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Reiländer A, Engel M, Nöth U, Deichmann R, Shrestha M, Wagner M, Gracien RM, Seiler A. Cortical microstructural involvement in cerebral small vessel disease. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100218. [PMID: 38510580 PMCID: PMC10951897 DOI: 10.1016/j.cccb.2024.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Background In cerebral small vessel disease (CSVD), cortical atrophy occurs at a later stage compared to microstructural abnormalities and therefore cannot be used for monitoring short-term disease progression. We aimed to investigate whether cortical diffusion tensor imaging (DTI) and quantitative (q) magnetic resonance imaging (MRI) are able to detect early microstructural involvement of the cerebral cortex in CSVD. Materials and Methods 33 CSVD patients without significant cortical or whole-brain atrophy and 16 healthy control subjects were included and underwent structural MRI, DTI and high-resolution qMRI with T2, T2* and T2' mapping at 3 T as well as comprehensive cognitive assessment. After tissue segmentation and reconstruction of the cortical boundaries with the Freesurfer software, DTI and qMRI parameters were saved as surface datasets and averaged across all vertices. Results Cortical diffusivity and quantitative T2 values were significantly increased in patients compared to controls (p < 0.05). T2 values correlated significantly positively with white matter hyperintensity (WMH) volume (p < 0.01). Both cortical diffusivity and T2 showed significant negative associations with axonal damage to the white matter fiber tracts (p < 0.05). Conclusions Cortical diffusivity and quantitative T2 mapping are suitable to detect microstructural involvement of the cerebral cortex in CSVD and represent promising imaging biomarkers for monitoring disease progression and effects of therapeutical interventions in clinical studies.
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Affiliation(s)
- Annemarie Reiländer
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
- Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Marlene Engel
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Manoj Shrestha
- Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Marlies Wagner
- Brain Imaging Center, Goethe University, Frankfurt, Germany
- Institute of Neuroradiology, Goethe University Hospital, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
- Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Alexander Seiler
- Brain Imaging Center, Goethe University, Frankfurt, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
- Neurovascular Center, University Hospital Schleswig-Holstein, Kiel, Germany
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2
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Hamid C, Maiworm M, Wagner M, Knake S, Nöth U, Deichmann R, Gracien RM, Seiler A. Focal epilepsy without overt epileptogenic lesions: no evidence of microstructural brain tissue damage in multi-parametric quantitative MRI. Front Neurol 2023; 14:1175971. [PMID: 37528856 PMCID: PMC10389268 DOI: 10.3389/fneur.2023.1175971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Background and purpose In patients with epilepsies of structural origin, brain atrophy and pathological alterations of the tissue microstructure extending beyond the putative epileptogenic lesion have been reported. However, in patients without any evidence of epileptogenic lesions on diagnostic magnetic resonance imaging (MRI), impairment of the brain microstructure has been scarcely elucidated. Using multiparametric quantitative (q) magnetic resonance imaging MRI, we aimed to investigate diffuse impairment of the microstructural tissue integrity in MRI-negative focal epilepsy patients. Methods 27 MRI-negative patients with focal epilepsy (mean age 33.1 ± 14.2 years) and 27 matched healthy control subjects underwent multiparametric qMRI including T1, T2, and PD mapping at 3 T. After tissue segmentation based on synthetic anatomies, mean qMRI parameter values were extracted from the cerebral cortex, the white matter (WM) and the deep gray matter (GM) and compared between patients and control subjects. Apart from calculating mean values for the qMRI parameters across the respective compartments, voxel-wise analyses were performed for each tissue class. Results There were no significant differences for mean values of quantitative T1, T2, and PD obtained from the cortex, the WM and the deep GM between the groups. Furthermore, the voxel-wise analyses did not reveal any clusters indicating significant differences between patients and control subjects for the qMRI parameters in the respective compartments. Conclusions Based on the employed methodology, no indication for an impairment of the cerebral microstructural tissue integrity in MRI-negative patients with focal epilepsy was found in this study. Further research will be necessary to identify relevant factors and mechanisms contributing to microstructural brain tissue damage in various subgroups of patients with epilepsy.
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Affiliation(s)
- Celona Hamid
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Frankfurt, Germany
| | - Michelle Maiworm
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Frankfurt, Germany
- Institute of Neuroradiology, Goethe University Hospital, Frankfurt, Germany
| | - Susanne Knake
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Frankfurt, Germany
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Frankfurt, Germany
| | - Alexander Seiler
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
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3
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Quantitative Relaxometry Metrics for Brain Metastases Compared to Normal Tissues: A Pilot MR Fingerprinting Study. Cancers (Basel) 2022; 14:cancers14225606. [PMID: 36428699 PMCID: PMC9688653 DOI: 10.3390/cancers14225606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of the present pilot study was to estimate T1 and T2 metric values derived simultaneously from a new, rapid Magnetic Resonance Fingerprinting (MRF) technique, as well as to assess their ability to characterize-brain metastases (BM) and normal-appearing brain tissues. Fourteen patients with BM underwent MRI, including prototype MRF, on a 3T scanner. In total, 108 measurements were analyzed: 42 from solid parts of BM's (21 each on T1 and T2 maps) and 66 from normal-appearing brain tissue (11 ROIs each on T1 and T2 maps for gray matter [GM], white matter [WM], and cerebrospinal fluid [CSF]). The BM's mean T1 and T2 values differed significantly from normal-appearing WM (p < 0.05). The mean T1 values from normal-appearing GM, WM, and CSF regions were 1205 ms, 840 ms, and 4233 ms, respectively. The mean T2 values were 108 ms, 78 ms, and 442 ms, respectively. The mean T1 and T2 values for untreated BM (n = 4) were 2035 ms and 168 ms, respectively. For treated BM (n = 17) the T1 and T2 values were 2163 ms and 141 ms, respectively. MRF technique appears to be a promising and rapid quantitative method for the characterization of free water content and tumor morphology in BMs.
