Detection of early neuronal damage in CADASIL patients by q-space MR imaging

Association between cerebrovasoreactivity and stroke in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

Background

Impaired cerebrovasoreactivity is thought to play an important role in the pathophysiology of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We aimed to clarify the association between cerebrovascular reactivity and stroke in patients with CADASIL.

Methods

We retrospectively recruited 14 patients with CADASIL, eight of whom had symptomatic stroke. They underwent quantitative single-photon emission computed tomography using an autoradiographic method at rest and after acetazolamide (ACZ) administration. Regional cerebral blood flow (rCBF) in the cerebral cortex, lenticular nucleus, thalamus, and cerebellum was measured. We compared the rCBF parameters between patients with and without stroke.

Results

The baseline characteristics and magnetic resonance imaging findings were similar between the two groups, except for a higher frequency of pyramidal tract sign (75% vs. 0%) and a larger number of old lacunes (15.4 ± 8.8 vs. 2.2 ± 1.8) in the patients with stroke. Of the rCBF parameters measured, significantly lower flow (mL/100 g/min) was observed in ACZ-rCBF in the thalamus (35.6 ± 9.4 vs. 51.1 ± 7.6, p = 0.01) and ΔrCBF in the thalamus (10.6 ± 3.7 vs. 21.0 ± 7.9, p = 0.02) in the patients with stroke.

Conclusion

Cerebrovasoreactivity in the thalamus was significantly associated with stroke in patients with CADASIL.

Research and application advances in rehabilitation assessment of stroke

Stroke has a high incidence and disability rate, and rehabilitation is an effective means to reduce the disability rate of patients. To systematize rehabilitation assessment, which is the foundation for rehabilitation therapy, we summarize the assessment methods commonly used in research and clinical applications, including the various types of stroke rehabilitation scales and their applicability, and related biomedical detection technologies, including surface electromyography (sEMG), motion analysis systems, transcranial magnetic stimulation (TMS), magnetic resonance imaging (MRI), and combinations of different techniques. We also introduce some assessment techniques that are still in the experimental phase, such as the prospective application of artificial intelligence (AI) with optical correlation tomography (OCT) in stroke rehabilitation. This review provides a useful bibliography for the assessment of not only the severity of stroke injury, but also the therapeutic effects of stroke rehabilitation, and establishes a solid base for the future development of stroke rehabilitation skills.

Can we shorten the q-space imaging to make it clinically feasible?

PURPOSE

Q-space imaging (QSI) is a novel magnetic resonance imaging (MRI) technique that enables assessment of micro-structural changes of white matter. The acquisition time, however, is comparatively long to use for routine clinical assessment. Therefore, the present study investigated the clinically feasible b value combinations to measure the water molecular displacement probability density function (PDF) in healthy subjects.

METHODS

The subjects consisted of five healthy volunteers (1 female and 4 male; 40.8 ± 13.2 years). All MRIs were examined at 1.5 T. The QSI was acquired using a single-shot echo-planar imaging and Δ/δ = 142/17 ms. The magnitude of the gradients was incremented in nine steps to reach a maximal b = 10,000 s/mm². The total acquisition time of this original QSI was 17.4 min. The feasibility of ten alternative b value combinations with the zero-filling or curve fitting technique was assessed. The mean diffusivities (MDs), kurtosis, and zero displacement probability (ZDP) were obtained, and these results were compared in manually segmented regions of interest.

RESULTS

There were alternative b value combinations with a 7.5-min acquisition time and with almost the same PDF.

CONCLUSION

A few alternative b value combinations with the curve fitting technique were found to be able to shorten the QSI acquisition for its clinical feasibility of MD and ZDP.

Imaging characteristics of cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL)

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is an autosomal dominant vascular disorder. Diagnosis and follow-up in patients with CADASIL are based mainly on magnetic resonance imaging (MRI). MRI shows white matter hyperintensities (WMHs), lacunar infarcts and cerebral microbleeds (CMBs). WMHs lesions tend to be symmetrical and bilateral, distributed in the periventricular and deep white matter. The anterior temporal lobe and external capsules are predilection sites for WMHs, with higher specificity and sensitivity of anterior temporal lobe involvement compared to an external capsule involvement. Lacunar infarcts are presented by an imaging signal that has intensity of cerebrospinal fluid in all MRI sequences. They are localized within the semioval center, thalamus, basal ganglia and pons. CMBs are depicted as focal areas of signal loss on T2 images which increases in size on the T2*-weighted gradient echo planar images ("blooming effect").