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van den Brink H, Kopczak A, Arts T, Onkenhout L, Siero JC, Zwanenburg JJ, Duering M, Blair GW, Doubal FN, Stringer MS, Thrippleton MJ, Kuijf HJ, de Luca A, Hendrikse J, Wardlaw JM, Dichgans M, Biessels GJ. Zooming in on cerebral small vessel function in small vessel diseases with 7T MRI: Rationale and design of the "ZOOM@SVDs" study. Cereb Circ Cogn Behav 2021; 2:100013. [PMID: 36324717 PMCID: PMC9616370 DOI: 10.1016/j.cccb.2021.100013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 06/01/2023]
Abstract
Background Cerebral small vessel diseases (SVDs) are a major cause of stroke and dementia. Yet, specific treatment strategies are lacking in part because of a limited understanding of the underlying disease processes. There is therefore an urgent need to study SVDs at their core, the small vessels themselves. Objective This paper presents the rationale and design of the ZOOM@SVDs study, which aims to establish measures of cerebral small vessel dysfunction on 7T MRI as novel disease markers of SVDs. Methods ZOOM@SVDs is a prospective observational cohort study with two years follow-up. ZOOM@SVDs recruits participants with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL, N = 20), sporadic SVDs (N = 60), and healthy controls (N = 40). Participants undergo 7T brain MRI to assess different aspects of small vessel function including small vessel reactivity, cerebral perforating artery flow, and pulsatility. Extensive work-up at baseline and follow-up further includes clinical and neuropsychological assessment as well as 3T brain MRI to assess conventional SVD imaging markers. Measures of small vessel dysfunction are compared between patients and controls, and related to the severity of clinical and conventional MRI manifestations of SVDs. Discussion ZOOM@SVDs will deliver novel markers of cerebral small vessel function in patients with monogenic and sporadic forms of SVDs, and establish their relation with disease burden and progression. These small vessel markers can support etiological studies in SVDs and may serve as surrogate outcome measures in future clinical trials to show target engagement of drugs directed at the small vessels.
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Key Words
- ASL, Arterial Spin Labeling
- BOLD, Blood Oxygenation Level-Dependent
- CADASIL
- CADASIL, Cerebral Autosomal Dominant Arteriopathy with Leukoencephalopathy and Subcortical Infarcts
- CDR, Clinical Dementia Rating scale
- CERAD+, Consortium to Establish a Disease Registry for Alzheimer's Disease Plus battery
- CES-D, Center for Epidemiologic Studies Depression Scale
- CO2, Carbon Dioxide
- CSF, Cerebrospinal Fluid
- Cerebral small vessel disease
- DTI, Diffusion Tensor Imaging
- EPIC, European Prospective Investigation into Cancer and Nutrition
- EtCO2, End-tidal Carbon Dioxide
- FLAIR, Fluid Attenuated Inversion Recovery
- FOV, Field Of View
- FWHM, Full-Width-at-Half-Maximum
- GE, Gradient Echo
- GM, Grey Matter
- GPRS, General Packet Radio Service
- HRF, Hemodynamic Response Function
- High field strength MRI
- LMU, Ludwig-Maximilians-Universität
- MMSE, Mini-Mental State Examination
- NAWM, Normal Appearing White Matter
- NIHSS, National Institute for Health Stroke Scale
- PI, Pulsatility Index
- ROI, Region Of Interest
- SPPB, Short Physical Performance Battery
- SVDs, Small Vessel Diseases
- SWI, Susceptibility Weighted Imaging
- Small vessel function
- Sporadic SVD
- Stroke
- TE, Echo Time
- TI, Inversion Time
- TR, Repetition Time
- TSE, Turbo Spin Echo
- UMCU, University Medical Center Utrecht
- Vmax, Maximum velocity
- Vmean, Mean velocity
- Vmin, Minimum velocity
- WM, White Matter
- WMH, White Matter Hyperintensity
- fMRI, Functional Magnetic Resonance Imaging
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Affiliation(s)
- