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Janssen E, van Dalen JW, Cai M, Jacob MA, Marques J, Duering M, Richard E, Tuladhar AM, de Leeuw FE, Hilkens N. Visit-to-visit blood pressure variability and progression of white matter hyperintensities over 14 years. Blood Press 2024; 33:2314498. [PMID: 38477113 DOI: 10.1080/08037051.2024.2314498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
Purpose: There is evidence that blood pressure variability (BPV) is associated with cerebral small vessel disease (SVD) and may therefore increase the risk of stroke and dementia. It remains unclear if BPV is associated with SVD progression over years. We examined whether visit-to-visit BPV is associated with white matter hyperintensity (WMH) progression over 14 years and MRI markers after 14 years. Materials and methods: We included participants with SVD from the Radboud University Nijmegen Diffusion tensor Magnetic resonance-imaging Cohort (RUNDMC) who underwent baseline assessment in 2006 and follow-up in 2011, 2015 and 2020. BPV was calculated as coefficient of variation (CV) of BP at all visits. Association between WMH progression rates over 14 years and BPV was examined using linear-mixed effects (LME) model. Regression models were used to examine association between BPV and MRI markers at final visit in participants. Results: A total of 199 participants (60.5 SD 6.6 years) who underwent four MRI scans and BP measurements were included, with mean follow-up of 13.7 (SD 0.5) years. Systolic BPV was associated with higher progression of WMH (β = 0.013, 95% CI 0.005 - 0.022) and higher risk of incident lacunes (OR: 1.10, 95% CI 1.01-1.21). There was no association between systolic BPV and grey and white matter volumes, Peak Skeleton of Mean Diffusivity (PSMD) or microbleed count after 13.7 years. Conclusions: Visit-to-visit systolic BPV is associated with increased progression of WMH volumes and higher risk of incident lacunes over 14 years in participants with SVD. Future studies are needed to examine causality of this association.
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Affiliation(s)
- Esther Janssen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Willem van Dalen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mengfei Cai
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, PR China
| | - Mina A Jacob
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José Marques
- Center for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Marco Duering
- Department of Biomedical Engineering, Medical Image Analysis Center (MIAC AG) and qbig, University of Basel, Basel, Switzerland
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Public and Occupational Health, AMC, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nina Hilkens
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Csiszar A, Ungvari A, Patai R, Gulej R, Yabluchanskiy A, Benyo Z, Kovacs I, Sotonyi P, Kirkpartrick AC, Prodan CI, Liotta EM, Zhang XA, Toth P, Tarantini S, Sorond FA, Ungvari Z. Atherosclerotic burden and cerebral small vessel disease: exploring the link through microvascular aging and cerebral microhemorrhages. GeroScience 2024:10.1007/s11357-024-01139-7. [PMID: 38639833 DOI: 10.1007/s11357-024-01139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Cerebral microhemorrhages (CMHs, also known as cerebral microbleeds) are a critical but frequently underestimated aspect of cerebral small vessel disease (CSVD), bearing substantial clinical consequences. Detectable through sensitive neuroimaging techniques, CMHs reveal an extensive pathological landscape. They are prevalent in the aging population, with multiple CMHs often being observed in a given individual. CMHs are closely associated with accelerated cognitive decline and are increasingly recognized as key contributors to the pathogenesis of vascular cognitive impairment and dementia (VCID) and Alzheimer's disease (AD). This review paper delves into the hypothesis that atherosclerosis, a prevalent age-related large vessel disease, extends its pathological influence into the cerebral microcirculation, thereby contributing to the development and progression of CSVD, with a specific focus on CMHs. We explore the concept of vascular aging as a continuum, bridging macrovascular pathologies like atherosclerosis with microvascular abnormalities characteristic of CSVD. We posit that the same risk factors precipitating accelerated aging in large vessels (i.e., atherogenesis), primarily through oxidative stress and inflammatory pathways, similarly instigate accelerated microvascular aging. Accelerated microvascular aging leads to increased microvascular fragility, which in turn predisposes to the formation of CMHs. The presence of hypertension and amyloid pathology further intensifies this process. We comprehensively overview the current body of evidence supporting this interconnected vascular hypothesis. Our review includes an examination of epidemiological data, which provides insights into the prevalence and impact of CMHs in the context of atherosclerosis and CSVD. Furthermore, we explore the shared mechanisms between large vessel aging, atherogenesis, microvascular aging, and CSVD, particularly focusing on how these intertwined processes contribute to the genesis of CMHs. By highlighting the role of vascular aging in the pathophysiology of CMHs, this review seeks to enhance the understanding of CSVD and its links to systemic vascular disorders. Our aim is to provide insights that could inform future therapeutic approaches and research directions in the realm of neurovascular health.
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Affiliation(s)
- Anna Csiszar
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Anna Ungvari
- Department of Public Health, Semmelweis University, Semmelweis University, Budapest, Hungary.
| | - Roland Patai
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rafal Gulej
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral College/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Zoltan Benyo
- Institute of Translational Medicine, Semmelweis University, 1094, Budapest, Hungary
- Cerebrovascular and Neurocognitive Disorders Research Group, HUN-REN, Semmelweis University, 1094, Budapest, Hungary
| | - Illes Kovacs
- Department of Ophthalmology, Semmelweis University, 1085, Budapest, Hungary
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, 10021, USA
| | - Peter Sotonyi
- Department of Vascular and Endovascular Surgery, Heart and Vascular Centre, Semmelweis University, 1122, Budapest, Hungary
| | - Angelia C Kirkpartrick
- Veterans Affairs Medical Center, Oklahoma City, OK, USA
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Calin I Prodan
- Veterans Affairs Medical Center, Oklahoma City, OK, USA
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Eric M Liotta
- International Training Program in Geroscience, Doctoral College/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Xin A Zhang
- Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Peter Toth
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Public Health, Semmelweis University, Semmelweis University, Budapest, Hungary
- Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary
- Neurotrauma Research Group, Szentagothai Research Centre, University of Pecs, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, University of Pecs, Pecs, Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral College/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Farzaneh A Sorond
- Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zoltan Ungvari
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral College/Department of Public Health, Semmelweis University, Budapest, Hungary
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Tang J, Heidari Pahlavian S, Joe E, Gamez MT, Zhao T, Ma SJ, Jin J, Cen SY, Chui HC, Yan L. Assessment of arterial pulsatility of cerebral perforating arteries using 7T high-resolution dual-VENC phase-contrast MRI. Magn Reson Med 2024. [PMID: 38440807 DOI: 10.1002/mrm.30073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/24/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE Directly imaging the function of cerebral perforating arteries could provide valuable insight into the pathology of cerebral small vessel diseases (cSVD). Arterial pulsatility has been identified as a useful biomarker for assessing vascular dysfunction. In this study, we investigate the feasibility and reliability of using dual velocity encoding (VENC) phase-contrast MRI (PC-MRI) to measure the pulsatility of cerebral perforating arteries at 7 T. METHODS Twenty participants, including 12 young volunteers and 8 elder adults, underwent high-resolution 2D PC-MRI scans with VENCs of 20 cm/s and 40 cm/s at 7T. The sensitivity of perforator detection and the reliability of pulsatility measurement of cerebral perforating arteries using dual-VENC PC-MRI were evaluated by comparison with the single-VENC data. The effects of temporal resolution in the PC-MRI acquisition and aging on the pulsatility measurements were investigated. RESULTS Compared to the single VENCs, dual-VENC PC-MRI provided improved sensitivity of perforator detection and more reliable pulsatility measurements. Temporal resolution impacted the pulsatility measurements, as decreasing temporal resolution led to an underestimation of pulsatility. Elderly adults had elevated pulsatility in cerebral perforating arteries compared to young adults, but there was no difference in the number of detected perforators between the two age groups. CONCLUSION Dual-VENC PC-MRI is a reliable imaging method for the assessment of pulsatility of cerebral perforating arteries, which could be useful as a potential imaging biomarker of aging and cSVD.
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Affiliation(s)
- Jianing Tang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Soroush Heidari Pahlavian
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Elizabeth Joe
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Maria Tereza Gamez
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Tianrui Zhao
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Samantha J Ma
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Siemens Medical Solutions USA, Los Angeles, California, USA
| | - Jin Jin
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Siemens Healthcare Pty Ltd, Brisbane, Queensland, Australia
| | - Steven Yong Cen
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Helena C Chui
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lirong Yan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Sarabi MS, Ma SJ, Jann K, Ringman JM, Wang DJJ, Shi Y. Vessel density mapping of small cerebral vessels on 3D high resolution black blood MRI. Neuroimage 2024; 286:120504. [PMID: 38216104 PMCID: PMC10834860 DOI: 10.1016/j.neuroimage.2023.120504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 11/19/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024] Open
Abstract
Small cerebral blood vessels are largely inaccessible to existing clinical in vivo imaging technologies. This study aims to present a novel analysis pipeline for vessel density mapping of small cerebral blood vessels from high-resolution 3D black-blood MRI at 3T. Twenty-eight subjects (10 under 35 years old, 18 over 60 years old) were imaged with the T1-weighted turbo spin-echo with variable flip angles (T1w TSE-VFA) sequence optimized for black-blood small vessel imaging with iso-0.5 mm spatial resolution (interpolated from 0.51×0.51×0.64 mm3) at 3T. Hessian-based vessel segmentation methods (Jerman, Frangi and Sato filter) were evaluated by vessel landmarks and manual annotation of lenticulostriate arteries (LSAs). Using optimized vessel segmentation, large vessel pruning and non-linear registration, a semiautomatic pipeline was proposed for quantification of small vessel density across brain regions and further for localized detection of small vessel changes across populations. Voxel-level statistics was performed to compare vessel density between two age groups. Additionally, local vessel density of aged subjects was correlated with their corresponding gross cognitive and executive function (EF) scores using Montreal Cognitive Assessment (MoCA) and EF composite scores compiled with Item Response Theory (IRT). Jerman filter showed better performance for vessel segmentation than Frangi and Sato filter which was employed in our pipeline. Small cerebral blood vessels including small artery, arterioles, small veins, and venules on the order of a few hundred microns can be delineated using the proposed analysis pipeline on 3D black-blood MRI at 3T. The mean vessel density across brain regions was significantly higher in young subjects compared to aged subjects. In the aged subjects, localized vessel density was positively correlated with MoCA and IRT EF scores. The proposed pipeline is able to segment, quantify, and detect localized differences in vessel density of small cerebral blood vessels based on 3D high-resolution black-blood MRI. This framework may serve as a tool for localized detection of small vessel density changes in normal aging and cerebral small vessel disease.
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Affiliation(s)
- Mona Sharifi Sarabi
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 2025 Zonal Avenue, Los Angeles, CA 90033, USA
| | - Samantha J Ma
- Siemens Medical Solutions USA, Inc., Los Angeles, CA, USA
| | - Kay Jann
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 2025 Zonal Avenue, Los Angeles, CA 90033, USA
| | - John M Ringman
- Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - Danny J J Wang
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 2025 Zonal Avenue, Los Angeles, CA 90033, USA
| | - Yonggang Shi
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 2025 Zonal Avenue, Los Angeles, CA 90033, USA.
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Zhang CY, Wang B, Hua XT, Fan K, Li YF. Serum vascular endothelial growth factor and cortisol expression to predict prognosis of patients with hypertensive cerebral hemorrhage. World J Clin Cases 2023; 11:5455-5461. [PMID: 37637696 PMCID: PMC10450374 DOI: 10.12998/wjcc.v11.i23.5455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Cerebral hemorrhage is a common and severe complication of hypertension in middle-aged and elderly men. AIM To investigate the correlation between vascular endothelial growth factor (VEGF) and cortisol (Cor) and the prognosis of patients with hypertensive cerebral hemorrhage. METHODS A hundred patients with hypertensive intracerebral hemorrhage were enrolled from January 2020 to December 2022 and assigned to the hypertensive intracerebral hemorrhage group. Another 100 healthy people who were examined at our hospital during the same period were selected and assigned to the healthy group. Peripheral venous blood was collected, and serum Cor and VGEF levels were measured through enzyme linked immunosorbent assay. RESULTS A statistically significant difference in serum Cor and VGEF levels was observed among patients with varying degrees of neurological impairment (P < 0.05). Serum Cor and VGEF levels were significantly higher in the severe group than in the mild-to-moderate group. Cor and VEGF levels were significantly higher in patients with poor prognoses than in those with good prognoses. Multiple logistic regression analysis revealed that serum Cor and VGEF levels were independent factors affecting hypertensive intracerebral hemorrhage (P < 0.05). CONCLUSION Cor and VGEF are associated with the occurrence and development of hypertensive cerebral hemorrhage and are significantly associated with neurological impairment and prognosis of patients.
