3
|
Rudilosso S, Chui E, Stringer MS, Thrippleton M, Chappell F, Blair GW, Garcia DJ, Doubal F, Hamilton I, Kopczak A, Ingrisch M, Kerkhofs D, Backes WH, Staals J, van Oostenbrugge R, Duering M, Dichgans M, Wardlaw JM. Prevalence and Significance of the Vessel-Cluster Sign on Susceptibility-Weighted Imaging in Patients With Severe Small Vessel Disease. Neurology 2022; 99:e440-e452. [PMID: 35606147 PMCID: PMC9421604 DOI: 10.1212/wnl.0000000000200614] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Magnetic resonance susceptibility-weighted imaging (SWI) can identify small brain blood vessels that contain deoxygenated blood due to its induced magnetic field disturbance. We observed focal clusters of possible dilated small vessels on SWI in white matter in severe small vessel disease (SVD). We assessed their prevalence, associations with SVD lesions, and vascular reactivity in patients with sporadic SVD and in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). METHODS Secondary cross-sectional analysis of a prospective multicenter observational study of patients with either sporadic SVD or CADASIL (INVESTIGATE-SVD) studied with 3 Tesla MRI including blood-oxygen-level-dependent MRI cerebrovascular reactivity (CVR). Two independent raters evaluated SWI sequences to identify "vessel-clusters" in white matter as focal low-signal dots/lines with small vessel appearance (interrater agreement, kappa statistic = 0.66). We assessed per-patient and per-cluster associations with SVD lesion type and severity on structural MRI sequences. We also assessed CVR within and at 2-voxel concentric intervals around the vessel-clusters using contralateral volumes as a reference. RESULTS Among the 77 patients enrolled, 76 had usable SWI sequences, 45 with sporadic SVD (mean age 64 years [SD 11], 26 men [58%]) and 31 with CADASIL (53 years [11], 15 men [48%]). We identified 94 vessel-clusters in 36 of the 76 patients (15/45 sporadic SVD, 21/31 CADASIL). In covariate-adjusted analysis, patients with vessel-clusters had more lacunes (OR, 95% CI) (1.30, 1.05-1.62), higher white matter hyperintensity (WMH) volume (per-log10 increase, 1.92, 1.04-3.56), and lower CVR in normal appearing white matter (per %/mm Hg, 0.77, 0.60-0.99), compared with patients without vessel-clusters. Fifty-seven of the 94 vessel-clusters (61%) corresponded to noncavitated or partially cavitated WMH on fluid-attenuated inversion recovery, and 37 of 94 (39%) to complete cavities. CVR magnitude was lower than in the corresponding contralateral volumes (mean difference [SD], t, p) within vessel-cluster volumes (-0.00046 [0.00088], -3.021, 0.005) and in the surrounding volume expansion shells up to 4 voxels (-0.00011 [0.00031], -2.140, 0.039; -0.00010 [0.00027], -2.295, 0.028) in vessel-clusters with complete cavities, but not in vessel-clusters without complete cavitation. DISCUSSION Vessel-clusters might correspond to maximally dilated vessels in white matter that are approaching complete tissue injury and cavitation. The pathophysiologic significance of this new feature warrants further longitudinal investigation.
Collapse
Affiliation(s)
- Salvatore Rudilosso
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Ernest Chui
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Michael S Stringer
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Michael Thrippleton
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Francesca Chappell
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Gordon W Blair
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Daniela Jaime Garcia
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Fergus Doubal
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Iona Hamilton
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Anna Kopczak
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Michael Ingrisch
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Danielle Kerkhofs
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Walter H Backes
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Julie Staals
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Robert van Oostenbrugge
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Marco Duering
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Martin Dichgans
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Joanna M Wardlaw
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany.
| |
Collapse
|