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4
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Brandhofe A, Stratmann C, Schüre JR, Pilatus U, Hattingen E, Deichmann R, Nöth U, Wagner M, Gracien RM, Seiler A. T 2 relaxation time of the normal-appearing white matter is related to the cognitive status in cerebral small vessel disease. J Cereb Blood Flow Metab 2021; 41:1767-1777. [PMID: 33327818 PMCID: PMC8221761 DOI: 10.1177/0271678x20972511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Previous diffusion tensor imaging (DTI) studies indicate that impaired microstructural integrity of the normal-appearing white matter (NAWM) is related to cognitive impairment in cerebral small vessel disease (SVD). This study aimed to investigate whether quantitative T2 relaxometry is a suitable imaging biomarker for the assessment of tissue changes related to cognitive abnormalities in patients with SVD. 39 patients and 18 age-matched healthy control subjects underwent 3 T magnetic resonance imaging (MRI) with T2-weighted multiple spin echo sequences for T2 relaxometry and DTI sequences, as well as comprehensive cognitive assessment. Averaged quantitative T2, fractional anisotropy (FA) and mean diffusivity (MD) were determined in the NAWM and related to cognitive parameters controlling for age, normalized brain volume, white matter hyperintensity volume and other conventional SVD markers. In SVD patients, quantitative T2 values were significantly increased compared to controls (p = 0.002) and significantly negatively correlated with the global cognitive performance (r= -0.410, p = 0.014) and executive function (r= -0.399, p = 0.016). DTI parameters did not correlate with cognitive function. T2 relaxometry of the NAWM seems to be sensitive to microstructural tissue damage associated with cognitive impairment in SVD and might be a promising imaging biomarker for evaluation of disease progression and possible effects of therapeutic interventions.
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Affiliation(s)
- Annemarie Brandhofe
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Christoph Stratmann
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Jan-Rüdiger Schüre
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrich Pilatus
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Alexander Seiler
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
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5
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Seiler A, Nöth U, Hok P, Reiländer A, Maiworm M, Baudrexel S, Meuth S, Rosenow F, Steinmetz H, Wagner M, Hattingen E, Deichmann R, Gracien RM. Multiparametric Quantitative MRI in Neurological Diseases. Front Neurol 2021; 12:640239. [PMID: 33763021 PMCID: PMC7982527 DOI: 10.3389/fneur.2021.640239] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/12/2021] [Indexed: 11/27/2022] Open
Abstract
Magnetic resonance imaging (MRI) is the gold standard imaging technique for diagnosis and monitoring of many neurological diseases. However, the application of conventional MRI in clinical routine is mainly limited to the visual detection of macroscopic tissue pathology since mixed tissue contrasts depending on hardware and protocol parameters hamper its application for the assessment of subtle or diffuse impairment of the structural tissue integrity. Multiparametric quantitative (q)MRI determines tissue parameters quantitatively, enabling the detection of microstructural processes related to tissue remodeling in aging and neurological diseases. In contrast to measuring tissue atrophy via structural imaging, multiparametric qMRI allows for investigating biologically distinct microstructural processes, which precede changes of the tissue volume. This facilitates a more comprehensive characterization of tissue alterations by revealing early impairment of the microstructural integrity and specific disease-related patterns. So far, qMRI techniques have been employed in a wide range of neurological diseases, including in particular conditions with inflammatory, cerebrovascular and neurodegenerative pathology. Numerous studies suggest that qMRI might add valuable information, including the detection of microstructural tissue damage in areas appearing normal on conventional MRI and unveiling the microstructural correlates of clinical manifestations. This review will give an overview of current qMRI techniques, the most relevant tissue parameters and potential applications in neurological diseases, such as early (differential) diagnosis, monitoring of disease progression, and evaluating effects of therapeutic interventions.
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Affiliation(s)
- Alexander Seiler
- Department of Neurology, Goethe University, Frankfurt, Germany.,Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Goethe University, Frankfurt, Germany
| | - Pavel Hok
- Department of Neurology, Palacký University Olomouc and University Hospital Olomouc, Olomouc, Czechia
| | - Annemarie Reiländer
- Department of Neurology, Goethe University, Frankfurt, Germany.,Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Michelle Maiworm
- Department of Neurology, Goethe University, Frankfurt, Germany.,Brain Imaging Center, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Goethe University, Frankfurt, Germany
| | - Simon Baudrexel
- Department of Neurology, Goethe University, Frankfurt, Germany.,Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Sven Meuth
- Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Felix Rosenow
- Department of Neurology, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Goethe University, Frankfurt, Germany.,Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital, Frankfurt, Germany
| | - Helmuth Steinmetz
- Department of Neurology, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Goethe University, Frankfurt, Germany
| | - Marlies Wagner
- Brain Imaging Center, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Goethe University, Frankfurt, Germany
| | - Elke Hattingen
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Goethe University, Frankfurt, Germany.,Department of Neuroradiology, Goethe University, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Goethe University, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University, Frankfurt, Germany.,Brain Imaging Center, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Goethe University, Frankfurt, Germany
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6
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Seiler A, Brandhofe A, Gracien RM, Pfeilschifter W, Hattingen E, Deichmann R, Nöth U, Wagner M. DSC perfusion-based collateral imaging and quantitative T2 mapping to assess regional recruitment of leptomeningeal collaterals and microstructural cortical tissue damage in unilateral steno-occlusive vasculopathy. J Cereb Blood Flow Metab 2021; 41:67-81. [PMID: 31987009 PMCID: PMC7747159 DOI: 10.1177/0271678x19898148] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Leptomeningeal collateral supply is considered pivotal in steno-occlusive vasculopathy to prevent chronic microstructural ischaemic tissue damage. The aim of this study was to assess the alleged protective role of leptomeningeal collaterals in patients with unilateral high-grade steno-occlusive vasculopathy using quantitative (q)T2 mapping and perfusion-weighted imaging (PWI)-based collateral abundance. High-resolution qT2 was used to estimate microstructural damage of the segmented normal-appearing cortex. Volumetric abundance of collaterals was assessed based on PWI source data. The ratio relative cerebral blood flow/relative cerebral blood volume (rCBF/rCBV) as a surrogate of relative cerebral perfusion pressure (rCPP) was used to investigate the intravascular hemodynamic competency of pial collateral vessels and the hemodynamic state of brain parenchyma. Within the dependent vascular territory with increased cortical qT2 values (P = 0.0001) compared to the contralateral side, parenchymal rCPP was decreased (P = 0.0001) and correlated negatively with increase of qT2 (P < 0.05). Furthermore, volumetric abundance of adjacent leptomeningeal collaterals was significantly increased (P < 0.01) and negatively correlated with changes of parenchymal rCPP (P = 0.01). Microstructural cortical damage is closely related to restrictions of antegrade blood flow despite increased pial collateral vessel abundance. Therefore, increased leptomeningeal collateral supply cannot necessarily be regarded as a sign of effective compensation in patients with high-grade steno-occlusive vasculopathy.