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Affiliation(s)
- Chao-Yong Zhang
- Department of Neurosurgery, Taihe Hospital Affiliated to Wannan Medical College, Taihe County People’s Hospital, Fuyang 236600, Anhui Province, China
| | - Bin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Xiang-Ting Hua
- Department of Neurosurgery, Taihe Hospital Affiliated to Wannan Medical College, Taihe County People’s Hospital, Fuyang 236600, Anhui Province, China
| | - Kui Fan
- Department of Neurosurgery, Taihe Hospital Affiliated to Wannan Medical College, Taihe County People’s Hospital, Fuyang 236600, Anhui Province, China
| | - Yu-Feng Li
- Department of Neurosurgery, Taihe Hospital Affiliated to Wannan Medical College, Taihe County People’s Hospital, Fuyang 236600, Anhui Province, China
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6
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Tap L, Vernooij MW, Wolters F, van den Berg E, Mattace-Raso FUS. New horizons in cognitive and functional impairment as a consequence of cerebral small vessel disease. Age Ageing 2023; 52:afad148. [PMID: 37585592 PMCID: PMC10431695 DOI: 10.1093/ageing/afad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/06/2023] [Indexed: 08/18/2023] Open
Abstract
Cerebral small vessel disease (cSVD) is a frequent finding in imaging of the brain in older adults, especially in the concomitance of cardiovascular disease risk factors. Despite the well-established link between cSVD and (vascular) cognitive impairment (VCI), it remains uncertain how and when these vascular alterations lead to cognitive decline. The extent of acknowledged markers of cSVD is at best modestly associated with the severity of clinical symptoms, but technological advances increasingly allow to identify and quantify the extent and perhaps also the functional impact of cSVD more accurately. This will facilitate a more accurate diagnosis of VCI, against the backdrop of concomitant other neurodegenerative pathology, and help to identify persons with the greatest risk of cognitive and functional deterioration. In this study, we discuss how better assessment of cSVD using refined neuropsychological and comprehensive geriatric assessment as well as modern image analysis techniques may improve diagnosis and possibly the prognosis of VCI. Finally, we discuss new avenues in the treatment of cSVD and outline how these contemporary insights into cSVD can contribute to optimise screening and treatment strategies in older adults with cognitive impairment and multimorbidity.
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Affiliation(s)
- Lisanne Tap
- Department of Internal Medicine, Section of Geriatric Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank Wolters
- Department of Epidemiology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Francesco U S Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Sun W, Cai B, Rao J, Zhou F. Characterization of cerebrovascular changes in mice treated with alcohol by photoacoustic imaging. J Biophotonics 2023:e202300038. [PMID: 37078184 DOI: 10.1002/jbio.202300038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
Abstract
Alcohol has complex effects on cerebrovascular health. Monitoring the pathology of alcohol induced cerebrovascular changes in vivo is essential for understanding the mechanism and developing potential treatment strategies. Here, photoacoustic imaging was employed to examine cerebrovascular changes in mice under the treatment of alcohol at different doses. By analyzing the association of cerebrovascular structure, hemodynamics, neuronal function and corresponding behavior, we found that alcohol affected brain function and behavior in a dose-dependent manner. Low dose of alcohol increased cerebrovascular blood volume and activated neurons, without addictive behaviors and cerebrovascular structure changes. With the dose increased, cerebrovascular blood volume gradually decreased, triggering obviously progressive effects on the immune microenvironment, cerebrovascular structure and addictive behavior. These findings will provide further insights into the characterization of the biphasic effects of alcohol.
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Affiliation(s)
- Weikang Sun
- Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical Engineering, Hainan University, Haikou, China
| | - Bingdong Cai
- Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical Engineering, Hainan University, Haikou, China
| | - Jie Rao
- Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical Engineering, Hainan University, Haikou, China
| | - Feifan Zhou
- Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical Engineering, Hainan University, Haikou, China
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Liu Y, Liu D, Liu M, Li K, Shi Q, Wang C, Pan Z, Zhou L. The microstructural abnormalities of cingulum was related to patients with mild cognitive impairment: a diffusion kurtosis imaging study. Neurol Sci 2023; 44:171-180. [PMID: 36169754 PMCID: PMC9816220 DOI: 10.1007/s10072-022-06408-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/13/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Our study aimed to investigate the correlations between microstructural changes of cingulum and patients with mild cognitive impairment (MCI) by diffusion kurtosis imaging (DKI) technique. METHOD A total of 104 patients with cerebral small vessel diseases (cSVD) were retrospectively enrolled in this study. According to Montreal Cognitive Assessment Scale (MoCA) scores, these patients were divided into MCI group (n = 59) and non-MCI group (n = 45). The general clinical data was collected and analyzed. The regions of interests (ROIs) were selected for investigation in cingulum. The values of DKI parameters were measured in each ROI and compared between the two groups, the correlations between DKI parameters and MoCA scores were examined. RESULTS Compared to non-MCI group, MCI patients had more severe white matter hyperintensities (WMHs) (P = 0.038) and lower MoCA scores (P < 0.01). MCI patients showed significantly decreased fractional anisotropy (FA), axial kurtosis (AK), mean kurtosis (MK), radial kurtosis (RK), and kurtosis fractional anisotropy (KFA) in the left cingulum in the cingulated cortex (CgC) region (all P < 0.0125). In the left CgC region, FA, AK, MK, RK, and KFA were positively correlated with MoCA scores (r = 0.348, 0.409, 0.310, 0.441, 0.422, all P < 0.001). Meanwhile, FA, AK, MK, RK, and KFA were also positively correlated with MoCA scores (r = 0.338, 0.352, 0.289, 0.380, 0.370, all P < 0.001) in the right CgC region. CONCLUSION DKI technique could be used to explore the microstructural changes of cingulum in MCI patients and DKI-derived parameters might be feasible to evaluate MCI patients.
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Affiliation(s)
- Yueyang Liu
- Department of Neurology, Civil Aviation General Hospital, Beijing, China
| | - Dongtao Liu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 5, Jingyuan Road, Beijing, China
| | - Mingyong Liu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 5, Jingyuan Road, Beijing, China
| | - Kun Li
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qinglei Shi
- MR Scientific Marketing, Diagnosis Imaging, Siemens Healthineers China, Beijing, China
| | - Chenlong Wang
- Department of Neurology, Civil Aviation General Hospital, Beijing, China
| | - Zhenyu Pan
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lichun Zhou
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 5, Jingyuan Road, Beijing, China
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Abstract
Cerebral small vessel disease (cSVD) is a major cause of stroke and dementia. This review summarizes recent developments in advanced neuroimaging of cSVD with a focus on clinical and research applications. In the first section, we highlight how advanced structural imaging techniques, including diffusion magnetic resonance imaging (MRI), enable improved detection of tissue damage, including characterization of tissue appearing normal on conventional MRI. These techniques enable progression to be monitored and may be useful as surrogate endpoint in clinical trials. Quantitative MRI, including iron and myelin imaging, provides insights into tissue composition on the molecular level. In the second section, we cover how advanced MRI techniques can demonstrate functional or dynamic abnormalities of the blood vessels, which could be targeted in mechanistic research and early-stage intervention trials. Such techniques include the use of dynamic contrast enhanced MRI to measure blood-brain barrier permeability, and MRI methods to assess cerebrovascular reactivity. In the third section, we discuss how the increased spatial resolution provided by ultrahigh field MRI at 7 T allows imaging of perforating arteries, and flow velocity and pulsatility within them. The advanced MRI techniques we describe are providing novel pathophysiological insights in cSVD and allow improved quantification of disease burden and progression. They have application in clinical trials, both in assessing novel therapeutic mechanisms, and as a sensitive endpoint to assess efficacy of interventions on parenchymal tissue damage. We also discuss challenges of these advanced techniques and suggest future directions for research.
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Affiliation(s)
- Hilde van den Brink
- Department of Neurology and
Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University,
Utrecht, The Netherlands
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Marco Duering
- Medical Image Analysis Center (MIAC AG)
and qbig, Department of Biomedical Engineering, University of Basel, Basel,
Switzerland,Marco Duering, Medical Image Analysis
Center (MIAC AG) and qbig, Department of Biomedical Engineering, University of
Basel, Marktgasse 8, Basel, CH-4051, Switzerland.
; @MarcoDuering
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10
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Aminuddin N, Achuthan A, Ruhaiyem NIR, Che Mohd Nassir CMN, Idris NS, Mustapha M. Reduced cerebral vascular fractal dimension among asymptomatic individuals as a potential biomarker for cerebral small vessel disease. Sci Rep 2022; 12:11780. [PMID: 35821514 PMCID: PMC9276662 DOI: 10.1038/s41598-022-15710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Cerebral small vessel disease is a neurological disease frequently found in the elderly and detected on neuroimaging, often as an incidental finding. White matter hyperintensity is one of the most commonly reported neuroimaging markers of CSVD and is linked with an increased risk of future stroke and vascular dementia. Recent attention has focused on the search of CSVD biomarkers. The objective of this study is to explore the potential of fractal dimension as a vascular neuroimaging marker in asymptomatic CSVD with low WMH burden. Df is an index that measures the complexity of a self-similar and irregular structure such as circle of Willis and its tributaries. This exploratory cross-sectional study involved 22 neurologically asymptomatic adult subjects (42 ± 12 years old; 68% female) with low to moderate 10-year cardiovascular disease risk prediction score (QRISK2 score) who underwent magnetic resonance imaging/angiography (MRI/MRA) brain scan. Based on the MRI findings, subjects were divided into two groups: subjects with low WMH burden and no WMH burden, (WMH+; n = 8) and (WMH−; n = 14) respectively. Maximum intensity projection image was constructed from the 3D time-of-flight (TOF) MRA. The complexity of the CoW and its tributaries observed in the MIP image was characterised using Df. The Df of the CoW and its tributaries, i.e., Df (w) was significantly lower in the WMH+ group (1.5172 ± 0.0248) as compared to WMH− (1.5653 ± 0.0304, p = 0.001). There was a significant inverse relationship between the QRISK2 risk score and Df (w), (rs = − .656, p = 0.001). Df (w) is a promising, non-invasive vascular neuroimaging marker for asymptomatic CSVD with WMH. Further study with multi-centre and long-term follow-up is warranted to explore its potential as a biomarker in CSVD and correlation with clinical sequalae of CSVD.
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Affiliation(s)
- Niferiti Aminuddin
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.,Department of Basic Medical Sciences, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang, Malaysia
| | - Anusha Achuthan
- School of Computer Sciences, Universiti Sains Malaysia, 11800, USM, Pulau Pinang, Malaysia
| | | | - Che Mohd Nasril Che Mohd Nassir
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Nur Suhaila Idris
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150, Kubang Kerian, Kelantan, Malaysia.,Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia. .,Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150, Kubang Kerian, Kelantan, Malaysia.
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11
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Langner SM, Terheyden JH, Geerling CF, Kindler C, Keil VCW, Turski CA, Turski GN, Behning C, Wintergerst MWM, Petzold GC, Finger RP. Structural retinal changes in cerebral small vessel disease. Sci Rep 2022; 12:9315. [PMID: 35662264 PMCID: PMC9166694 DOI: 10.1038/s41598-022-13312-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/16/2022] [Indexed: 01/11/2023] Open
Abstract
Cerebral small vessel disease (CSVD) is an important contributor to cognitive impairment and stroke. Previous research has suggested associations with alterations in single retinal layers. We have assessed changes of all individual retinal layers in CSVD using high-resolution optical coherence tomography (OCT) for the first time. Subjects with recent magnetic resonance imaging (MRI) underwent macular and peripapillary retinal imaging using OCT for this case-control study. Number and volume ratio index (WMRI) of white matter lesions (WML) were determined on MRI. Data were analyzed using multiple linear regression models. 27 CSVD patients and 9 control participants were included. Ganglion cell layer (GCL) volume was significantly reduced in patients with CSVD compared to age-matched controls (p = 0.008). In patients with CSVD, larger foveal outer plexiform layer (OPL) volume and decreased temporal peripapillary retinal nerve fiber layer (RNFL) thickness were significantly associated with a higher WMRI in linear regression when controlling for age (p ≤ 0.033). Decreased foveal GCL volume and temporal-inferior RNFL thickness at Bruch's membrane opening (MRW), and increased temporal MRW were associated with a higher WML burden (p ≤ 0.037). Thus, we identified alterations in several OCT layers in individuals with CSVD (GCL, OPL, MRW and RNFL). Their potential diagnostic value merits further study.
