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Drenthen GS, van der Thiel MM. Editorial for "Exploring Radial Asymmetry in Diffusion Tensor Imaging and Its Impact on the Interpretation of Glymphatic Mechanisms". J Magn Reson Imaging 2024. [PMID: 38580445 DOI: 10.1002/jmri.29377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 04/07/2024] Open
Affiliation(s)
- Gerhard S Drenthen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Merel M van der Thiel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
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2
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Voorter PHM, van Dinther M, Jansen WJ, Postma AA, Staals J, Jansen JFA, van Oostenbrugge RJ, van der Thiel MM, Backes WH. Blood-Brain Barrier Disruption and Perivascular Spaces in Small Vessel Disease and Neurodegenerative Diseases: A Review on MRI Methods and Insights. J Magn Reson Imaging 2024; 59:397-411. [PMID: 37658640 DOI: 10.1002/jmri.28989] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023] Open
Abstract
Perivascular spaces (PVS) and blood-brain barrier (BBB) disruption are two key features of cerebral small vessel disease (cSVD) and neurodegenerative diseases that have been linked to cognitive impairment and are involved in the cerebral waste clearance system. Magnetic resonance imaging (MRI) offers the possibility to study these pathophysiological processes noninvasively in vivo. This educational review provides an overview of the MRI techniques used to assess PVS functionality and BBB disruption. MRI-visible PVS can be scored on structural images by either (subjectively) counting or (automatically) delineating the PVS. We highlight emerging (diffusion) techniques to measure proxies of perivascular fluid and its movement, which may provide a more comprehensive understanding of the role of PVS in diseases. For the measurement of BBB disruption, we explain the most commonly used MRI technique, dynamic contrast-enhanced (DCE) MRI, as well as a more recently developed technique based on arterial spin labeling (ASL). DCE MRI and ASL are thought to measure complementary characteristics of the BBB. Furthermore, we describe clinical studies that have utilized these MRI techniques in cSVD and neurodegenerative diseases, particularly Alzheimer's disease (AD). These studies demonstrate the role of PVS and BBB dysfunction in these diseases and provide insight into the large overlap, but also into the differences between cSVD and AD. Overall, MRI techniques may provide valuable insights into the pathophysiological mechanisms underlying these diseases and have the potential to be used as markers for disease progression and treatment response. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Paulien H M Voorter
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Maud van Dinther
- School for Cardiovascular Disease, Maastricht University, Maastricht, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Willemijn J Jansen
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Julie Staals
- School for Cardiovascular Disease, Maastricht University, Maastricht, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jacobus F A Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Robert J van Oostenbrugge
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- School for Cardiovascular Disease, Maastricht University, Maastricht, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Merel M van der Thiel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Walter H Backes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- School for Cardiovascular Disease, Maastricht University, Maastricht, the Netherlands
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van der Thiel MM, van der Knaap N, Freeze WM, Postma AA, Ariës MJH, Backes WH, Jansen JFA. The dependence of cerebral interstitial fluid on diffusion-sensitizing directions: A multi-b-value diffusion MRI study in a memory clinic sample. Magn Reson Imaging 2023; 104:97-104. [PMID: 37820977 DOI: 10.1016/j.mri.2023.10.003] [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: 06/27/2023] [Revised: 08/08/2023] [Accepted: 10/07/2023] [Indexed: 10/13/2023]
Abstract
Three-component intravoxel incoherent motion (3C-IVIM) imaging with spectral analysis provides a proxy for interstitial fluid (ISF) (e.g., in perivascular spaces (PVS), granting a potential marker for altered cerebral clearance. When 3C-IVIM images are acquired with three orthogonal diffusion-sensitizing directions, these are often averaged into the Trace image. This may result in loss of valuable direction-specific information, particularly in PVS-rich regions (basal ganglia (BG) and centrum semiovale (CSO)). This study assessed the dependence of individual diffusion-sensitizing directions to the ISF fraction in PVS-rich regions. Additionally, we explored the value of diffusion direction-specific information on ISF characteristics in distinguishing thirty-one patients with cognitive impairment (CI) (Alzheimer's disease (n = 15) or Mild Cognitive Impairment (n = 16)) from thirty cognitively healthy elderly controls (CON). Multi-b-value diffusion-weighted images were acquired in three orthogonal directions (L-R (left-right), A-P (anterior-posterior) and S-I (superior-inferior)) at 3 T. Voxel-based spectral analysis using non-negative least squares was conducted to independently analyze the L-R, A-P, S-I, and Trace images. 3C-IVIM measures were first compared between diffusion-sensitizing directions and the Trace within the BG using repeated measures ANOVA. Subsequently, the 3C-IVIM measures were compared per direction between the CI and CSO group in the BG and CSO with multivariable linear regression. Our results show that the ISF fraction significantly differs between all diffusion-sensitizing directions and Trace in the BG, with the highest ISF fraction detected using S-I. Solely using S-I, a higher ISF fraction was identified in CI compared to CON in the BG (p = .020) and CSO (p = .046). Thereby, this study found that the measured ISF fraction depends on the acquired diffusion-sensitizing direction, where S-I is most sensitive to detect ISF and differences between CI and CON. The Trace approach is not always sensitive enough to ISF characteristics. Solely acquiring S-I may offer an alternative to reduce scanning time.