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Affiliation(s)
- Alexander Seiler
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Alexander Seiler, Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528 Frankfurt, Germany.
| | - Annemarie Brandhofe
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Elke Hattingen
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
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7
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On the influence of two coexisting species of susceptibility-producing structures on the R2∗ relaxation rate. Magn Reson Imaging 2020; 71:170-177. [DOI: 10.1016/j.mri.2020.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/06/2020] [Accepted: 06/09/2020] [Indexed: 01/01/2023]
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8
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Seiler A, Schöngrundner S, Stock B, Nöth U, Hattingen E, Steinmetz H, Klein JC, Baudrexel S, Wagner M, Deichmann R, Gracien RM. Cortical aging - new insights with multiparametric quantitative MRI. Aging (Albany NY) 2020; 12:16195-16210. [PMID: 32852283 PMCID: PMC7485732 DOI: 10.18632/aging.103629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
Understanding the microstructural changes related to physiological aging of the cerebral cortex is pivotal to differentiate healthy aging from neurodegenerative processes. The aim of this study was to investigate the age-related global changes of cortical microstructure and regional patterns using multiparametric quantitative MRI (qMRI) in healthy subjects with a wide age range. 40 healthy participants (age range: 2nd to 8th decade) underwent high-resolution qMRI including T1, PD as well as T2, T2* and T2′ mapping at 3 Tesla. Cortical reconstruction was performed with the FreeSurfer toolbox, followed by tests for correlations between qMRI parameters and age. Cortical T1 values were negatively correlated with age (p=0.007) and there was a widespread age-related decrease of cortical T1 involving the frontal and the parietotemporal cortex, while T2 was correlated positively with age, both in frontoparietal areas and globally (p=0.004). Cortical T2′ values showed the most widespread associations across the cortex and strongest correlation with age (r= -0.724, p=0.0001). PD and T2* did not correlate with age. Multiparametric qMRI allows to characterize cortical aging, unveiling parameter-specific patterns. Quantitative T2′ mapping seems to be a promising imaging biomarker of cortical age-related changes, suggesting that global cortical iron deposition is a prominent process in healthy aging.
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Affiliation(s)
- Alexander Seiler
- Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Sophie Schöngrundner
- Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Department of Neuroradiology, Goethe University, Frankfurt am Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Benjamin Stock
- Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Department of Neuroradiology, Goethe University, Frankfurt am Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe University, Frankfurt am Main, Germany
| | - Helmuth Steinmetz
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Johannes C Klein
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon Baudrexel
- Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Marlies Wagner
- Department of Neuroradiology, Goethe University, Frankfurt am Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
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9
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Seiler A, Brandhofe A, Gracien RM, Pfeilschifter W, Hattingen E, Deichmann R, Nöth U, Wagner M. Microstructural Alterations Analogous to Accelerated Aging of the Cerebral Cortex in Carotid Occlusive Disease. Clin Neuroradiol 2020; 31:709-720. [PMID: 32638029 PMCID: PMC8463359 DOI: 10.1007/s00062-020-00928-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Abstract
Purpose To investigate cortical thickness and cortical quantitative T2 values as imaging markers of microstructural tissue damage in patients with unilateral high-grade internal carotid artery occlusive disease (ICAOD). Methods A total of 22 patients with ≥70% stenosis (mean age 64.8 years) and 20 older healthy control subjects (mean age 70.8 years) underwent structural magnetic resonance imaging (MRI) and high-resolution quantitative (q)T2 mapping. Generalized linear mixed models (GLMM) controlling for age and white matter lesion volume were employed to investigate the effect of ICAOD on imaging parameters of cortical microstructural integrity in multivariate analyses. Results There was a significant main effect (p < 0.05) of the group (patients/controls) on both cortical thickness and cortical qT2 values with cortical thinning and increased cortical qT2 in patients compared to controls, irrespective of the hemisphere. The presence of upstream carotid stenosis had a significant main effect on cortical qT2 values (p = 0.01) leading to increased qT2 in the poststenotic hemisphere, which was not found for cortical thickness. The GLMM showed that in general cortical thickness was decreased and cortical qT2 values were increased with increasing age (p < 0.05). Conclusion Unilateral high-grade carotid occlusive disease is associated with widespread cortical thinning and prolongation of cortical qT2, presumably reflecting hypoperfusion-related microstructural cortical damage similar to accelerated aging of the cerebral cortex. Cortical thinning and increase of cortical qT2 seem to reflect different aspects and different pathophysiological states of cortical degeneration. Quantitative T2 mapping might be a sensitive imaging biomarker for early cortical microstructural damage.