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Affiliation(s)
- S Magdalena Langner
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Jan H Terheyden
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Clara F Geerling
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Christine Kindler
- Department of Neurology, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Vera C W Keil
- Department of Radiology, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Christopher A Turski
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Gabrielle N Turski
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Charlotte Behning
- Institute of Biomedical Statistics, Computer Science and Epidemiology, University Hospital Bonn, Bonn, Germany
| | | | - Gabor C Petzold
- Department of Neurology, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Division of Vascular Neurology, University Hospital Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
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12
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Jansen MG, Griffanti L, Mackay CE, Anatürk M, Melazzini L, Lange AMGD, Filippini N, Zsoldos E, Wiegertjes K, Leeuw FED, Singh-Manoux A, Kivimäki M, Ebmeier KP, Suri S. Association of cerebral small vessel disease burden with brain structure and cognitive and vascular risk trajectories in mid-to-late life. J Cereb Blood Flow Metab 2022; 42:600-612. [PMID: 34610763 PMCID: PMC8943617 DOI: 10.1177/0271678x211048411] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We characterize the associations of total cerebral small vessel disease (SVD) burden with brain structure, trajectories of vascular risk factors, and cognitive functions in mid-to-late life. Participants were 623 community-dwelling adults from the Whitehall II Imaging Sub-study with multi-modal MRI (mean age 69.96, SD = 5.18, 79% men). We used linear mixed-effects models to investigate associations of SVD burden with up to 25-year retrospective trajectories of vascular risk and cognitive performance. General linear modelling was used to investigate concurrent associations with grey matter (GM) density and white matter (WM) microstructure, and whether these associations were modified by cognitive status (Montreal Cognitive Asessment [MoCA] scores of < 26 vs. ≥ 26). Severe SVD burden in older age was associated with higher mean arterial pressure throughout midlife (β = 3.36, 95% CI [0.42-6.30]), and faster cognitive decline in letter fluency (β = -0.07, 95% CI [-0.13--0.01]), and verbal reasoning (β = -0.05, 95% CI [-0.11--0.001]). Moreover, SVD burden was related to lower GM volumes in 9.7% of total GM, and widespread WM microstructural decline (FWE-corrected p < 0.05). The latter association was most pronounced in individuals who demonstrated cognitive impairments on MoCA (MoCA < 26; F3,608 = 2.14, p = 0.007). These findings highlight the importance of managing midlife vascular health to preserve brain structure and cognitive function in old age.
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Affiliation(s)
- Michelle G Jansen
- Donders Centre for Cognition, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ludovica Griffanti
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK
| | - Clare E Mackay
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK
| | - Melis Anatürk
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Centre for Medical Image Computing, Department of Computer Science, 4919University College London, University College London, London, UK
| | - Luca Melazzini
- Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Ann-Marie G de Lange
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Department of Psychology, 6305University of Oslo, University of Oslo, Oslo, Norway
| | | | - Enikő Zsoldos
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, 4919University College London, University College London, London, UK.,INSERM, Epidemiology of Ageing and Neurogenerative Diseases, Université de Paris, Paris, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, 4919University College London, University College London, London, UK
| | - Klaus P Ebmeier
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK
| | - Sana Suri
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK
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13
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Song Y, Kwon B, Al-Abdulwahhab AH, Nam YK, Ahn Y, Jeong SY, Seo EJ, Lee JK, Suh DC. Rare Neurovascular Diseases in Korea: Classification and Related Genetic Variants. Korean J Radiol 2021; 22:1379-1396. [PMID: 34047503 PMCID: PMC8316781 DOI: 10.3348/kjr.2020.1171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/07/2020] [Accepted: 01/23/2021] [Indexed: 01/19/2023] Open
Abstract
Rare neurovascular diseases (RNVDs) have not been well-recognized in Korea. They involve the central nervous system and greatly affect the patients' lives. However, these diseases are difficult to diagnose and treat due to their rarity and incurability. We established a list of RNVDs by referring to the previous literature and databases worldwide to better understand the diseases and their current management status. We categorized 68 RNVDs based on their pathophysiology and clinical manifestations and estimated the prevalence of each disease in Korea. Recent advances in genetic, molecular, and developmental research have enabled further understanding of these RNVDs. Herein, we review each disease, while considering its classification based on updated pathologic mechanisms, and discuss the management status of RNVD in Korea.
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Affiliation(s)
- Yunsun Song
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boseong Kwon
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Abdulrahman Hamed Al-Abdulwahhab
- Department of Diagnostic and Interventional Radiology, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi Arabia
| | - Yeo Kyoung Nam
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yura Ahn
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeong Jeong
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eul Ju Seo
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Keuk Lee
- Asan Institute of Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Chul Suh
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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14
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Du J, Zhu H, Yu L, Lu P, Qiu Y, Zhou Y, Cao W, Lu D, Zhao W, Yang J, Sun J, Xu Q. Multi-Dimensional Diffusion Tensor Imaging Biomarkers for Cognitive Decline From the Preclinical Stage: A Study of Post-stroke Small Vessel Disease. Front Neurol 2021; 12:687959. [PMID: 34322083 PMCID: PMC8311001 DOI: 10.3389/fneur.2021.687959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: We aim to investigate whether multi-dimensional diffusion tensor imaging (DTI) measures can sensitively identify different cognitive status of cerebral small vessel disease (CSVD) and to explore the underlying pattern of white matter disruption in CSVD. Methods: Two hundred and two participants were recruited, composed of 99 CSVD patients with mild cognitive impairment (VaMCI) and 60 with no cognitive impairment (NCI) and 43 healthy subjects as normal controls (NC). Full domain neuropsychological tests and diffusion-weighted imaging were performed on each subject. DTI metrics such as fractional anisotropy (FA), mean diffusivity (MD), the skeletonized mean diffusivity (PSMD), and structural brain network measures including network strength, global efficiency (EGlobal), and local efficiency (ELocal) were calculated. Region of interest (ROI) analysis of 42 white matter tracts was performed to examine the regional anatomical white matter disruption for each group. Results: Significant differences of multiple cognitive test scores across all cognitive domains especially processing and executive function existed among the three groups. DTI measures (FA, MD, and PSMD) showed significant group difference with the cognitive status changing. FA and EGlobal showed significant correlation with processing speed, executive function, and memory. ROI analysis found that white matter integrity impairment occurred from the preclinical stage of vascular cognitive impairment (VCI) due to CSVD. These lesions in the NCI group mainly involved some longitudinal fibers such as right superior longitudinal fasciculus (SLF-R), right superior fronto-occipital fasciculus (SFO-R), and right uncinate fasciculus (UNC-R), which might be more vulnerable to the cerebrovascular aging and disease process. Conclusions: DTI measures are sensitive neuroimaging markers in detecting the early cognitive impairment and able to differentiate the different cognitive status due to CSVD. Subtle changes of some vulnerable white matter tracts may be observed from the preclinical stage of VCI and have a local to general spreading pattern during the disease progression.
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Affiliation(s)
- Jing Du
- Renji-UNSW CHeBA (Centre for Healthy Brain Ageing of University of New South Wales) Neurocognitive Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.,Department of Neurology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.,Department of Health Management Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Hong Zhu
- Shanghai Med-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ling Yu
- Renji-UNSW CHeBA (Centre for Healthy Brain Ageing of University of New South Wales) Neurocognitive Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.,Department of Neurology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Peiwen Lu
- Renji-UNSW CHeBA (Centre for Healthy Brain Ageing of University of New South Wales) Neurocognitive Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.,Department of Neurology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.,Department of Health Management Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Yage Qiu
- Department of Radiology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Wenwei Cao
- Renji-UNSW CHeBA (Centre for Healthy Brain Ageing of University of New South Wales) Neurocognitive Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.,Department of Neurology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Dong Lu
- Renji-UNSW CHeBA (Centre for Healthy Brain Ageing of University of New South Wales) Neurocognitive Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.,Department of Neurology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Wei Zhao
- Renji-UNSW CHeBA (Centre for Healthy Brain Ageing of University of New South Wales) Neurocognitive Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.,Department of Neurology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Jie Yang
- Renji-UNSW CHeBA (Centre for Healthy Brain Ageing of University of New South Wales) Neurocognitive Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.,Department of Neurology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Junfeng Sun
- Shanghai Med-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qun Xu
- Renji-UNSW CHeBA (Centre for Healthy Brain Ageing of University of New South Wales) Neurocognitive Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.,Department of Neurology, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.,Department of Health Management Center, Renji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
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15
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Blair GW, Stringer MS, Thrippleton MJ, Chappell FM, Shuler K, Hamilton I, Garcia DJ, Doubal FN, Kopczak A, Duering M, Ingrisch M, Kerkhofs D, Staals J, van den Brink H, Arts T, Backes WH, van Oostenbrugge R, Biessels GJ, Dichgans M, Wardlaw JM. Imaging neurovascular, endothelial and structural integrity in preparation to treat small vessel diseases. The INVESTIGATE-SVDs study protocol. Part of the SVDs@Target project. Cereb Circ Cogn Behav 2021; 2:100020. [PMID: 36324725 DOI: 10.1016/j.cccb.2021.100020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/25/2021] [Accepted: 06/20/2021] [Indexed: 12/30/2022]
Abstract
Background Sporadic cerebral small vessel disease (SVD) and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) share clinical and neuroimaging features and possibly vascular dysfunction(s). However few studies have included both conditions, assessed more than one vascular dysfunction simultaneously, or included more than one centre. The INVESTIGATE-SVDs study will assess several cerebrovascular dysfunctions with MRI in participants with sporadic SVD or CADASIL at three European centres. Methods We will recruit participants with sporadic SVDs (ischaemic stroke or vascular cognitive impairment) and CADASIL in Edinburgh, Maastricht and Munich. We will perform detailed clinical and neuropsychological phenotyping of the participants, and neuroimaging including structural MRI, cerebrovascular reactivity MRI (CVR: using carbon dioxide challenge), phase contrast MRI (arterial, venous and CSF flow and pulsatility), dynamic contrast-enhanced MRI (blood brain barrier (BBB) leakage) and multishell diffusion imaging. Participants will measure their blood pressure (BP) and its variability over seven days using a telemetric device. Discussion INVESTIGATE-SVDs will assess the relationships of BBB integrity, CVR, pulsatility and CSF flow in sporadic SVD and CADASIL using a multisite, multimodal MRI protocol. We aim to establish associations between these measures of vascular function, risk factors particularly BP and its variability, and brain parenchymal lesions in these two SVD phenotypes. Additionally we will test feasibility of complex multisite MRI, provide reliable intermediary outcome measures and sample size estimates for future trials.
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Key Words
- BBB, blood brain barrier
- BOLD, blood oxygen level dependent
- BP, blood pressure
- BPv, blood pressure variability
- Blood-brain barrier permeability
- CADASIL
- CADASIL, cerebral autosomal dominant arteriopathy with leukoencephalopathy and subcortical infarcts
- CBF, cerebral blood flow
- CERAD+, consortium to establish a disease registry for Alzheimer's disease plus battery
- CO2, carbon dioxide
- CSF, cerebrospinal fluid
- CVR, cerebrovascular reactivity
- Cerebral small vessel disease
- Cerebrovascular reactivity
- DCE, dynamic contrast enhanced
- EtCO2, end-tidal carbon dioxide
- GM, grey matter
- MMSE, mini-mental state examination
- MRI
- MoCA, Montreal cognitive exam
- NIHSS, national institute for health stroke scale
- PI, pulsatility index
- PVS, perivascular space
- RSSI, recent small subcortical infarct
- SVDs, small vessel diseases
- WM, white matter
- WMH, white matter hyperintensity
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16
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Balakrishnan R, Valdés Hernández MDC, Farrall AJ. Automatic segmentation of white matter hyperintensities from brain magnetic resonance images in the era of deep learning and big data - A systematic review. Comput Med Imaging Graph 2021; 88:101867. [PMID: 33508567 DOI: 10.1016/j.compmedimag.2021.101867] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND White matter hyperintensities (WMH), of presumed vascular origin, are visible and quantifiable neuroradiological markers of brain parenchymal change. These changes may range from damage secondary to inflammation and other neurological conditions, through to healthy ageing. Fully automatic WMH quantification methods are promising, but still, traditional semi-automatic methods seem to be preferred in clinical research. We systematically reviewed the literature for fully automatic methods developed in the last five years, to assess what are considered state-of-the-art techniques, as well as trends in the analysis of WMH of presumed vascular origin. METHOD We registered the systematic review protocol with the International Prospective Register of Systematic Reviews (PROSPERO), registration number - CRD42019132200. We conducted the search for fully automatic methods developed from 2015 to July 2020 on Medline, Science direct, IEE Explore, and Web of Science. We assessed risk of bias and applicability of the studies using QUADAS 2. RESULTS The search yielded 2327 papers after removing 104 duplicates. After screening titles, abstracts and full text, 37 were selected for detailed analysis. Of these, 16 proposed a supervised segmentation method, 10 proposed an unsupervised segmentation method, and 11 proposed a deep learning segmentation method. Average DSC values ranged from 0.538 to 0.91, being the highest value obtained from an unsupervised segmentation method. Only four studies validated their method in longitudinal samples, and eight performed an additional validation using clinical parameters. Only 8/37 studies made available their methods in public repositories. CONCLUSIONS We found no evidence that favours deep learning methods over the more established k-NN, linear regression and unsupervised methods in this task. Data and code availability, bias in study design and ground truth generation influence the wider validation and applicability of these methods in clinical research.
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17
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Murray KD, Singh MV, Zhuang Y, Uddin MN, Qiu X, Weber MT, Tivarus ME, Wang HZ, Sahin B, Zhong J, Maggirwar SB, Schifitto G. Pathomechanisms of HIV-Associated Cerebral Small Vessel Disease: A Comprehensive Clinical and Neuroimaging Protocol and Analysis Pipeline. Front Neurol 2020; 11:595463. [PMID: 33384655 PMCID: PMC7769815 DOI: 10.3389/fneur.2020.595463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022] Open
Abstract
Rationale: We provide an in-depth description of a comprehensive clinical, immunological, and neuroimaging study that includes a full image processing pipeline. This approach, although implemented in HIV infected individuals, can be used in the general population to assess cerebrovascular health. Aims: In this longitudinal study, we seek to determine the effects of neuroinflammation due to HIV-1 infection on the pathomechanisms of cerebral small vessel disease (CSVD). The study focuses on the interaction of activated platelets, pro-inflammatory monocytes and endothelial cells and their impact on the neurovascular unit. The effects on the neurovascular unit are evaluated by a novel combination of imaging biomarkers. Sample Size: We will enroll 110 HIV-infected individuals on stable combination anti-retroviral therapy for at least three months and an equal number of age-matched controls. We anticipate a drop-out rate of 20%. Methods and Design: Subjects are followed for three years and evaluated by flow cytometric analysis of whole blood (to measure platelet activation, platelet monocyte complexes, and markers of monocyte activation), neuropsychological testing, and brain MRI at the baseline, 18- and 36-month time points. MRI imaging follows the recommended clinical small vessel imaging standards and adds several advanced sequences to obtain quantitative assessments of brain tissues including white matter microstructure, tissue susceptibility, and blood perfusion. Discussion: The study provides further understanding of the underlying mechanisms of CSVD in chronic inflammatory disorders such as HIV infection. The longitudinal study design and comprehensive approach allows the investigation of quantitative changes in imaging metrics and their impact on cognitive performance.
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Affiliation(s)
- Kyle D Murray
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, United States
| | - Meera V Singh
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, United States
| | - Yuchuan Zhuang
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States
| | - Md Nasir Uddin
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Xing Qiu
- Department of Biostatistics, University of Rochester, Rochester, NY, United States
| | - Miriam T Weber
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Madalina E Tivarus
- Department of Imaging Sciences, University of Rochester, Rochester, NY, United States.,Department of Neuroscience, University of Rochester, Rochester, NY, United States
| | - Henry Z Wang
- Department of Imaging Sciences, University of Rochester, Rochester, NY, United States
| | - Bogachan Sahin
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Jianhui Zhong
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, United States.,Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States.,Department of Biostatistics, University of Rochester, Rochester, NY, United States
| | - Sanjay B Maggirwar
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, DC, United States
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester, Rochester, NY, United States.,Department of Imaging Sciences, University of Rochester, Rochester, NY, United States
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Yakushiji Y. [Trends and challenges in clinical research on cerebral small vessel disease, with a particular emphasis on type-1 small vessel disease]. Rinsho Shinkeigaku 2020; 60:743-751. [PMID: 33115998 DOI: 10.5692/clinicalneurol.cn-001488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cerebral small vessel disease (SVD) is defined as difficulty maintaining efficient microcirculation, metabolism, and neural networks caused by degeneration of small vessels of the brain, as well as cognitive or physical dysfunction caused by this difficulty. The most common SVD (i.e., type 1 SVD), which is driven by hypertensive arteriopathy, appears to be more prevalent in people with East Asian ethnicity than in Whites. Recent attention has been paid to a SVD scoring system using major MRI markers of SVD in an attempt to comprehensively semi-quantify the SVD burden in the brain. This concept raised a new question: "Is there a practical threshold for the comprehensive SVD score?" The development of computational methods to assess SVD imaging markers could answer this question, and may help identify the optimal intervention for patients with type 1 SVD to prevent stroke and dementia.
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Arts T, Siero JCW, Biessels GJ, Zwanenburg JJM. Automated Assessment of Cerebral Arterial Perforator Function on 7T MRI. J Magn Reson Imaging 2020; 53:234-241. [PMID: 32810376 PMCID: PMC7754489 DOI: 10.1002/jmri.27304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 01/04/2023] Open
Abstract
Background Blood flow velocity and pulsatility of small cerebral perforating arteries can be measured using 7T quantitative 2D phase contrast (PC) MRI. However, ghosting artifacts arising from subject movement and pulsating large arteries cause false positives when applying a previously published perforator detection method. Purpose To develop a robust, automated method to exclude perforators located in ghosting artifacts. Study Type Retrospective. Subjects Fifteen patients with vascular cognitive impairment or carotid occlusive disease and 10 healthy controls. Field Strength/Sequence 7T/cardiac‐gated 2D PC MRI. Assessment Perforators were automatically excluded from ghosting regions, which were defined as bands in the phase‐encoding direction of large arteries. As reference, perforators were manually excluded by two raters (T.A., J.J.M.Z.), based on perforator location with respect to visible ghosting artifacts. The performance of both censoring methods was assessed for the number of (Nincluded), mean velocity (Vmean), and pulsatility index (PI) of the included perforators. Statistical Tests For within‐method comparisons, inter‐ and intrarater reliability were assessed for the manual method, and test–retest reliability was assessed for both methods from repeated 2D PC scans (without repositioning). Intraclass correlation coefficients (ICCs) and their 95% confidence intervals (CIs) were determined for Nincluded, Vmean, and PI for all within‐method comparisons. The ICC to compare between the two methods was determined with the use of both (test–retest) scans using a multilevel nonlinear mixed model. Results The automated censoring method showed a moderate to good ICC (95% CI) vs. manual censoring for Nincluded (0.73 [0.58–0.87]) and Vmean (0.90 [0.84–0.96]), and a moderate ICC for PI (0.57 [0.37–0.76]). The test–retest reliability of the manual censoring method was considerably lower than the interrater and intrarater reliability, indicating that scanner noise dominates the uncertainty of the analysis. Data Conclusion The proposed automated censoring method can reliably exclude small perforators affected by ghosting artifacts. Level of Evidence 3. Technical Efficacy Stage 1.
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Affiliation(s)
- Tine Arts
- Department of Radiology, Centre for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen C W Siero
- Department of Radiology, Centre for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands.,Spinoza Centre for Neuroimaging, Amsterdam, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jaco J M Zwanenburg
- Department of Radiology, Centre for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
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Scheifele HM, Ulbrich P, Garz C, Carare RO, Heinze HJ, Schreiber S, Jandke S. Retinal Vascular Pathology in a Rat Model of Cerebral Small Vessel Disease. Front Neurol 2020; 11:533. [PMID: 32695061 PMCID: PMC7338761 DOI: 10.3389/fneur.2020.00533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/13/2020] [Indexed: 01/26/2023] Open
Abstract
Introduction: The initial disease stages of hypertensive arteriopathy (HA) and cerebral amyloid angiopathy (CAA), the two main forms of sporadic human cerebral small vessel diseases (CSVD), are too subtle to be detectable on clinical routine imaging. Small vessel disease (SVD) is a systemic condition, affecting not only the brain, but also other organs. The retina appears as an ideal marker for the early detection of incipient CSVD. We therefore investigated the retinal microvasculature of the spontaneously hypertensive stroke-prone rat (SHRSP), an animal model of sporadic CSVD. Materials and Methods: The brains and retinas of 26 male SHRSP (18–44 weeks) were examined histologically and immunohistochemically for the presence of HA phenomena (erythrocyte thrombi, small perivascular bleeds) and amyloid angiopathy (AA). Results: CAA and AA in the retina showed a significant correlation with age (CAA: rho = 0.55, p = 0.005; AA: rho = 0.89, p < 0.001). The number of erythrocyte thrombi in the brain correlated with the severity of retinal erythrocyte thrombi (rho = 0.46, p = 0.023), while the occurrence of CAA correlated with the appearance of AA in the retina (rho = 0.51, p = 0.012). Retinal SVD markers predicted CSVD markers with good sensitivity. Conclusions: These results indicate that SVD also occurs in the retinal microvasculature of SHRSP and the prediction of cerebral erythrocyte thrombi and CAA might be possible using retinal biomarkers. This underlines the important role of the investigation of the retina in the early diagnosis of CSVD.
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Affiliation(s)
- Heinrich Maximilian Scheifele
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) Within the Helmholtz Association, Magdeburg, Germany
| | - Philipp Ulbrich
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) Within the Helmholtz Association, Magdeburg, Germany
| | - Cornelia Garz
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) Within the Helmholtz Association, Magdeburg, Germany.,Department of Behavioral Neurology, Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany
| | | | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) Within the Helmholtz Association, Magdeburg, Germany.,Department of Behavioral Neurology, Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) Within the Helmholtz Association, Magdeburg, Germany
| | - Solveig Jandke
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) Within the Helmholtz Association, Magdeburg, Germany
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21
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Dobrynina LA, Zabitova MR, Shabalina AA, Kremneva EI, Akhmetzyanov BM, Gadzhieva ZS, Berdalin AB, Kalashnikova LA, Gnedovskaya EV, Krotenkova MV. MRI Types of Cerebral Small Vessel Disease and Circulating Markers of Vascular Wall Damage. Diagnostics (Basel) 2020; 10:E354. [PMID: 32485815 PMCID: PMC7345277 DOI: 10.3390/diagnostics10060354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 01/08/2023] Open
Abstract
The evaluation of the clustering of magnetic resonance imaging (MRI) signs into MRI types and their relationship with circulating markers of vascular wall damage were performed in 96 patients with cerebral small vessel disease (cSVD) (31 men and 65 women; mean age, 60.91 ± 6.57 years). The serum concentrations of the tumor necrosis factor-α (TNF-α), transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor-A (VEGF-A), and hypoxia-inducible factor 1-α (HIF-1α) were investigated in 70 patients with Fazekas stages 2 and 3 of white matter hyperintensities (WMH) and 21 age- and sex-matched volunteers with normal brain MRI using ELISA. The cluster analysis excluded two patients from the further analysis due to restrictions in their scanning protocol. MRI signs of 94 patients were distributed into two clusters. In the first group there were 18 patients with Fazekas 3 stage WMH. The second group consisted of 76 patients with WMH of different stages. The uneven distribution of patients between clusters limited the subsequent steps of statistical analysis; therefore, a cluster comparison was performed in patients with Fazekas stage 3 WMH, designated as MRI type 1 and type 2 of Fazekas 3 stage. There were no differences in age, sex, degree of hypertension, or other risk factors. MRI type 1 had significantly more widespread WMH, lacunes in many areas, microbleeds, atrophy, severe cognitive and gait impairments, and was associated with downregulation of VEGF-A compared with MRI type 2. MRI type 2 had more severe deep WMH, lacunes in the white matter, no microbleeds or atrophy, and less severe clinical manifestations and was associated with upregulation of TNF-α compared with MRI type 1. The established differences reflect the pathogenetic heterogeneity of cSVD and explain the variations in the clinical manifestations observed in Fazekas stage 3 of this disease.