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Affiliation(s)
- Merel M van der Thiel
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands.
| | - Noa van der Knaap
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Intensive Care, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Whitney M Freeze
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Alida A Postma
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Marcel J H Ariës
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Intensive Care, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Walter H Backes
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands.
| | - Jacobus F A Jansen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
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4
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Drenthen GS, Elschot EP, van der Knaap N, Uher D, Voorter PHM, Backes WH, Jansen JFA, van der Thiel MM. Imaging Interstitial Fluid With MRI: A Narrative Review on the Associations of Altered Interstitial Fluid With Vascular and Neurodegenerative Abnormalities. J Magn Reson Imaging 2023. [PMID: 37823526 DOI: 10.1002/jmri.29056] [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: 07/14/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023] Open
Abstract
Interstitial fluid (ISF) refers to the fluid between the parenchymal cells and along the perivascular spaces (PVS). ISF plays a crucial role in delivering nutrients and clearing waste products from the brain. This narrative review focuses on the use of MRI techniques to measure various ISF characteristics in humans. The complementary value of contrast-enhanced and noncontrast-enhanced techniques is highlighted. While contrast-enhanced MRI methods allow measurement of ISF transport and flow, they lack quantitative assessment of ISF properties. Noninvasive MRI techniques, including multi-b-value diffusion imaging, free-water-imaging, T2 -decay imaging, and DTI along the PVS, offer promising alternatives to derive ISF measures, such as ISF volume and diffusivity. The emerging role of these MRI techniques in investigating ISF alterations in neurodegenerative diseases (eg, Alzheimer's disease and Parkinson's disease) and cerebrovascular diseases (eg, cerebral small vessel disease and stroke) is discussed. This review also emphasizes current challenges of ISF imaging, such as the microscopic scale at which ISF has to be measured, and discusses potential focus points for future research to overcome these challenges, for example, the use of high-resolution imaging techniques. Noninvasive MRI methods for measuring ISF characteristics hold significant potential and may have a high clinical impact in understanding the pathophysiology of neurodegenerative and cerebrovascular disorders, as well as in evaluating the efficacy of ISF-targeted therapies in clinical trials. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Gerhard S Drenthen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Elles P Elschot
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Noa van der Knaap
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Daniel Uher
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paulien H M Voorter
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Walter H Backes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jacobus F A Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Merel M van der Thiel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
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5
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Voorter PHM, Backes WH, Gurney-Champion OJ, Wong SM, Staals J, van Oostenbrugge RJ, van der Thiel MM, Jansen JFA, Drenthen GS. Improving microstructural integrity, interstitial fluid, and blood microcirculation images from multi-b-value diffusion MRI using physics-informed neural networks in cerebrovascular disease. Magn Reson Med 2023. [PMID: 37317641 DOI: 10.1002/mrm.29753] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To obtain better microstructural integrity, interstitial fluid, and microvascular images from multi-b-value diffusion MRI data by using a physics-informed neural network (PINN) fitting approach. METHODS Test-retest whole-brain inversion recovery diffusion-weighted images with multiple b-values (IVIM: intravoxel incoherent motion) were acquired on separate days for 16 patients with cerebrovascular