hospital; Lille France
- INSERM U837; Lille France
| | - D. Leys
- Université Lille Nord de France, UDSL; EA 1046; Lille France
- Neurovascular Department; Lille University Hospital; Lille France
| | - F. Pasquier
- Université Lille Nord de France, UDSL; EA 1046; Lille France
- Memory Clinic; Lille University Hospital; Lille France
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