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Affiliation(s)
- Larisa A. Dobrynina
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | - Maryam R. Zabitova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | - Alla A. Shabalina
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | - Elena I. Kremneva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | | | - Zukhra Sh. Gadzhieva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | - Alexander B. Berdalin
- Federal State Budgetary Institution “Federal Center for Cerebrovascular Pathology and Stroke”, 1, stroenie 10, Ostrovityanova, 117342 Moscow, Russia;
| | - Ludmila A. Kalashnikova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | - Elena V. Gnedovskaya
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | - Marina V. Krotenkova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
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22
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Blair GW, Thrippleton MJ, Shi Y, Hamilton I, Stringer M, Chappell F, Dickie DA, Andrews P, Marshall I, Doubal FN, Wardlaw JM. Intracranial hemodynamic relationships in patients with cerebral small vessel disease. Neurology 2020; 94:e2258-e2269. [PMID: 32366534 PMCID: PMC7357294 DOI: 10.1212/wnl.0000000000009483] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/10/2019] [Indexed: 02/06/2023] Open
Abstract
Objective To investigate cerebrovascular reactivity (CVR), blood flow, vascular and CSF pulsatility, and their independent relationship with cerebral small vessel disease (SVD) features in patients with minor ischemic stroke and MRI evidence of SVD. Methods We recruited patients with minor ischemic stroke and assessed CVR using blood oxygen level–dependent MRI during a hypercapnic challenge, cerebral blood flow (CBF), vascular and CSF pulsatility using phase-contrast MRI, and structural magnetic resonance brain imaging to quantify white matter hyperintensities (WMHs) and perivascular spaces (PVSs). We used multiple regression to identify parameters associated with SVD features, controlling for patient characteristics. Results Fifty-three of 60 patients completed the study with a full data set (age 68.0% ± 8.8 years, 74% male, 75% hypertensive). After controlling for age, sex, and systolic blood pressure, lower white matter CVR was associated with higher WMH volume (−0.01%/mm Hg per log10 increase in WMH volume, p = 0.02), basal ganglia PVS (−0.01%/mm Hg per point increase in the PVS score, p = 0.02), and higher venous pulsatility (superior sagittal sinus −0.03%/mm Hg, p = 0.02, per unit increase in the pulsatility index) but not with CBF (p = 0.58). Lower foramen magnum CSF stroke volume was associated with worse white matter CVR (0.04%/mm Hg per mL increase in stroke volume, p = 0.04) and more severe basal ganglia PVS (p = 0.09). Conclusions Lower CVR, higher venous pulsatility, and lower foramen magnum CSF stroke volume indicate that dynamic vascular dysfunctions underpin PVS dysfunction and WMH development. Further exploration of microvascular dysfunction and CSF dynamics may uncover new mechanisms and intervention targets to reduce SVD lesion development, cognitive decline, and stroke.
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Affiliation(s)
- Gordon W Blair
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Michael J Thrippleton
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Yulu Shi
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Iona Hamilton
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Michael Stringer
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Francesca Chappell
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - David Alexander Dickie
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Peter Andrews
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Ian Marshall
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Fergus N Doubal
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Joanna M Wardlaw
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom.
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Abstract
PURPOSE OF REVIEW The AT(N) research framework was introduced in 2018 to define Alzheimer's disease as a biological entity. It is recognized that Alzheimer's disease lesions rarely occur in isolation in older brains, with cerebrovascular disease (CVD) being a common comorbidity. To fully characterize the disorder of dementia, the AT(N) framework needs to be extended with biomarkers for other disorders. The present review examines some of the requirements for adding a 'V' to the AT(N), and examines the currently available biomarkers as definitive markers of CVD. RECENT FINDINGS Neuroimaging biomarkers of CVD have received the greatest attention, with rapid advances in MRI techniques showing the greatest promise. Challenges remain in standardization of techniques, validation of some of the results and assessing total CVD burden from diverse lesion types. Retinal imaging shows promise as a window to cerebral vasculature. Biochemical markers are advancing rapidly, but their specificity for CVD is not established. SUMMARY Biomarkers of CVD have seen rapid advances but further validation and determination of their specificity are needed before they can be reliably used to delineate a V in the AT(N) framework as definitive indicators of significant CVD.
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Affiliation(s)
- Perminder S Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales and the Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
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24
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Ito MT, da Silva Costa SM, Baptista LC, Carvalho-Siqueira GQ, Albuquerque DM, Rios VM, Ospina-Prieto S, Saez RC, Vieira KP, Cendes F, Ozelo MC, Saad STO, Costa FF, Melo MB. Angiogenesis-Related Genes in Endothelial Progenitor Cells May Be Involved in Sickle Cell Stroke. J Am Heart Assoc 2020; 9:e014143. [PMID: 32009522 PMCID: PMC7033889 DOI: 10.1161/jaha.119.014143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The clinical aspects of sickle cell anemia (SCA) are heterogeneous, and different patients may present significantly different clinical evolutions. Almost all organs can be affected, particularly the central nervous system. Transient ischemic events, infarcts, and cerebral hemorrhage can be observed and affect ≈25% of the patients with SCA. Differences in the expression of molecules produced by endothelial cells may be associated with the clinical heterogeneity of patients affected by vascular diseases. In this study, we investigated the differential expression of genes involved in endothelial cell biology in SCA patients with and without stroke. Methods and Results Endothelial progenitor cells from 4 SCA patients with stroke and 6 SCA patients without stroke were evaluated through the polymerase chain reaction array technique. The analysis of gene expression profiling identified 29 differentially expressed genes. Eleven of these genes were upregulated, and most were associated with angiogenesis (55%), inflammatory response (18%), and coagulation (18%) pathways. Downregulated expression was observed in 18 genes, with the majority associated with angiogenesis (28%), apoptosis (28%), and cell adhesion (22%) pathways. Remarkable overexpression of the MMP1 (matrix metalloproteinase 1) gene in the endothelial progenitor cells of all SCA patients with stroke (fold change: 204.64; P=0.0004) was observed. Conclusions Our results strongly suggest that angiogenesis is an important process in sickle cell stroke, and differences in the gene expression profile of endothelial cell biology, especially MMP1, may be related to stroke in SCA patients.
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Affiliation(s)
- Mirta T Ito
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Sueli M da Silva Costa
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Letícia C Baptista
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
| | | | | | - Vinicius M Rios
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
| | | | - Roberta C Saez
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Karla P Vieira
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory Department of Neurology University of Campinas, UNICAMP Campinas São Paulo Brazil
| | - Margareth C Ozelo
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Sara Teresinha O Saad
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Fernando F Costa
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Mônica B Melo
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
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Liu D, Li K, Ma X, Li Y, Bu Q, Pan Z, Feng X, Shi Q, Zhou L, Hu W. Correlations Between the Microstructural Changes of the Medial Temporal Cortex and Mild Cognitive Impairment in Patients With Cerebral Small Vascular Disease (cSVD): A Diffusion Kurtosis Imaging Study. Front Neurol 2020; 10:1378. [PMID: 32010043 PMCID: PMC6974677 DOI: 10.3389/fneur.2019.01378] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/13/2019] [Indexed: 12/18/2022] Open
Abstract
Object: The purpose of our study was to investigate the microstructural changes of the medial temporal cortex in mild cognitive impairment (MCI) patients with cerebral small vascular disease (cSVD) using diffusion kurtosis imaging (DKI) and to examine whether DKI parameters are correlated with MCI. Method: A total of 82 cSVD patients admitted to the Department of Neurology Beijing Chaoyang Hospital, Capital Medical University, were retrospectively enrolled in this study. The Montreal cognitive assessment scale (MoCA) score was used to assess overall cognitive function. According to the presence or absence of MCI, these patients were divided into an MCI group (n = 48) and a non-MCI group (n = 34). The general clinical data of the two groups were collected and analyzed. The regions of interest (ROIs) in the medial temporal cortex were selected for investigation. The averaged values of DKI parameters were measured in each ROI and compared between the two groups, and the correlations between DKI parameters and MoCA score and between diffusion and kurtosis parameters were examined. Results: Compared to the non-MCI group, MCI patients showed significantly increased mean diffusion (MD) and radial diffusion (RD) and significantly decreased mean kurtosis (MK) in the left hippocampus (P = 0.005, 0.006, 0.002, respectively). In the left hippocampus, fractional anisotropy (FA), MK, radial kurtosis (RK), and kurtosis fractional anisotropy (KFA) showed significantly positive correlations with MoCA score (r = 0.374, 0.37, 0.392, 0.242, respectively, all P < 0.05), while MK and RD were negatively correlated with MoCA score (r = -0.227, -0.255, respectively, both P < 0.05). In the left parahippocampal region, axial kurtosis (AK) and KFA were positively correlated with MoCA score (r = 0.228, 0.282, respectively, both P < 0.05), while RK was positively correlated with MoCA score in the right parahippocampal region (r = 0.231, P < 0.05). Significant correlations of MD with MK, RD with RK, and FA with KFA were observed in the medial temporal cortex (r = -0.254, -0.395, 0.807, respectively, all P < 0.05) but not of axial diffusion (AD) with AK. Conclusion: The DKI technique can be used to observe microstructural changes of the medial temporal cortex in MCI patients with cSVD. The DKI-derived parameters might be a feasible means of evaluating patients with MCI.
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Affiliation(s)
- Dongtao Liu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kun Li
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiangke Ma
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qiao Bu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Pan
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiang Feng
- MR Scientific Marketing, Diagnosis Imaging, Siemens Healthineers China, Beijing, China
| | - Qinglei Shi
- MR Scientific Marketing, Diagnosis Imaging, Siemens Healthineers China, Beijing, China
| | - Lichun Zhou
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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26
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Smith EE, Biessels GJ, De Guio F, de Leeuw FE, Duchesne S, Düring M, Frayne R, Ikram MA, Jouvent E, MacIntosh BJ, Thrippleton MJ, Vernooij MW, Adams H, Backes WH, Ballerini L, Black SE, Chen C, Corriveau R, DeCarli C, Greenberg SM, Gurol ME, Ingrisch M, Job D, Lam BY, Launer LJ, Linn J, McCreary CR, Mok VC, Pantoni L, Pike GB, Ramirez J, Reijmer YD, Romero JR, Ropele S, Rost NS, Sachdev PS, Scott CJ, Seshadri S, Sharma M, Sourbron S, Steketee RM, Swartz RH, van Oostenbrugge R, van Osch M, van Rooden S, Viswanathan A, Werring D, Dichgans M, Wardlaw JM. Harmonizing brain magnetic resonance imaging methods for vascular contributions to neurodegeneration. Alzheimers Dement (Amst) 2019; 11:191-204. [PMID: 30859119 PMCID: PMC6396326 DOI: 10.1016/j.dadm.2019.01.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Many consequences of cerebrovascular disease are identifiable by magnetic resonance imaging (MRI), but variation in methods limits multicenter studies and pooling of data. The European Union Joint Program on Neurodegenerative Diseases (EU JPND) funded the HARmoNizing Brain Imaging MEthodS for VaScular Contributions to Neurodegeneration (HARNESS) initiative, with a focus on cerebral small vessel disease. METHODS Surveys, teleconferences, and an in-person workshop were used to identify gaps in knowledge and to develop tools for harmonizing imaging and analysis. RESULTS A framework for neuroimaging biomarker development was developed based on validating repeatability and reproducibility, biological principles, and feasibility of implementation. The status of current MRI biomarkers was reviewed. A website was created at www.harness-neuroimaging.org with acquisition protocols, a software database, rating scales and case report forms, and a deidentified MRI repository. CONCLUSIONS The HARNESS initiative provides resources to reduce variability in measurement in MRI studies of cerebral small vessel disease.
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Affiliation(s)
- Eric E. Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - François De Guio
- Department of Neurology, Lariboisière Hospital, University Paris Diderot, Paris, France
| | - Frank Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Simon Duchesne
- CERVO Research Center, Quebec Mental Health Institute, Québec, Canada
- Radiology Department, Université Laval, Québec, Canada
| | - Marco Düring
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität LMU, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Richard Frayne
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
- Seaman Family MR Centre, Foothills Medical Centre, Calgary, Alberta, Canada
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Eric Jouvent
- Department of Neurology, Lariboisière Hospital, University Paris Diderot, Paris, France
| | - Bradley J. MacIntosh
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hieab Adams
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Walter H. Backes
- Department of Radiology & Nuclear Medicine, School for Mental Health & Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lucia Ballerini
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sandra E. Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Chen
- Memory Aging and Cognition Centre, Department of Pharmacology, National University of Singapore, Singapore
| | - Rod Corriveau
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Charles DeCarli
- Department of Neurology and Center for Neuroscience, University of California at Davis, Davis, CA, USA
| | - Steven M. Greenberg
- J. Philip Kistler Stroke Research Center, Stroke Service and Memory Disorders Unit, Massachusetts General Hospital, Boston, MA, USA
| | - M. Edip Gurol
- J. Philip Kistler Stroke Research Center, Stroke Service and Memory Disorders Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Ingrisch
- Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Dominic Job
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Bonnie Y.K. Lam
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lenore J. Launer
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Linn
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Cheryl R. McCreary
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Seaman Family MR Centre, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Vincent C.T. Mok
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Leonardo Pantoni
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - G. Bruce Pike
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Joel Ramirez
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Yael D. Reijmer
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jose Rafael Romero
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Natalia S. Rost
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Christopher J.M. Scott
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Mukul Sharma
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine (Neurology) McMaster University, Hamilton, Ontario, Canada
| | - Steven Sourbron
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Rebecca M.E. Steketee
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Richard H. Swartz
- Department of Medicine (Neurology), University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Robert van Oostenbrugge
- Department of Neurology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matthias van Osch
- C.J. Gorter Center for high field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanneke van Rooden
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anand Viswanathan
- J. Philip Kistler Stroke Research Center, Stroke Service and Memory Disorders Unit, Massachusetts General Hospital, Boston, MA, USA
| | - David Werring
- University College London Queen Square institute of Neurology, London, UK
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität LMU, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
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27
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Abstract
Background and Purpose- In the general population, we investigated the association of a recently developed cerebral small vessel disease (CSVD) sum score with stroke, dementia, and mortality. Methods- One thousand six hundred fifty-one stroke-free and nondemented participants (mean age, 73.3 years; 54.5% women) of the population-based Rotterdam Study underwent brain magnetic resonance imaging (1.5T) in 2005-2011 and were followed for stroke, dementia, and mortality until 2016-2017. The CSVD sum score was composed by counting the presence of 4 magnetic resonance imaging markers (white matter hyperintensities, lacunes, cerebral microbleeds, and perivascular spaces; range, 0-4). We determined the association of the CSVD score with risk of stroke, dementia, and mortality using Cox models, adjusting for age, sex, and other Framingham Stroke Risk Profile predictors. Additionally, we assessed mortality as a competing risk for stroke and dementia and calculated absolute risk estimates for all outcomes. Results- During a mean follow-up of 7.2 years, 66 participants developed stroke, 76 developed dementia, and 306 died. The Framingham Stroke Risk Profile-adjusted hazard ratios of 1 point higher sum score were 1.54 (95% CI, 1.16-2.03) for stroke, 1.25 (95% CI, 0.95-1.64) for dementia, and 1.15 (95% CI, 1.01-1.31) for mortality. No significant differences were seen for subdistribution hazard ratios for stroke and dementia. A higher CSVD score yielded higher absolute risk estimates for all outcomes, calculated during 10 years. Conclusions- The CSVD score is a practical measure of global vascular brain injury. A higher sum score on magnetic resonance imaging is associated with higher risk of suffering a stroke, developing dementia, and death.
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Affiliation(s)
- Pinar Yilmaz
- From the Department of Epidemiology (P.Y., M.K.I., M.A.I., M.W.V.), Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine (P.Y., W.J.N., M.W.V.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - M Kamran Ikram
- From the Department of Epidemiology (P.Y., M.K.I., M.A.I., M.W.V.), Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Neurology (M.K.I.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Wiro J Niessen
- Department of Radiology and Nuclear Medicine (P.Y., W.J.N., M.W.V.), Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- From the Department of Epidemiology (P.Y., M.K.I., M.A.I., M.W.V.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Meike W Vernooij
- From the Department of Epidemiology (P.Y., M.K.I., M.A.I., M.W.V.), Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine (P.Y., W.J.N., M.W.V.), Erasmus Medical Center, Rotterdam, the Netherlands
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28
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Lu Y, Zhang C, Lu X, Moeini M, Thorin E, Lesage F. Impact of atherosclerotic disease on cerebral microvasculature and tissue oxygenation in awake LDLR-/-hApoB+/+ transgenic mice. Neurophotonics 2019; 6:045003. [PMID: 31673566 PMCID: PMC6811703 DOI: 10.1117/1.nph.6.4.045003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/17/2019] [Indexed: 05/17/2023]
Abstract
We explore cortical microvasculature changes during the progression of atherosclerosis using young and old transgenic atherosclerotic (ATX) mice with thinned-skull cranial window. In awake animals, exploiting intrinsic signal optical imaging, Doppler optical coherence tomography, and two-photon microscopy, we investigate how the progression of atherosclerotic disease affects the morphology and function of cortical microvasculature as well as baseline cerebral tissue oxygenation. Results show that aged ATX mice exhibited weaker hemodynamic response in the somatosensory cortex to whisker stimulation and that the diameter of their descending arterioles and associated mean blood flow decreased significantly compared with the young ATX group. Data from two-photon phosphorescence lifetime microscopy indicate that old ATX mice had lower and more heterogeneous partial pressure of oxygen ( PO 2 ) in cortical tissue than young ATX mice. In addition, hypoxic micropockets in cortical tissue were found in old, but not young, ATX mice. Capillary red blood cell (RBC) flux, RBC velocity, RBC velocity heterogeneity, hematocrit, and diameter were also measured using line scans with two-photon fluorescence microscopy. When compared with the young group, RBC flux, velocity, and hematocrit decreased and RBC velocity heterogeneity increased in old ATX mice, presumably due to disturbed blood supply from arterioles that were affected by atherosclerosis. Finally, dilation of capillaries in old ATX mice was observed, which suggests that capillaries play an active role in compensating for an oxygen deficit in brain tissue.
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Affiliation(s)
- Yuankang Lu
- École Polytechnique de Montréal, Laboratoire d’Imagerie optique et moléculaire, Montréal, Québec, Canada
| | - Cong Zhang
- Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Xuecong Lu
- École Polytechnique de Montréal, Laboratoire d’Imagerie optique et moléculaire, Montréal, Québec, Canada
| | - Mohammad Moeini
- Amirkabir University of Technology (Tehran Polytechnic), Biomedical Engineering Department, Tehran, Iran
| | - Eric Thorin
- Institut de Cardiologie de Montréal, Montréal, Québec, Canada
- Université de Montréal, Department of Pharmacology and Physiology, Faculty of Medicine, Montréal, Québec, Canada
| | - Frédéric Lesage
- École Polytechnique de Montréal, Laboratoire d’Imagerie optique et moléculaire, Montréal, Québec, Canada
- Institut de Cardiologie de Montréal, Montréal, Québec, Canada
- Address all correspondence to Frédéric Lesage, E-mail:
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29
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Abstract
Small vessel disease (SVD) refers to conditions where damage to arterioles and capillaries is predominant, leading to reduced, or interrupted perfusion of the affected organ. Data suggest that when this condition is evident in any organ, it is already systemic in its occurrence and consequences. SVD affects primarily organs that receive significant portions of cardiac output such as the brain, the kidney, and the retina. Thus, SVD is a major etiologic cause in debilitating conditions such as renal failure, blindness, lacunar infarcts, and dementia. The factors that lead to this devastating condition include all the known vascular risk factors when they are not strictly controlled, but lifestyles that include sedentary existence, obesity, and poor sleep patterns are also recognized drivers of SVD. In addition, depression is now recognized as a vascular risk factor. Inflammation is a mediator of SVD, but it is not known which factor(s) predominate in its etiology. This article emphasizes the need for more investigations to define this link further and suggests clinical and societal responses that might reduce the major impacts of this condition on populations.
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Affiliation(s)
- Antoine M Hakim
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada.,Division of Neurology, University of Ottawa, Ottawa, ON, Canada
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30
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Kant IMJ, Mutsaerts HJMM, van Montfort SJT, Jaarsma-Coes MG, Witkamp TD, Winterer G, Spies CD, Hendrikse J, Slooter AJC, de Bresser J; BioCog Consortium. The association between frailty and MRI features of cerebral small vessel disease. Sci Rep 2019; 9:11343. [PMID: 31383903 DOI: 10.1038/s41598-019-47731-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022] Open
Abstract
Frailty is a common syndrome in older individuals that is associated with poor cognitive outcome. The underlying brain correlates of frailty are unclear. The aim of this study was to investigate the association between frailty and MRI features of cerebral small vessel disease in a group of non-demented older individuals. We included 170 participants who were classified as frail (n = 30), pre-frail (n = 85) or non-frail (n = 55). The association of frailty and white matter hyperintensity volume and shape features, lacunar infarcts and cerebral perfusion was investigated by regression analyses adjusted for age and sex. Frail and pre-frail participants were older, more often female and showed higher white matter hyperintensity volume (0.69 [95%-CI 0.08 to 1.31], p = 0.03 respectively 0.43 [95%-CI: 0.04 to 0.82], p = 0.03) compared to non-frail participants. Frail participants showed a non-significant trend, and pre-frail participants showed a more complex shape of white matter hyperintensities (concavity index: 0.04 [95%-CI: 0.03 to 0.08], p = 0.03; fractal dimensions: 0.07 [95%-CI: 0.00 to 0.15], p = 0.05) compared to non-frail participants. No between group differences were found in gray matter perfusion or in the presence of lacunar infarcts. In conclusion, increased white matter hyperintensity volume and a more complex white matter hyperintensity shape may be structural brain correlates of the frailty phenotype.
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31
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Thrippleton MJ, Backes WH, Sourbron S, Ingrisch M, van Osch MJP, Dichgans M, Fazekas F, Ropele S, Frayne R, van Oostenbrugge RJ, Smith EE, Wardlaw JM. Quantifying blood-brain barrier leakage in small vessel disease: Review and consensus recommendations. Alzheimers Dement 2019; 15:840-858. [PMID: 31031101 PMCID: PMC6565805 DOI: 10.1016/j.jalz.2019.01.013] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/22/2018] [Accepted: 01/18/2019] [Indexed: 12/12/2022]
Abstract
Cerebral small vessel disease (cSVD) comprises pathological processes of the small vessels in the brain that may manifest clinically as stroke, cognitive impairment, dementia, or gait disturbance. It is generally accepted that endothelial dysfunction, including blood-brain barrier (BBB) failure, is pivotal in the pathophysiology. Recent years have seen increasing use of imaging, primarily dynamic contrast-enhanced magnetic resonance imaging, to assess BBB leakage, but there is considerable variability in the approaches and findings reported in the literature. Although dynamic contrast-enhanced magnetic resonance imaging is well established, challenges emerge in cSVD because of the subtle nature of BBB impairment. The purpose of this work, authored by members of the HARNESS Initiative, is to provide an in-depth review and position statement on magnetic resonance imaging measurement of subtle BBB leakage in clinical research studies, with aspects requiring further research identified. We further aim to provide information and consensus recommendations for new investigators wishing to study BBB failure in cSVD and dementia.
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Affiliation(s)
- Michael J Thrippleton
- Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK; Dementia Research Institute, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging, University of Edinburgh, Edinburgh, UK.
| | - Walter H Backes
- Department of Radiology & Nuclear Medicine, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Steven Sourbron
- Leeds Imaging Biomarkers group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Michael Ingrisch
- Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Matthias J P van Osch
- Department of Radiology, C. J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-University München & Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Richard Frayne
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Robert J van Oostenbrugge
- Department of Neurology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Eric E Smith
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Joanna M Wardlaw
- Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK; Dementia Research Institute, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
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32
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Staszewski J, Skrobowska E, Piusińska-Macoch R, Brodacki B, Stępień A. Cerebral and Extracerebral Vasoreactivity in Patients With Different Clinical Manifestations of Cerebral Small-Vessel Disease: Data From the Significance of Hemodynamic and Hemostatic Factors in the Course of Different Manifestations of Cerebral Small-Vessel Disease Study. J Ultrasound Med 2019; 38:975-987. [PMID: 30208231 DOI: 10.1002/jum.14782] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Endothelial dysfunction has been implicated in the pathogenesis of cerebral small-vessel disease (SVD). Little is known about the relationship between SVD and measures of endothelium-dependent vasodilatation and cerebral vasomotor reactivity. The aim of this study was to evaluate cerebral and extracerebral endothelial dysfunction in patients with different manifestations of SVD and to assess the relationship between endothelial dysfunction and radiologic markers of SVD. METHODS The vasomotor reactivity reserve (VMRr), breath-holding index (BHI) of the middle cerebral arteries, and brachial artery flow-mediated dilatation (FMD) were measured with ultrasound techniques in 90 patients (30 in each group) older than 60 years with extensive white matter lesions (Fazekas grade ≥ 2) with a history of lacunar stroke, vascular dementia, or parkinsonism and 30 individuals with normal magnetic resonance imaging findings (control group). All groups were matched for age, sex, hypertension, and diabetes. RESULTS The mean age ± SD (71.8 ± 3.4 versus 71.7 ± 3.4 years), sex distribution, and prevalence of the main vascular risk factors were similar in the SVD and control groups. The VMRr (56.6% ± 18.3% versus 77.1% ± 16.9%), BHI (0.8 ± 0.3 versus 1.1 ± 0.4), and FMD (5.8% ± 4 versus 12.1% ± 5.2%) were severely impaired in the SVD groups compared to the control group (P < .01). The vascular responses to all tests was similar in the SVD groups, but they were significantly decreased in patients with severe white matter lesions, marked brain atrophy, and enlarged perivascular spaces. CONCLUSIONS This study was the first that simultaneously evaluated cerebral and extracerebral vasodilator responses in a well-phenotyped cohort of patients with lacunar stroke, vascular dementia, or parkinsonism. The VMRr, BHI, and FMD were more severely impaired in patients with SVD, regardless of its clinical manifestation, than in control participants. All measures were significantly lower in patients with severe white-matter lesions, brain atrophy, or enlarged perivascular spaces.