disease on a 3.0T MRI system. The performance of the PINN three-component IVIM (3C-IVIM) model fitting approach was compared with conventional fitting approaches (i.e., non-negative least squares and two-step least squares) in terms of (1) parameter map quality, (2) test-retest repeatability, and (3) voxel-wise accuracy. Using the in vivo data, the parameter map quality was assessed by the parameter contrast-to-noise ratio (PCNR) between normal-appearing white matter and white matter hyperintensities, and test-retest repeatability was expressed by the coefficient of variation (CV) and intraclass correlation coefficient (ICC). The voxel-wise accuracy of the 3C-IVIM parameters was determined by 10,000 computer simulations mimicking our in vivo data. Differences in PCNR and CV values obtained with the PINN approach versus conventional fitting approaches were assessed using paired Wilcoxon signed-rank tests. RESULTS The PINN-derived 3C-IVIM parameter maps were of higher quality and more repeatable than those of conventional fitting approaches, while also achieving higher voxel-wise accuracy. CONCLUSION Physics-informed neural networks enable robust voxel-wise estimation of three diffusion components from the diffusion-weighted signal. The repeatable and high-quality biological parameter maps generated with PINNs allow for visual evaluation of pathophysiological processes in cerebrovascular disease.
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Affiliation(s)
- Paulien H M Voorter
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Walter H Backes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands
| | - Oliver J Gurney-Champion
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Sau-May Wong
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Julie Staals
- School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert J van Oostenbrugge
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Merel M van der Thiel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jacobus F A Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gerhard S Drenthen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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6
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van den Kerkhof M, van der Thiel MM, Postma AA, van Oostenbrugge RJ, Kroon AA, Jansen JFA, Backes WH. Hypertension Correlates With Stronger Blood Flow Pulsatility in Small Perforating Cerebral Arteries Assessed With 7 Tesla Magnetic Resonance Imaging. Hypertension 2023; 80:802-810. [PMID: 36722349 DOI: 10.1161/hypertensionaha.122.19866] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hypertension alters the structure and function of cerebral blood vessels, and is an important risk factor for stroke and cerebral small vessel disease (cSVD). However, the pathophysiological process is not yet well understood. This study aimed to investigate the relationship between the pulsatility measures in small perforating arteries and hypertension, since hypertension-induced arterial stiffening may lead to a higher blood flow pulsatility and lower damping. METHODS We examined 28 patients with essential hypertension and 25 age- and sex-matched healthy controls (mean age: 63.4, range: 43-81 years, 26 males). Blood flow velocity waveforms were acquired in the lenticulostriate arteries (LSAs) and the middle cerebral artery using phase-contrast MRI at 7 Tesla. Several cSVD markers were scored. The velocity and pulsatility measures were compared between the hypertensives and controls. RESULTS A higher pulsatility index (PI) in the LSAs and a lower damping factor (DF) was found in the hypertensive compared to the normotensive group (P=0.015, P=0.015, respectively), but no association was found for the PI in the middle cerebral artery. Higher systolic and mean arterial pressures were associated with higher PI in the LSA and DF. For diastolic blood pressure, only an association with a lower DF was found. Adjusting for cSVD score did not alter these relationships. CONCLUSIONS This study shows a higher PI in the LSAs and a lower DF in subjects with hypertension, independent of cSVD presence. This supports the hypothesis that hypertension-induced arterial remodeling may alter the intracerebral blood flow velocity profiles, which could eventually contribute to cerebral tissue damage. REGISTRATION URL: https://trialsearch.who.int/; Unique identifier: NL7537 and NL8798.