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Affiliation(s)
- Alexander Seiler
- Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. .,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany.
| | - Annemarie Brandhofe
- Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Waltraud Pfeilschifter
- Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
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10
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Kaczmarz S, Hyder F, Preibisch C. Oxygen extraction fraction mapping with multi-parametric quantitative BOLD MRI: Reduced transverse relaxation bias using 3D-GraSE imaging. Neuroimage 2020; 220:117095. [PMID: 32599265 PMCID: PMC7730517 DOI: 10.1016/j.neuroimage.2020.117095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 01/22/2023] Open
Abstract
Magnetic resonance imaging (MRI)-based quantification of the blood-oxygenation-level-dependent (BOLD) effect allows oxygen extraction fraction (OEF) mapping. The multi-parametric quantitative BOLD (mq-BOLD) technique facilitates relative OEF (rOEF) measurements with whole brain coverage in clinically applicable scan times. Mq-BOLD requires three separate scans of cerebral blood volume and transverse relaxation rates measured by gradient-echo (1/T2*) and spin-echo (1/T2). Although the current method is of clinical merit in patients with stroke, glioma and internal carotid artery stenosis (ICAS), there are relaxation measurement artefacts that impede the sensitivity of mq-BOLD and artificially elevate reported rOEF values. We posited that T2-related biases caused by slice refocusing imperfections during rapid 2D-GraSE (Gradient and Spin Echo) imaging can be reduced by applying 3D-GraSE imaging sequences, because the latter requires no slice selective pulses. The removal of T2-related biases would decrease overestimated rOEF values measured by mq-BOLD. We characterized effects of T2-related bias in mq-BOLD by comparing the initially employed 2D-GraSE and two proposed 3D-GraSE sequences to multiple single spin-echo reference measurements, both in vitro and in vivo. A phantom and 25 participants, including young and elderly healthy controls as well as ICAS-patients, were scanned. We additionally proposed a procedure to reliably identify and exclude artefact affected voxels. In the phantom, 3D-GraSE derived T2 values had 57% lower deviation from the reference. For in vivo scans, the formerly overestimated rOEF was reduced by −27% (p < 0.001). We obtained rOEF = 0.51, which is much closer to literature values from positron emission tomography (PET) measurements. Furthermore, increased sensitivity to a focal rOEF elevation in an ICAS-patient was demonstrated. In summary, the application of 3D-GraSE improves the mq-BOLD-based rOEF quantification while maintaining clinically feasible scan times. Thus, mq-BOLD with non-slice selective T2 imaging is highly promising to improve clinical diagnostics of cerebrovascular diseases such as ICAS.
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Affiliation(s)
- Stephan Kaczmarz
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Munich, Germany; Departments of Radiology & Biomedical Imaging and of Biomedical Engineering, Magnetic Resonance Research Center, Yale University, New Haven, CT, 06520, USA; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Munich, Germany.
| | - Fahmeed Hyder
- Departments of Radiology & Biomedical Imaging and of Biomedical Engineering, Magnetic Resonance Research Center, Yale University, New Haven, CT, 06520, USA
| | - Christine Preibisch
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Clinic for Neurology, Munich, Germany
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11
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Wang DQ, Wang L, Wei MM, Xia XS, Tian XL, Cui XH, Li X. Relationship Between Type 2 Diabetes and White Matter Hyperintensity: A Systematic Review. Front Endocrinol (Lausanne) 2020; 11:595962. [PMID: 33408693 PMCID: PMC7780232 DOI: 10.3389/fendo.2020.595962] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/18/2020] [Indexed: 01/14/2023] Open
Abstract
White matter (WM) disease is recognized as an important cause of cognitive decline and dementia. White matter lesions (WMLs) appear as white matter hyperintensities (WMH) on T2-weighted magnetic resonance imaging (MRI) scans of the brain. Previous studies have shown that type 2 diabetes (T2DM) is associated with WMH. In this review, we reviewed the literature on the relationship between T2DM and WMH in PubMed and Cochrane over the past five years and explored the possible links among the presence of T2DM, the course or complications of diabetes, and WMH. We found that: (1) Both from a macro- and micro-scopic point of view, most studies support the relationship of a larger WMH and a decrease in the integrity of WMH in T2DM; (2) From the relationship between brain structural changes and cognition in T2DM, the poor performance in memory, attention, and executive function tests associated with abnormal brain structure is consistent; (3) Diabetic microangiopathy or peripheral neuropathy may be associated with WMH, suggesting that the brain may be a target organ for T2DM microangiopathy; (4) Laboratory markers such as insulin resistance and fasting insulin levels were significantly associated with WMH. High HbA1c and high glucose variability were associated with WMH but not glycemic control.
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Affiliation(s)
- Dan-Qiong Wang
- Department of General Medical, Shanxi Bethune Hospital Shanxi Academy of Medical Sciences, Taiyuan, China
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lei Wang
- Department of General Medical, Shanxi Bethune Hospital Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Miao-Miao Wei
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiao-Shuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiao-Lin Tian
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiao-Hong Cui
- Department of Psychiatry, Shanxi Bethune Hospital Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
- *Correspondence: Xin Li,
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12
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Balasubramanian M, Polimeni JR, Mulkern RV. In vivo measurements of irreversible and reversible transverse relaxation rates in human basal ganglia at 7 T: making inferences about the microscopic and mesoscopic structure of iron and calcification deposits. NMR IN BIOMEDICINE 2019; 32:e4140. [PMID: 31322331 PMCID: PMC6817385 DOI: 10.1002/nbm.4140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 05/29/2019] [Accepted: 06/12/2019] [Indexed: 05/24/2023]
Abstract
The goal of this study was to measure irreversible and reversible transverse relaxation rates in the globus pallidus and putamen at 7 T, and to use these rates to make inferences about the sub-voxel structure of iron and calcification deposits. Gradient Echo Sampling of a Spin Echo (GESSE) data were acquired at 7 T on eighteen volunteers spanning a large range of ages (23-85 years), with calcifications in the globus pallidus incidentally observed in one volunteer. Maps of transverse relaxation rates were derived from the GESSE data, and the mean value of these rates in globus pallidus and putamen was estimated for each volunteer. Both irreversible and reversible transverse relaxation rates increased with the expected age-dependent iron content in these structures, except for the individual with calcifications for whom extremely large reversible relaxation rates but normal irreversible relaxation rates were found in the globus pallidus. Given the sensitivity of irreversible and reversible transverse relaxation rates to microscopic and mesoscopic field variations, respectively, our findings suggest that joint consideration of these rates may yield information not only about the amount of iron and calcification deposited in the brain, but also about the sub-voxel structure of these deposits, perhaps revealing certain aspects of their geometry and cellular distribution.
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Affiliation(s)
- Mukund Balasubramanian
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Boston Children’s Hospital, Boston, MA, USA
| | - Jonathan R. Polimeni
- Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Robert V. Mulkern
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Boston Children’s Hospital, Boston, MA, USA
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13
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Seiler A, Kammerer S, Gühl A, Schüre JR, Deichmann R, Nöth U, Pfeilschifter W, Hattingen E, Keese M, Pilatus U, Wagner M. Revascularization of High-Grade Carotid Stenosis Restores Global Cerebral Energy Metabolism. Stroke 2019; 50:1742-1750. [PMID: 31164069 DOI: 10.1161/strokeaha.118.023559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Chronic cerebral hemodynamic impairment due to high-grade occlusive carotid disease may lead to compromised energy metabolism. This might result in chronic subtle tissue damage, even in patients without overt brain infarction. The aim of this study was to investigate hypoperfusion-related changes of cerebral energy metabolism and their potential restitution after revascularization. For this purpose, 3-dimensional 31P magnetic resonance spectroscopy and oxygenation-sensitive T2' magnetic resonance imaging were used (with 1/T2'=1/T2*-1/T2), which were expected to cross-validate each other. Methods- Ten patients with unilateral high-grade carotid artery stenosis resulting in a transient ischemic attack or a nondisabling cerebral ischemia were included. Then, high-energy metabolites, intracellular pH, and oxygenation-sensitive quantitative (q)T2' values were determined in noninfarcted hypoperfused areas delineated on time-to-peak maps from perfusion-weighted imaging and in unaffected contralateral areas before and shortly after carotid stenting/endarterectomy. Repeated measures ANOVA was used to test for intervention effects. Results- Within dependent hypoperfused areas ipsilateral to the stenosis, qT2' was significantly decreased ( P<0.05) as compared to corresponding contralateral areas before carotid intervention. There was a significant effect of carotid intervention on qT2' values in both hemispheres ( P<0.001). No differences between hemispheres were found for qT2' after revascularization. Intracellular pH and qT2' values showed a significant negative relationship ( P=0.005) irrespective of time point and hemisphere. Conclusions- After revascularization of unilateral high-grade carotid stenosis, previously decreased qT2' in the dependent hypoperfused territory as marker of hypoxia reincreases not only in the dependent territory but also in corresponding contralateral brain tissue. This might indicate a restriction of the whole-brain oxygen metabolism in case of unilateral high-grade carotid stenosis and an improvement of whole-brain oxygenation after revascularization that goes beyond acute clinically apparent affection of the dependent territory. Furthermore, tissue oxygen supply seems to be closely linked to intracellular pH.
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Affiliation(s)
- Alexander Seiler
- From the Department of Neurology (A.S., W.P.), Goethe University Frankfurt, Germany
| | - Sara Kammerer
- Institute of Neuroradiology (S.K., A.G., J.R.S., E.H., U.P., M.W.), Goethe University Frankfurt, Germany
| | - Alexander Gühl
- Institute of Neuroradiology (S.K., A.G., J.R.S., E.H., U.P., M.W.), Goethe University Frankfurt, Germany
| | - Jan Rüdiger Schüre
- Institute of Neuroradiology (S.K., A.G., J.R.S., E.H., U.P., M.W.), Goethe University Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center (R.D., U.N.), Goethe University Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center (R.D., U.N.), Goethe University Frankfurt, Germany
| | | | - Elke Hattingen
- Institute of Neuroradiology (S.K., A.G., J.R.S., E.H., U.P., M.W.), Goethe University Frankfurt, Germany
| | - Michael Keese
- Department of Vascular Surgery (M.K.), Goethe University Frankfurt, Germany
| | - Ulrich Pilatus
- Institute of Neuroradiology (S.K., A.G., J.R.S., E.H., U.P., M.W.), Goethe University Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology (S.K., A.G., J.R.S., E.H., U.P., M.W.), Goethe University Frankfurt, Germany
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14
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Atwi S, Metcalfe AWS, Robertson AD, Rezmovitz J, Anderson ND, MacIntosh BJ. Attention-Related Brain Activation Is Altered in Older Adults With White Matter Hyperintensities Using Multi-Echo fMRI. Front Neurosci 2018; 12:748. [PMID: 30405336 PMCID: PMC6200839 DOI: 10.3389/fnins.2018.00748] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 09/28/2018] [Indexed: 11/19/2022] Open
Abstract
Cognitive decline is often undetectable in the early stages of accelerated vascular aging. Attentional processes are particularly affected in older adults with white matter hyperintensities (WMH), although specific neurovascular mechanisms have not been elucidated. We aimed to identify differences in attention-related neurofunctional activation and behavior between adults with and without WMH. Older adults with moderate to severe WMH (n = 18, mean age = 70 years), age-matched adults (n = 28, mean age = 72), and healthy younger adults (n = 19, mean age = 25) performed a modified flanker task during multi-echo blood oxygenation level dependent functional magnetic resonance imaging. Task-related activation was assessed using a weighted-echo approach. Healthy older adults had more widespread response and higher amplitude of activation compared to WMH adults in fronto-temporal and parietal cortices. Activation associated with processing speed was absent in the WMH group, suggesting attention-related activation deficits that may be a consequence of cerebral small vessel disease. WMH adults had greater executive contrast activation in the precuneous and posterior cingulate gyrus compared to HYA, despite no performance benefits, reinforcing the network dysfunction theory in WMH.
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Affiliation(s)
- Sarah Atwi
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Arron W S Metcalfe
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Centre for Youth Bipolar Disorder, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Andrew D Robertson
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Jeremy Rezmovitz
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole D Anderson
- Department of Psychiatry and Psychology, University of Toronto, Toronto, ON, Canada.,Rotman Research Institute, Baycrest Centre, University of Toronto, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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15
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Yi HA, Won KS, Chang HW, Kim HW. Association between white matter lesions and cerebral Aβ burden. PLoS One 2018; 13:e0204313. [PMID: 30248123 PMCID: PMC6152974 DOI: 10.1371/journal.pone.0204313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/05/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION White matter lesions (WMLs), detected as hyperintensities on T2-weighted MRI, represent small vessel disease in the brain and are considered a potential risk factor for memory and cognitive impairment in older adults. The purpose of this study was to evaluate the association between WMLs and cerebral amyloid-β (Aβ) burden in patients with cognitive impairment. METHODS A total of 83 patients with cognitive impairment, who underwent brain MRI and F-18 florbetaben PET, were included prospectively: 19 patients were cognitively unimpaired, 30 exhibited mild cognitive impairment (MCI), and 34 exhibited dementia. The Fazekas scale was used to quantify WMLs on T2-weighted brain MR images. Cerebral Aβ burden was quantitatively estimated using volume-of-interest analysis. Differences in cerebral Aβ burden were evaluated between low-WML (Fazekas scale ≤1) and high-WML (Fazekas scale ≥2) groups. The relationship between the Fazekas rating and cerebral Aβ burden was evaluated using linear regression analysis after adjusting for age and sex. RESULTS In the overall cohort, the high-WML group exhibited significantly higher Aβ burden compared with the low-WML group (P = 0.011) and cerebral Aβ burden was positively correlated with Fazekas rating (β = 0.299, P = 0.006). In patients with MCI, the high-WML group exhibited significantly higher Aβ burden compared with the low-WML group (P = 0.019) and cerebral Aβ burden was positively correlated with Fazekas rating (β = 0.517, P = 0.003). CONCLUSION The presence of WMLs was associated with cerebral Aβ burden in patients with MCI. Our findings suggest that small vessel disease in the brain is related to Alzheimer's disease pathology.
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Affiliation(s)
- Hyon-Ah Yi
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Kyoung Sook Won
- Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hyuk Won Chang
- Department of Radiology, Semyung Radiology Clinic, Gumi, Republic of Korea
| | - Hae Won Kim
- Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
- * E-mail:
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16
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Seiler A, Deichmann R, Nöth U, Lauer A, Pfeilschifter W, Singer OC, Wagner M. Extent of Microstructural Tissue Damage Correlates with Hemodynamic Failure in High-Grade Carotid Occlusive Disease: An MRI Study Using Quantitative T2 and DSC Perfusion. AJNR Am J Neuroradiol 2018; 39:1273-1279. [PMID: 29748200 DOI: 10.3174/ajnr.a5666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/15/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Chronic hemodynamic impairment in high-grade carotid occlusive disease is thought to cause microstructural abnormalities that might be subclinical or lead to subtle symptoms including cognitive impairment. Quantitative MR imaging allows assessing pathologic structural changes beyond macroscopically visible tissue damage. In this study, high-resolution quantitative T2 mapping combined with DSC-based PWI was used to investigate quantitative T2 changes as a potential marker of microstructural damage in relation to hemodynamic impairment in patients with unilateral high-grade carotid occlusive disease. MATERIALS AND METHODS Eighteen patients with unilateral high-grade ICA or MCA stenosis/occlusion were included in the study. T2 values and deconvolved perfusion parameters, including relative CBF, relative CBV, and the relative CBF/relative CBV ratio as a potential indicator of local cerebral perfusion pressure, were determined within areas with delayed TTP and compared with values from contralateral unaffected areas after segmentation of normal-appearing hypoperfused WM and cortical regions. Hemispheric asymmetry indices were calculated for all parameters. RESULTS Quantitative T2 was significantly prolonged (P < .01) in hypoperfused tissue and correlated significantly (P < .01) with TTP delay and relative CBF/relative CBV reduction in WM. Significant correlations (P < .001) between TTP delay and the relative CBF/relative CBV ratio were found both in WM and in cortical areas. CONCLUSIONS Quantitative T2 can be used as a marker of microstructural tissue damage even in normal-appearing GM and WM within a vascular territory affected by high-grade carotid occlusive disease. Furthermore, the extent of damage correlates with the degree of hemodynamic failure measured by DSC perfusion parameters.
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Affiliation(s)
- A Seiler
- From the Department of Neurology (A.S., W.P., O.C.S.)
| | | | - U Nöth
- Brain Imaging Center (R.D., U.N.)
| | - A Lauer
- Institute of Neuroradiology (A.L., M.W.), Goethe University Frankfurt, Frankfurt, Germany
| | | | - O C Singer
- From the Department of Neurology (A.S., W.P., O.C.S.)
| | - M Wagner
- Institute of Neuroradiology (A.L., M.W.), Goethe University Frankfurt, Frankfurt, Germany
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17
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Giralt-Steinhauer E, Medrano S, Soriano-Tárraga C, Mola-Caminal M, Rasal R, Cuadrado-Godia E, Rodríguez-Campello A, Ois A, Capellades J, Jimenez-Conde J, Roquer J. Brainstem leukoaraiosis independently predicts poor outcome after ischemic stroke. Eur J Neurol 2018; 25:1086-1092. [PMID: 29660221 DOI: 10.1111/ene.13659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/02/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Increased supratentorial white matter hyperintensities volume (S-WMHV) has been reported to be a predictor of worse outcome in patients with acute ischemic stroke (AIS). However, few studies have focused on less common locations, such as brainstem white matter hyperintensities (B-WMH), and their relationship to S-WMHV. This study aimed to examine whether B-WMH affect clinical outcome after AIS or transient ischemic attack (TIA). METHODS Based on magnetic resonance imaging evidence, B-WMH were evaluated in 313 prospectively identified patients with AIS/TIA and registered as absent or present. Standardized S-WMHV was quantified using a validated volumetric image analysis and natural log-transformed (Log_S-WMHV). Poor outcome was defined as a modified Rankin Scale score of 3-6 at 3 months after the index event. RESULTS Brainstem white matter hyperintensities were detected in 57 (18.2%) patients. In unadjusted analyses for outcome, the presence of B-WMH was associated with worse outcome, compared with patients without B-WMH (P = 0.034). In multivariate analysis controlling for age, atrial fibrillation, stroke severity, reperfusion therapies and Log_S-WMHV, only B-WMH [odds ratio (OR), 2.46; P = 0.021] and stroke severity (OR, 1.23; P < 0.001) remained independently associated with unfavourable 90-day modified Rankin Scale score. Patients with B-WMH were older (OR, 1.06; P < 0.001) and tended to have more hyperlipidaemia (OR, 2.21; P = 0.023) and peripheral arterial disease (OR, 2.57; P = 0.031). CONCLUSIONS Brainstem white matter hyperintensities are an independent predictor of poor outcome after AIS/TIA and this relationship persists after adjustment for important prognostic factors. Our results also show that leukoaraiosis in this location identifies patients with a specific risk factor profile, suggesting differences in the underlying pathogenesis.
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Affiliation(s)
- E Giralt-Steinhauer
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - S Medrano
- Neuroradiology Department, Hospital del Mar, Universistat Autònoma de Barcelona, Barcelona
| | - C Soriano-Tárraga
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - M Mola-Caminal
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - R Rasal
- Neurology Service, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - E Cuadrado-Godia
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - A Rodríguez-Campello
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - A Ois
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - J Capellades
- Neuroradiology Department, Hospital del Mar, Universistat Autònoma de Barcelona, Barcelona
| | - J Jimenez-Conde
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
| | - J Roquer
- Department of Neurology, Hospital del Mar, Barcelona.,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona.,Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona
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18
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Recent Advances in Leukoaraiosis: White Matter Structural Integrity and Functional Outcomes after Acute Ischemic Stroke. Curr Cardiol Rep 2017; 18:123. [PMID: 27796861 DOI: 10.1007/s11886-016-0803-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Leukoaraiosis, a radiographic marker of cerebral small vessel disease detected on T2-weighted brain magnetic resonance imaging (MRI) as white matter hyperintensity (WMH), is a key contributor to the risk and severity of acute cerebral ischemia. Prior investigations have emphasized the pathophysiology of WMH development and progression; however, more recently, an association between WMH burden and functional outcomes after stroke has emerged. There is growing evidence that WMH represents macroscopic injury to the white matter and that the extent of WMH burden on MRI influences functional recovery in multiple domains following acute ischemic stroke (AIS). In this review, we discuss the current understanding of WMH pathogenesis and its impact on AIS and functional recovery.
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19
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Etherton MR, Wu O, Cougo P, Giese AK, Cloonan L, Fitzpatrick KM, Kanakis AS, Boulouis G, Karadeli HH, Lauer A, Rosand J, Furie KL, Rost NS. Integrity of normal-appearing white matter and functional outcomes after acute ischemic stroke. Neurology 2017; 88:1701-1708. [PMID: 28381507 DOI: 10.1212/wnl.0000000000003890] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/06/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To characterize the effect of white matter microstructural integrity on cerebral tissue and long-term functional outcomes after acute ischemic stroke (AIS). METHODS Consecutive AIS patients with brain MRI acquired within 48 hours of symptom onset and 90-day modified Rankin Scale (mRS) score were included. Acute infarct volume on diffusion-weighted imaging (DWIv) and white matter hyperintensity volume (WMHv) on T2 fluid-attenuated inversion recovery MRI were measured. Median fractional anisotropy (FA), mean diffusivity, radial diffusivity, and axial diffusivity values were calculated within normal-appearing white matter (NAWM) in the hemisphere contralateral to the acute lesion. Regression models were used to assess the association between diffusivity metrics and acute cerebral tissue and long-term functional outcomes in AIS. Level of significance was set at p < 0.05 for all analyses. RESULTS Among 305 AIS patients with DWIv and mRS score, mean age was 64.4 ± 15.9 years, and 183 participants (60%) were male. Median NIH Stroke Scale (NIHSS) score was 3 (interquartile range [IQR] 1-8), and median normalized WMHv was 6.19 cm3 (IQR 3.0-12.6 cm3). Admission stroke severity (β = 0.16, p < 0.0001) and small vessel stroke subtype (β = -1.53, p < 0.0001), but not diffusivity metrics, were independently associated with DWIv. However, median FA in contralesional NAWM was independently associated with mRS score (β = -9.74, p = 0.02), along with age, female sex, NIHSS score, and DWIv. CONCLUSIONS FA decrease in NAWM contralateral to the acute infarct is associated with worse mRS category at 90 days after stroke. These data suggest that white matter integrity may contribute to functional recovery after stroke.
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Affiliation(s)
- Mark R Etherton
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence.
| | - Ona Wu
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence
| | - Pedro Cougo
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence
| | - Anne-Katrin Giese
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence
| | - Lisa Cloonan
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence
| | - Kaitlin M Fitzpatrick
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence
| | - Allison S Kanakis
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence
| | - Gregoire Boulouis
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence
| | - Hasan H Karadeli
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence
| | - Arne Lauer
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence
| | - Jonathan Rosand
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence
| | - Karen L Furie
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence
| | - Natalia S Rost
- From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence
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Shi Y, Thrippleton MJ, Makin SD, Marshall I, Geerlings MI, de Craen AJM, van Buchem MA, Wardlaw JM. Cerebral blood flow in small vessel disease: A systematic review and meta-analysis. J Cereb Blood Flow Metab 2016; 36:1653-1667. [PMID: 27496552 PMCID: PMC5076792 DOI: 10.1177/0271678x16662891] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/08/2016] [Indexed: 11/15/2022]
Abstract
White matter hyperintensities are frequent on neuroimaging of older people and are a key feature of cerebral small vessel disease. They are commonly attributed to chronic hypoperfusion, although whether low cerebral blood flow is cause or effect is unclear. We systematically reviewed studies that assessed cerebral blood flow in small vessel disease patients, performed meta-analysis and sensitivity analysis of potential confounders. Thirty-eight studies (n = 4006) met the inclusion criteria, including four longitudinal and 34 cross-sectional studies. Most cerebral blood flow data were from grey matter. Twenty-four cross-sectional studies (n = 1161) were meta-analysed, showing that cerebral blood flow was lower in subjects with more white matter hyperintensity, globally and in most grey and white matter regions (e.g. mean global cerebral blood flow: standardised mean difference-0.71, 95% CI -1.12, -0.30). These cerebral blood flow differences were attenuated by excluding studies in dementia or that lacked age-matching. Four longitudinal studies (n = 1079) gave differing results, e.g., more baseline white matter hyperintensity predated falling cerebral blood flow (3.9 years, n = 575); cerebral blood flow was low in regions that developed white matter hyperintensity (1.5 years, n = 40). Cerebral blood flow is lower in subjects with more white matter hyperintensity cross-sectionally, but evidence for falling cerebral blood flow predating increasing white matter hyperintensity is conflicting. Future studies should be longitudinal, obtain more white matter data, use better age-correction and stratify by clinical diagnosis.
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Affiliation(s)
- Yulu Shi
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephen D Makin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mirjam I Geerlings
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Postmortem MRI: a novel window into the neurobiology of late life cognitive decline. Neurobiol Aging 2016; 45:169-177. [PMID: 27459937 PMCID: PMC5003419 DOI: 10.1016/j.neurobiolaging.2016.05.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/02/2016] [Accepted: 05/30/2016] [Indexed: 01/30/2023]
Abstract
This study tested the hypothesis that indices of brain tissue integrity derived from postmortem magnetic resonance imaging (MRI) are associated with late life decline in cognitive function and dementia, over and above contributions from common age-related neuropathologies. Cerebral hemispheres were obtained from 425 deceased older adults who had undergone 2 or more annual cognitive assessments, which included clinical diagnosis of dementia. Specimens underwent MRI to produce maps of transverse relaxation rate, R2. Voxelwise regression revealed brain regions where R2 was associated with cognitive decline. We then used random effects models to quantify the extent to which R2 accounted for variation in decline, after adjustment for demographics and neuropathologic indices of the 3 most common causes of dementia: Alzheimer's disease, cerebrovascular disease, and Lewy body disease. We additionally tested whether R2 was tied to greater likelihood of clinical diagnosis of Alzheimer's dementia using logistic regression models. During an average of 8.1 years, the mean rate of decline in global cognitive function was 0.13 unit per year (p < 0.0001). The tissue alteration most commonly related to decline was R2 slowing in white matter. Each unit decrease in R2 was associated with an additional 0.053-unit per year steepening of the rate of global cognitive decline (p < 0.001). Furthermore, R2 accounted for 8.4% of the variance in rate of global cognitive decline, above and beyond the 26.5% accounted for by demographics and neuropathologic indices, and 7.1%-11.2% of the variance of the decline rates in episodic, semantic, and working memory and perceptual speed. Alterations in R2 were also related to an increased odds of clinical diagnosis of Alzheimer's dementia (odds ratio = 2.000, 95% confidence interval 1.600, 2.604). Therefore, postmortem MRI indices of brain tissue integrity, particularly in white matter, are useful for elucidating the basis of late life cognitive impairment in older adults and complement traditional indices of neuropathology derived using histopathologic methods.
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Seiler A, Deichmann R, Pfeilschifter W, Hattingen E, Singer OC, Wagner M. T2-Imaging to Assess Cerebral Oxygen Extraction Fraction in Carotid Occlusive Disease: Influence of Cerebral Autoregulation and Cerebral Blood Volume. PLoS One 2016; 11:e0161408. [PMID: 27560515 PMCID: PMC4999181 DOI: 10.1371/journal.pone.0161408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Quantitative T2'-mapping detects regional changes of the relation of oxygenated and deoxygenated hemoglobin (Hb) by using their different magnetic properties in gradient echo imaging and might therefore be a surrogate marker of increased oxygen extraction fraction (OEF) in cerebral hypoperfusion. Since elevations of cerebral blood volume (CBV) with consecutive accumulation of Hb might also increase the fraction of deoxygenated Hb and, through this, decrease the T2'-values in these patients we evaluated the relationship between T2'-values and CBV in patients with unilateral high-grade large-artery stenosis. MATERIALS AND METHODS Data from 16 patients (13 male, 3 female; mean age 53 years) with unilateral symptomatic or asymptomatic high-grade internal carotid artery (ICA) or middle cerebral artery (MCA) stenosis/occlusion were analyzed. MRI included perfusion-weighted imaging and high-resolution T2'-mapping. Representative relative (r)CBV-values were analyzed in areas of decreased T2' with different degrees of perfusion delay and compared to corresponding contralateral areas. RESULTS No significant elevations in cerebral rCBV were detected within areas with significantly decreased T2'-values. In contrast, rCBV was significantly decreased (p<0.05) in regions with severe perfusion delay and decreased T2'. Furthermore, no significant correlation between T2'- and rCBV-values was found. CONCLUSIONS rCBV is not significantly increased in areas of decreased T2' and in areas of restricted perfusion in patients with unilateral high-grade stenosis. Therefore, T2' should only be influenced by changes of oxygen metabolism, regarding our patient collective especially by an increase of the OEF. T2'-mapping is suitable to detect altered oxygen consumption in chronic cerebrovascular disease.
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Affiliation(s)
- Alexander Seiler
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- * E-mail:
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Elke Hattingen
- Department of Neuroradiology, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Oliver C. Singer
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- Department of Neurology, Helios HSK Hospital, Wiesbaden, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
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