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Affiliation(s)
| | - Ewa Skrobowska
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
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Raja R, Rosenberg G, Caprihan A. Review of diffusion MRI studies in chronic white matter diseases. Neurosci Lett 2019; 694:198-207. [PMID: 30528980 PMCID: PMC6380179 DOI: 10.1016/j.neulet.2018.12.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 02/07/2023]
Abstract
Diffusion MRI studies characterizing the changes in white matter (WM) due to vascular cognitive impairment, which includes all forms of small vessel disease are reviewed. We reviewed the usefulness of diffusion methods in discriminating the affected WM regions and its relation to cognitive impairment. These studies were categorized based on the diffusion MRI techniques used. The most common method was the diffusion tensor imaging, whereas other methods included diffusion weighted imaging, diffusion kurtosis imaging, intravoxel incoherent motion, and studies based on diffusion tractography. The diffusion measures showed correlation with cognitive scores and disease progression, with mean diffusivity being the most robust parameter. Future studies should focus on incorporating multi-compartment and higher order diffusion models, which can handle the presence of multiple and crossing fibers inside a voxel.
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Affiliation(s)
- Rajikha Raja
- The MIND Research Network, Albuquerque, NM, United States.
| | - Gary Rosenberg
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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Abstract
Cerebral small vessel disease is associated with late-life depression, cognitive impairment, executive dysfunction, distress, and loss of life for older adults. Late-life depression is becoming a substantial public health burden, and a considerable number of older adults presenting to primary care have significant clinical depression. Even though white matter hyperintensities are linked with small vessel disease, white matter hyperintensities are nonspecific to small vessel disease and can co-occur with other brain diseases. Advanced neuroimaging techniques at the ultrahigh field magnetic resonance imaging are enabling improved characterization, identification of cerebral small vessel disease and are elucidating some of the mechanisms that associate small vessel disease with late-life depression.
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Affiliation(s)
- Nadim S Farhat
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Theiss
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tales Santini
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tamer S Ibrahim
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Radiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Howard J Aizenstein
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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Cao R, Li J, Zhang C, Zuo Z, Hu S. Photoacoustic microscopy of obesity-induced cerebrovascular alterations. Neuroimage 2018; 188:369-379. [PMID: 30553918 DOI: 10.1016/j.neuroimage.2018.12.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/05/2018] [Accepted: 12/12/2018] [Indexed: 12/14/2022] Open
Abstract
Cerebral small vessel disease has been linked to cognitive, psychiatric and physical disabilities, especially in the elderly. However, the underlying pathophysiology remains incompletely understood, largely due to the limited accessibility of these small vessels in the live brain. Here, we report an intravital imaging and analysis platform for high-resolution, quantitative and comprehensive characterization of pathological alterations in the mouse cerebral microvasculature. By exploiting multi-parametric photoacoustic microscopy (PAM), microvascular structure, blood perfusion, oxygenation and flow were imaged in the awake brain. With the aid of vessel segmentation, these structural and functional parameters were extracted at the single-microvessel level, from which vascular density, tortuosity, wall shear stress, resistance and associated cerebral oxygen extraction fraction and metabolism were also quantified. With the use of vasodilatory stimulus, multifaceted cerebrovascular reactivity (CVR) was characterized in vivo. By extending the classic Evans blue assay to in vivo, permeability of the blood-brain barrier (BBB) was dynamically evaluated. The utility of this enabling technique was examined by studying cerebrovascular alterations in an established mouse model of high-fat diet-induced obesity. Our results revealed increased vascular density, reduced arterial flow, enhanced oxygen extraction, impaired BBB integrity, and increased multifaceted CVR in the obese brain. Interestingly, the 'counterintuitive' increase of CVR was supported by the elevated active endothelial nitric oxide synthase in the obese mouse. Providing comprehensive and quantitative insights into cerebral microvessels and their responses under pathological conditions, this technique opens a new door to mechanistic studies of the cerebral small vessel disease and its implications in neurodegeneration and stroke.
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Affiliation(s)
- Rui Cao
- Department of Biomedical Engineering, University of Virginia, Charlottesville, USA
| | - Jun Li
- Department of Anesthesiology, University of Virginia, Charlottesville, USA
| | - Chenchu Zhang
- Department of Biomedical Engineering, University of Virginia, Charlottesville, USA
| | - Zhiyi Zuo
- Department of Anesthesiology, University of Virginia, Charlottesville, USA.
| | - Song Hu
- Department of Biomedical Engineering, University of Virginia, Charlottesville, USA.
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Abstract
The medical field is creating large amount of data that physicians are unable to decipher and use efficiently. Moreover, rule-based expert systems are inefficient in solving complicated medical tasks or for creating insights using big data. Deep learning has emerged as a more accurate and effective technology in a wide range of medical problems such as diagnosis, prediction, and intervention. Deep learning is a representation learning method that consists of layers that transform data nonlinearly, thus, revealing hierarchical relationships and structures. In this review, we survey deep learning application papers that use structured data, and signal and imaging modalities from cardiology. We discuss the advantages and limitations of applying deep learning in cardiology that also apply in medicine in general, while proposing certain directions as the most viable for clinical use.
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Abstract
Cerebral small vessel disease (CSVD) is composed of several diseases affecting the small arteries, arterioles, venules, and capillaries of the brain, and refers to several pathological processes and etiologies. Neuroimaging features of CSVD include recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain atrophy. The main clinical manifestations of CSVD include stroke, cognitive decline, dementia, psychiatric disorders, abnormal gait, and urinary incontinence. Currently, there are no specific preventive or therapeutic measures to improve this condition. In this review, we will discuss the pathophysiology, clinical aspects, neuroimaging, progress of research to treat and prevent CSVD and current treatment of this disease.
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Affiliation(s)
- Qian Li
- 1 Department of Pediatrics, The Third Affiliated Hospital & Field Surgery Institution, Army Medical University, Chongqing, China.,Both the authors contributed equally as co-authors
| | - Yang Yang
- 2 Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Both the authors contributed equally as co-authors
| | - Cesar Reis
- 3 Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Tao Tao
- 2 Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Wanwei Li
- 1 Department of Pediatrics, The Third Affiliated Hospital & Field Surgery Institution, Army Medical University, Chongqing, China
| | - Xiaogang Li
- 2 Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - John H Zhang
- 3 Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA.,4 Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Brown R, Benveniste H, Black SE, Charpak S, Dichgans M, Joutel A, Nedergaard M, Smith KJ, Zlokovic BV, Wardlaw JM. Understanding the role of the perivascular space in cerebral small vessel disease. Cardiovasc Res 2018; 114:1462-1473. [PMID: 29726891 PMCID: PMC6455920 DOI: 10.1093/cvr/cvy113] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/18/2018] [Accepted: 05/02/2018] [Indexed: 12/17/2022] Open
Abstract
Small vessel diseases (SVDs) are a group of disorders that result from pathological alteration of the small blood vessels in the brain, including the small arteries, capillaries and veins. Of the 35-36 million people that are estimated to suffer from dementia worldwide, up to 65% have an SVD component. Furthermore, SVD causes 20-25% of strokes, worsens outcome after stroke and is a leading cause of disability, cognitive impairment and poor mobility. Yet the underlying cause(s) of SVD are not fully understood. Magnetic resonance imaging has confirmed enlarged perivascular spaces (PVS) as a hallmark feature of SVD. In healthy tissue, these spaces are proposed to form part of a complex brain fluid drainage system which supports interstitial fluid exchange and may also facilitate clearance of waste products from the brain. The pathophysiological signature of PVS and what this infers about their function and interaction with cerebral microcirculation, plus subsequent downstream effects on lesion development in the brain has not been established. Here we discuss the potential of enlarged PVS to be a unique biomarker for SVD and related brain disorders with a vascular component. We propose that widening of PVS suggests presence of peri-vascular cell debris and other waste products that form part of a vicious cycle involving impaired cerebrovascular reactivity, blood-brain barrier dysfunction, perivascular inflammation and ultimately impaired clearance of waste proteins from the interstitial fluid space, leading to accumulation of toxins, hypoxia, and tissue damage. Here, we outline current knowledge, questions and hypotheses regarding understanding the brain fluid dynamics underpinning dementia and stroke through the common denominator of SVD.
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Affiliation(s)
- Rosalind Brown
- Centre for Clinical Brain Sciences, The University of Edinburgh, Chancellor's Building, Edinburgh, UK
| | - Helene Benveniste
- Department of Anesthesiology, Yale School of Medicine, New Haven, USA
| | - Sandra E Black
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Serge Charpak
- INSERM U1128, Laboratory of Neurophysiology and New Microscopies, Université Paris Descartes, Paris, France
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Anne Joutel
- Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, Université Paris Diderot-Paris 7, Paris, France
- DHU NeuroVasc, Sorbonne Paris Cité, Paris, France
| | - Maiken Nedergaard
- Section for Translational Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
- Division of Glia Disease and Therapeutics, Center for Translational Neuromedicine, University of Rochester Medical School, Rochester, USA
| | - Kenneth J Smith
- Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Berislav V Zlokovic
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, USA
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, Chancellor's Building, Edinburgh, UK
- UK Dementia Research Institute at The University of Edinburgh, Chancellor's Building, Edinburgh, UK
- Row Fogo Centre for Research into Ageing and the Brain, The University of Edinburgh, Chancellor's Building, Edinburgh, UK
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Chen H, Li H, Li Y, Jing J, Raza HK, Zhang Z, Dong L, Ye X, Hua F, Cui G. Clinical and imaging characteristics of subacute combined degeneration complicated with white matter lesions in the brain: a report of five cases. Somatosens Mot Res 2018; 35:119-123. [PMID: 30107753 DOI: 10.1080/08990220.2018.1484353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To report five cases of subacute combined degeneration (SCD) with brain involvement and explore its clinical and imaging characteristics. METHODS A retrospective study was performed on the clinical data and brain MRI of five patients with subacute combined degeneration with brain involvement (out of 107 cases with SCD in total). White matter lesions (WML) assessment was performed qualitatively using Fazekas scale score. RESULTS The main symptoms in four patients were weakness in both lower extremities and unstable walking (limb weakness in three patients, dizziness in three patients, and blurred vision in one patient). One patient had memory loss and cognitive dysfunction. The MMSE scale indicated mild dementia in one patient. On head MRI (Magnetic Resonance Imaging), multifocal and symmetrical high signals of T2WI and FLAIR were observed in the frontal lobe and periventricular white matter in four patients, while another patient showed preferential atrophy in frontal regions. Fazekas scale scores ranged from 1-6. CONCLUSION Adult subacute combined degeneration seldom involves the brain. Multifocal and symmetrical high signal white matter lesions can be found on FLAIR and T2WI, as well as frontal atrophy on head MRI.
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Affiliation(s)
- Hao Chen
- a Department of Neurology , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , PR China
| | - Hengyu Li
- a Department of Neurology , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , PR China
| | - Yuncheng Li
- a Department of Neurology , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , PR China
| | - Jia Jing
- b Department of Biology , Georgia State University , Atlanta , GA , USA
| | - Hafiz Khuram Raza
- a Department of Neurology , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , PR China.,c School of International Education , Xuzhou Medical University , Xuzhou , PR China
| | - Zuohui Zhang
- a Department of Neurology , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , PR China
| | - Liguo Dong
- a Department of Neurology , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , PR China
| | - Xinchun Ye
- a Department of Neurology , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , PR China
| | - Fang Hua
- a Department of Neurology , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , PR China
| | - Guiyun Cui
- a Department of Neurology , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , PR China
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Wei W, Chen Y, Lei D, Zhang Y, Weng X, Zhou Y, Zhang L. Plasma brain natriuretic peptide is a biomarker for screening ischemic cerebral small vessel disease in patients with hypertension. Medicine (Baltimore) 2018; 97:e12088. [PMID: 30170428 PMCID: PMC6392776 DOI: 10.1097/md.0000000000012088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/02/2018] [Indexed: 11/26/2022] Open
Abstract
Plasma brain natriuretic peptide (BNP), a diagnostic marker of cardiovascular diseases, has been previously linked to cerebrovascular diseases. Our goal was to determine whether plasma BNP level is helpful for identifying high-risk individuals who are likely to present with the 3 main subtypes of cerebral small vessel diseases (CSVDs), namely, white matter lesions, lacunar infarcts, and cerebral microbleeds, on magnetic resonance imaging (MRI) in patients with hypertension.Three hundred forty-six consecutive hypertensive patients presenting at our cardiology or neurology clinic were investigated. Plasma BNP level was measured by chemiluminescent microparticle immunoassay. The presence of CSVD was assessed by 1.5-T brain MRI. Multivariate linear regression was used to determine whether individual or combined MRI-defined CSVD subtypes were associated with BNP level, after adjustment for several covariates.The mean age of patients was 69.1 ± 9.8 years, and 44.2% were female. The highest quartile BNP group was positively associated with advanced age, female sex, clinically manifesting cardiac diseases, and ischemic CSVD (white matter lesions and lacunar infarcts) and no association with cerebral microbleeds. According to multivariate linear regression, white matter lesions [β = 0.722; 95% confidence interval (95% CI), 0.624-0.819] and lacunar infarcts (β = 0.635; 95% CI, 0.508-0.762) were independently associated with BNP level, even after controlling for vascular risk factors and clinically manifesting cardiac diseases. Combined white matter lesions and lacunar infarcts were more strongly associated with BNP level than each subtype alone. With the cutoff value of 106.4 pg/mL, BNP level had a sensitivity, a specificity, and an area under the curve of 95.2%, 64.9%, and 0.799, respectively, for white matter lesions, whereas the values were 143.0 pg/mL, 81.6%, 73.5%, and 0.848, respectively, for lacunar infarcts.Plasma BNP level, which is independently correlated with individual or combined white matter lesions and lacunar infarcts, is a useful molecular marker for identifying ischemic CSVD in patients with hypertension.
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Affiliation(s)
- Weimin Wei
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University
- Department of Neurology, Zengcheng People's Hospital (Boji-Affiliated Hospital of Sun Yat-sen University)
| | - Yan Chen
- School of Clinical Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou
| | - Da Lei
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University
| | - Yanan Zhang
- Veterinary medicine, Northeast Agricultural University, Haerbin, China
| | - Xiuhong Weng
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University
| | - Yuliang Zhou
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University
| | - Li Zhang
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University
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Abstract
PURPOSE OF REVIEW We review recent MRI research that addresses two important challenges in cerebral small vessel disease (SVD) research: early diagnosis, and linking SVD with cognitive impairment. First, we review studies of MRI measurements of blood flow and blood-brain barrier integrity. Second, we review MRI studies identifying neuroimaging correlates of SVD-related cognitive dysfunction, focusing on brain connectivity and white matter microarchitecture. This research is placed in context through discussion of recent recommendations for management of incidentally discovered SVD, and neuroimaging biomarker use in clinical trials. RECENT FINDINGS Cerebral perfusion, cerebrovascular reactivity (CVR), blood-brain barrier permeability, and white matter microarchitecture are measurable using MRI, and are altered in SVD. Lower cerebral blood flow predicts a higher future risk for dementia, whereas decreased CVR occurs at early stages of SVD and is associated with future white matter hyperintensity growth. Two new approaches to analyzing diffusion tensor imaging (DTI) data in SVD patients have emerged: graph theory-based analysis of networks of DTI connectivity between cortical nodes, and analysis of histograms of mean diffusivity of the hemispheric white matter. SUMMARY New, advanced quantitative neuroimaging techniques are not ready for routine radiological practice but are already being employed as monitoring biomarkers in the newest generation of trials for SVD.
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Abstract
The blood-brain barrier (BBB) is a continuous endothelial membrane within brain microvessels that has sealed cell-to-cell contacts and is sheathed by mural vascular cells and perivascular astrocyte end-feet. The BBB protects neurons from factors present in the systemic circulation and maintains the highly regulated CNS internal milieu, which is required for proper synaptic and neuronal functioning. BBB disruption allows influx into the brain of neurotoxic blood-derived debris, cells and microbial pathogens and is associated with inflammatory and immune responses, which can initiate multiple pathways of neurodegeneration. This Review discusses neuroimaging studies in the living human brain and post-mortem tissue as well as biomarker studies demonstrating BBB breakdown in Alzheimer disease, Parkinson disease, Huntington disease, amyotrophic lateral sclerosis, multiple sclerosis, HIV-1-associated dementia and chronic traumatic encephalopathy. The pathogenic mechanisms by which BBB breakdown leads to neuronal injury, synaptic dysfunction, loss of neuronal connectivity and neurodegeneration are described. The importance of a healthy BBB for therapeutic drug delivery and the adverse effects of disease-initiated, pathological BBB breakdown in relation to brain delivery of neuropharmaceuticals are briefly discussed. Finally, future directions, gaps in the field and opportunities to control the course of neurological diseases by targeting the BBB are presented.
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Affiliation(s)
- Melanie D Sweeney
- Department of Physiology and Neuroscience and the Zilkha Neurogenetic Institute, Keck School of Medicine of the University of Southern California, 1501 San Pablo Street, Los Angeles, California 90089, USA
| | - Abhay P Sagare
- Department of Physiology and Neuroscience and the Zilkha Neurogenetic Institute, Keck School of Medicine of the University of Southern California, 1501 San Pablo Street, Los Angeles, California 90089, USA
| | - Berislav V Zlokovic
- Department of Physiology and Neuroscience and the Zilkha Neurogenetic Institute, Keck School of Medicine of the University of Southern California, 1501 San Pablo Street, Los Angeles, California 90089, USA
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Levin OS, Chimagomedova AS, Polyakova TA, Arablinsky AV. 60 years towards definition of dyscirculatory (vascular) encephalopathy: can we put new wine into old wineskins? Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:13-26. [DOI: 10.17116/jnevro201811806213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wallin A, Román GC, Esiri M, Kettunen P, Svensson J, Paraskevas GP, Kapaki E. Update on Vascular Cognitive Impairment Associated with Subcortical Small-Vessel Disease. J Alzheimers Dis 2018; 62:1417-1441. [PMID: 29562536 PMCID: PMC5870030 DOI: 10.3233/jad-170803] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 02/06/2023]
Abstract
Subcortical small-vessel disease (SSVD) is a disorder well characterized from the clinical, imaging, and neuropathological viewpoints. SSVD is considered the most prevalent ischemic brain disorder, increasing in frequency with age. Vascular risk factors include hypertension, diabetes, hyperlipidemia, elevated homocysteine, and obstructive sleep apnea. Ischemic white matter lesions are the hallmark of SSVD; other pathological lesions include arteriolosclerosis, dilatation of perivascular spaces, venous collagenosis, cerebral amyloid angiopathy, microbleeds, microinfarcts, lacunes, and large infarcts. The pathogenesis of SSVD is incompletely understood but includes endothelial changes and blood-brain barrier alterations involving metalloproteinases, vascular endothelial growth factors, angiotensin II, mindin/spondin, and the mammalian target of rapamycin pathway. Metabolic and genetic conditions may also play a role but hitherto there are few conclusive studies. Clinical diagnosis of SSVD includes early executive dysfunction manifested by impaired capacity to use complex information, to formulate strategies, and to exercise self-control. In comparison with Alzheimer's disease (AD), patients with SSVD show less pronounced episodic memory deficits. Brain imaging has advanced substantially the diagnostic tools for SSVD. With the exception of cortical microinfarcts, all other lesions are well visualized with MRI. Diagnostic biomarkers that separate AD from SSVD include reduction of cerebrospinal fluid amyloid-β (Aβ)42 and of the ratio Aβ42/Aβ40 often with increased total tau levels. However, better markers of small-vessel function of intracerebral blood vessels are needed. The treatment of SSVD remains unsatisfactory other than control of vascular risk factors. There is an urgent need of finding targets to slow down and potentially halt the progression of this prevalent, but often unrecognized, disorder.
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Affiliation(s)
- Anders Wallin
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden and Memory Clinic at Department of Neuropsychiatry, Sahlgrenska University, Hospital, Gothenburg, Sweden
| | - Gustavo C. Román
- Department of Neurology, Methodist Neurological Institute, Houston, TX, USA
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Margaret Esiri
- Neuropathology Department, West Wing, John Radcliffe Hospital, Oxford, UK
| | - Petronella Kettunen
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden and Memory Clinic at Department of Neuropsychiatry, Sahlgrenska University, Hospital, Gothenburg, Sweden
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, John Radcliffe Hospital, Oxford, UK
| | - Johan Svensson
- Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - George P. Paraskevas
- 1st Department of Neurology, Neurochemistry Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Kapaki
- 1st Department of Neurology, Neurochemistry Unit, National and Kapodistrian University of Athens, Athens, Greece
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Chen YK, Xiao WM, Li W, Ni ZX, Liu YL, Xu L, Qu JF, Ng CH, Xiang YT. Microbleeds in fronto-subcortical circuits are predictive of dementia conversion in patients with vascular cognitive impairment but no dementia. Neural Regen Res 2018; 13:1913-1918. [PMID: 30233064 PMCID: PMC6183047 DOI: 10.4103/1673-5374.239441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is a common etiology of vascular cognitive impairment with no dementia (V-CIND). Studies have revealed that cerebral microbleeds (CMBs), a feature of CSVD, contribute to cognitive impairment. However, the association between CMBs and dementia conversion in individuals with V-CIND is still unclear. Here, we analyzed the predictive role of CMBs in the conversion from V-CIND to dementia in CSVD patients. We recruited and prospectively assessed 85 patients with CSVD and V-CIND. V-CIND was evaluated using a series of comprehensive neuropsychological scales, including the Chinese version of the Montreal Cognitive Assessment and the Clinical Dementia Rating. MRI assessments were used to quantify lacunar infarcts, white matter hyperintensities, CMBs, and medial temporal lobe atrophy. Eighty-two of the 85 patients completed the assessment for dementia conversion at a 1-year follow-up assessment. Multivariate logistic regression analyses were conducted to examine independent clinical and MRI variables associated with dementia conversion. Twenty-four patients (29.3%) had converted to dementia at the 1-year follow-up, and these individuals had significantly more CMBs in the fronto-subcortical circuits. Multivariate logistic regression analyses revealed that the patients with CMBs in the fronto-subcortical circuits (odds ratio = 4.4; 95% confidence interval: 1.602–12.081, P = 0.004) and 5 or more CMBs overall (odds ratio = 17.6, 95% confidence interval: 3.23–95.84, P = 0.001) had a significantly increased risk of dementia at the 1-year follow-up. These findings indicate that CMBs in the fronto-subcortical circuits may be predictive of dementia conversion in CSVD patients with V-CIND, and thus extend the clinical significance of CMBs. This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800017077). Protocol version: 1.0.
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Affiliation(s)
- Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Wei-Min Xiao
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Wei Li
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Zhuo-Xin Ni
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan; Faculty of Neurology, Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Li Xu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao SAR, China
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Alves GS, de Carvalho LDA, Sudo FK, Briand L, Laks J, Engelhardt E. A panel of clinical and neuropathological features of cerebrovascular disease through the novel neuroimaging methods. Dement Neuropsychol 2017; 11:343-355. [PMID: 29354214 PMCID: PMC5769992 DOI: 10.1590/1980-57642016dn11-040003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED The last decade has witnessed substantial progress in acquiring diagnostic biomarkers for the diagnostic workup of cerebrovascular disease (CVD). Advanced neuroimaging methods not only provide a strategic contribution for the differential diagnosis of vascular dementia (VaD) and vascular cognitive impairment (VCI), but also help elucidate the pathophysiological mechanisms ultimately leading to small vessel disease (SVD) throughout its course. OBJECTIVE In this review, the novel imaging methods, both structural and metabolic, were summarized and their impact on the diagnostic workup of age-related CVD was analysed. Methods: An electronic search between January 2010 and 2017 was carried out on PubMed/MEDLINE, Institute for Scientific Information Web of Knowledge and EMBASE. RESULTS The use of full functional multimodality in simultaneous Magnetic Resonance (MR)/Positron emission tomography (PET) may potentially improve the clinical characterization of VCI-VaD; for structural imaging, MRI at 3.0 T enables higher-resolution scanning with greater imaging matrices, thinner slices and more detail on the anatomical structure of vascular lesions. CONCLUSION Although the importance of most of these techniques in the clinical setting has yet to be recognized, there is great expectancy in achieving earlier and more refined therapeutic interventions for the effective management of VCI-VaD.
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Affiliation(s)
| | | | - Felipe Kenji Sudo
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, RJ, Brazil
- Instituto D'Or de Ensino e Pesquisa, Rio de Janeiro, RJ, Brazil
| | - Lucas Briand
- Departamento de Medicina Interna, Universidade Federal do Ceará, CE, Brazil
| | - Jerson Laks
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brazil
- Programa de Pós-Graduação em Biomedicina Translacional (BIOTRANS), Unigranrio, Duque de Caxias, RJ, Brazil
| | - Eliasz Engelhardt
- Setor de Neurologia Cognitiva e do Comportamento, Instituto de Neurologia Deolindo Couto (INDC-CDA/IPUB), Rio de Janeiro, RJ, Brazil
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