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Affiliation(s)
- Marieke van den Kerkhof
- Department of Radiology and Nuclear Medicine (M.v.d.K., M.M.v.d.T., A.A.P., J.F.A.J., W.H.B.), Maastricht University Medical Center, The Netherlands.,School for Mental Health and Neuroscience (M.v.d.K., M.M.v.d.T., A.A.P., R.J.v.O., J.F.A.J., W.H.B.), Maastricht University, The Netherlands
| | - Merel M van der Thiel
- Department of Radiology and Nuclear Medicine (M.v.d.K., M.M.v.d.T., A.A.P., J.F.A.J., W.H.B.), Maastricht University Medical Center, The Netherlands.,School for Mental Health and Neuroscience (M.v.d.K., M.M.v.d.T., A.A.P., R.J.v.O., J.F.A.J., W.H.B.), Maastricht University, The Netherlands.,Department of Psychiatry and Neuropsychology (M.M.v.d.T.), Maastricht University, The Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine (M.v.d.K., M.M.v.d.T., A.A.P., J.F.A.J., W.H.B.), Maastricht University Medical Center, The Netherlands.,School for Mental Health and Neuroscience (M.v.d.K., M.M.v.d.T., A.A.P., R.J.v.O., J.F.A.J., W.H.B.), Maastricht University, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology (R.J.v.O.), Maastricht University Medical Center, The Netherlands.,School for Mental Health and Neuroscience (M.v.d.K., M.M.v.d.T., A.A.P., R.J.v.O., J.F.A.J., W.H.B.), Maastricht University, The Netherlands.,Cardiovascular Research Institute Maastricht (R.J.v.O., A.A.K., W.H.B.), Maastricht University, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine (A.A.K.), Maastricht University Medical Center, The Netherlands.,Cardiovascular Research Institute Maastricht (R.J.v.O., A.A.K., W.H.B.), Maastricht University, The Netherlands
| | - Jacobus F A Jansen
- Department of Radiology and Nuclear Medicine (M.v.d.K., M.M.v.d.T., A.A.P., J.F.A.J., W.H.B.), Maastricht University Medical Center, The Netherlands.,School for Mental Health and Neuroscience (M.v.d.K., M.M.v.d.T., A.A.P., R.J.v.O., J.F.A.J., W.H.B.), Maastricht University, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands (J.F.A.J.)
| | - Walter H Backes
- Department of Radiology and Nuclear Medicine (M.v.d.K., M.M.v.d.T., A.A.P., J.F.A.J., W.H.B.), Maastricht University Medical Center, The Netherlands.,School for Mental Health and Neuroscience (M.v.d.K., M.M.v.d.T., A.A.P., R.J.v.O., J.F.A.J., W.H.B.), Maastricht University, The Netherlands.,Cardiovascular Research Institute Maastricht (R.J.v.O., A.A.K., W.H.B.), Maastricht University, The Netherlands
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van den Kerkhof M, van der Thiel MM, van Oostenbrugge RJ, Postma AA, Kroon AA, Backes WH, Jansen JF. Impaired damping of cerebral blood flow velocity pulsatility is associated with the number of perivascular spaces as measured with 7T MRI. J Cereb Blood Flow Metab 2023; 43:937-946. [PMID: 36704826 DOI: 10.1177/0271678x231153374] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Arterial walls stiffen with age, cardiovascular risk factors, and various vascular diseases, which may lead to less damping of the arterial blood flow pulse, subsequent microvascular damage, and enlarged perivascular spaces (PVS). However, the exact interplay between these processes is unclear. This study aimed to investigate the relation between blood flow velocity pulsatility in the small lenticulostriate arteries and their supplying middle cerebral artery and the respective damping factor (DF), with the number of MRI-visible PVS in elderly subjects. Blood flow velocity waveforms were obtained in 45 subjects (median age [range]: 64 [48-81] years, 47% male) using 7T MRI. PVS were scored in the basal ganglia (BG) and centrum semiovale (CSO). Spearman correlation analyses were used to determine associations of the blood flow pulsatility and the DF, with PVS score, adjusted for age and sex. We found a significant association between a lower DF and a higher number of PVS in the BG (rs = -0.352, P = 0.021), but not in the CSO. This finding supports the supposed pathophysiological mechanism in which excessive kinetic energy deposition leads to damage of small perforating arteries and contributes to the enlargement of PVS at the level of the BG, but possible other pathways might also be of influence.
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Affiliation(s)
- Marieke van den Kerkhof
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Merel M van der Thiel
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Robert J van Oostenbrugge
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Alida A Postma
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Abraham A Kroon
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Walter H Backes
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jacobus Fa Jansen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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8
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van der Thiel MM, Backes WH, Ramakers IHGB, Jansen JFA. Novel developments in non-contrast enhanced MRI of the perivascular clearance system: What are the possibilities for Alzheimer's disease research? Neurosci Biobehav Rev 2023; 144:104999. [PMID: 36529311 DOI: 10.1016/j.neubiorev.2022.104999] [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: 06/21/2022] [Revised: 11/21/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
The cerebral waste clearance system (i.e, glymphatic or intramural periarterial drainage) works through a network of perivascular spaces (PVS). Dysfunction of this system likely contributes to aggregation of Amyloid-β and subsequent toxic plaques in Alzheimer's disease (AD). A promising, non-invasive technique to study this system is MRI, though applications in dementia are still scarce. This review focusses on recent non-contrast enhanced (non-CE) MRI techniques which determine and visualise physiological aspects of the clearance system at multiple levels, i.e., cerebrospinal fluid flow, PVS-flow and interstitial fluid movement. Furthermore, various MRI studies focussing on aspects of the clearance system which are relevant to AD are discussed, such as studies on ageing, sleep alterations, and cognitive decline. Additionally, the complementary function of non-CE to CE methods is elaborated upon. We conclude that non-CE studies have great potential to determine which parts of the waste clearance system are affected by AD and in which stages of cognitive impairment dysfunction of this system occurs, which could allow future clinical trials to target these specific mechanisms.
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Affiliation(s)
- Merel M van der Thiel
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Psychiatry &Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Walter H Backes
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands; School for Cardiovascular Disease, Maastricht University, Maastricht, the Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry &Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Jacobus F A Jansen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
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van der Thiel MM, Roos NA, Drenthen GS, Voorter PH, Feiweier T, Ramakers IH, Backes WH, Jansen JF. On the origin of a potential clearance marker: The contribution of enlarged perivascular fluid diffusion to an MRI derived proxy of interstitial fluid. Alzheimers Dement 2022. [DOI: 10.1002/alz.063077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Merel M. van der Thiel
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | - Nathalie A. Roos
- Maastricht University Medical Center + Maastricht Netherlands
- Eindhoven University of Technology Eindhoven Netherlands
| | - Gerhard S. Drenthen
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | - Paulien H.M. Voorter
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | | | | | - Walter H. Backes
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | - Jacobus F.A. Jansen
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
- Eindhoven University of Technology Eindhoven Netherlands
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10
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van der Thiel MM, Backes WH, Drenthen GS, Voorter PH, Feiweier T, Ramakers IH, Jansen JF. Association of sleep quality and diffusion MRI derived interstitial fluid content – insights in cerebral waste clearance. Alzheimers Dement 2022. [DOI: 10.1002/alz.062299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Merel M. van der Thiel
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | - Walter H. Backes
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | - Gerhard S. Drenthen
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | - Paulien H.M. Voorter
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | | | | | - Jacobus F.A. Jansen
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
- Eindhoven University of Technology Eindhoven Netherlands
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11
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van der Thiel MM, Backes WH, Drenthen GS, Voorter PH, Feiweier T, Ramakers IH, Jansen JF. Association of sleep quality and diffusion MRI derived interstitial fluid content – insights in cerebral waste clearance. Alzheimers Dement 2022. [DOI: 10.1002/alz.063113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Merel M. van der Thiel
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | - Walter H. Backes
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | - Gerhard S. Drenthen
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | - Paulien H.M. Voorter
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | | | | | - Jacobus F.A. Jansen
- Maastricht University Medical Center + Maastricht Netherlands
- Maastricht University Maastricht Netherlands
- Eindhoven University of Technology Eindhoven Netherlands
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12
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van der Thiel MM, Roos NA, Drenthen GS, Voorter PH, Feiweier T, Ramakers IH, Backes WH, Jansen JF. On the origin of a potential clearance marker: The contribution of enlarged perivascular fluid diffusion to an MRI derived proxy of interstitial fluid. Alzheimers Dement 2022. [DOI: 10.1002/alz.063089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Merel M. van der Thiel
- Maastricht University Medical Center Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | - Nathalie A. Roos
- Maastricht University Medical Center Maastricht Netherlands
- Eindhoven University of Technology Eindhoven Netherlands
| | - Gerhard S. Drenthen
- Maastricht University Medical Center Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | - Paulien H.M. Voorter
- Maastricht University Medical Center Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | | | | | - Walter H. Backes
- Maastricht University Medical Center Maastricht Netherlands
- Maastricht University Maastricht Netherlands
| | - Jacobus F.A. Jansen
- Maastricht University Medical Center Maastricht Netherlands
- Maastricht University Maastricht Netherlands
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13
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van der Thiel MM, Freeze WM, Verheggen ICM, Wong SM, de Jong JJA, Postma AA, Hoff EI, Gronenschild EHBM, Verhey FR, Jacobs HIL, Ramakers IHGB, Backes WH, Jansen JFA. Associations of increased interstitial fluid with vascular and neurodegenerative abnormalities in a memory clinic sample. Neurobiol Aging 2021; 106:257-267. [PMID: 34320463 DOI: 10.1016/j.neurobiolaging.2021.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/28/2020] [Revised: 06/15/2021] [Accepted: 06/19/2021] [Indexed: 12/21/2022]
Abstract
The vascular and neurodegenerative processes related to clinical dementia cause cell loss which induces, amongst others, an increase in interstitial fluid (ISF). We assessed microvascular, parenchymal integrity, and a proxy of ISF volume alterations with intravoxel incoherent motion imaging in 21 healthy controls and 53 memory clinic patients - mainly affected by neurodegeneration (mild cognitive impairment, Alzheimer's disease dementia), vascular pathology (vascular cognitive impairment), and presumed to be without significant pathology (subjective cognitive decline). The microstructural components were quantified with spectral analysis using a non-negative least squares method. Linear regression was employed to investigate associations of these components with hippocampal and white matter hyperintensity (WMH) volumes. In the normal appearing white matter, a large fint (a proxy of ISF volume) was associated with a large WMH volume and low hippocampal volume. Likewise, a large fint value was associated with a lower hippocampal volume in the hippocampi. Large ISF volume (fint) was shown to be a prominent factor associated with both WMHs and neurodegenerative abnormalities in memory clinic patients and is argued to play a potential role in impaired glymphatic functioning.
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Affiliation(s)
- Merel M van der Thiel
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Whitney M Freeze
- Department of Psychiatry &Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Inge C M Verheggen
- Department of Psychiatry &Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Sau May Wong
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joost J A de Jong
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Alida A Postma
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Erik I Hoff
- Department of Neurology, Zuyderland Medical Center Heerlen, Heerlen, the Netherlands
| | - Ed H B M Gronenschild
- Department of Psychiatry &Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Frans R Verhey
- Department of Psychiatry &Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Heidi I L Jacobs
- Department of Psychiatry &Neuropsychology, Maastricht University, Maastricht, the Netherlands; Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Inez H G B Ramakers
- Department of Psychiatry &Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Walter H Backes
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands; School for Cardiovascular Disease, Maastricht University, Maastricht, the Netherlands
| | - Jacobus F A Jansen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health & Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
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van der Thiel MM, Freeze WM, Verheggen IC, Wong SM, de Jong JJ, Postma LA, Verhey FR, Ramakers IH, Backes WH, Jansen JF. Vascular and neurodegenerative imaging markers are associated with increased interstitial fluid diffusion in memory clinic patients. Alzheimers Dement 2020. [DOI: 10.1002/alz.039700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Merel M. van der Thiel
- Maastricht University Medical Center Maastricht Netherlands
- Alzheimer Center Limburg School for Mental Health and Neuroscience Maastricht University Maastricht Netherlands
| | - Whitney M. Freeze
- Alzheimer Center Limburg School for Mental Health and Neuroscience Maastricht University Maastricht Netherlands
- Leiden University Medical Center Leiden Netherlands
| | - Inge C.M. Verheggen
- Alzheimer Center Limburg School for Mental Health and Neuroscience Maastricht University Maastricht Netherlands
| | - Sau May Wong
- Maastricht University Medical Center Maastricht Netherlands
| | | | | | - Frans R.J. Verhey
- Maastricht University Medical Center Maastricht Netherlands
- Alzheimer Center Limburg School for Mental Health and Neuroscience Maastricht University Maastricht Netherlands
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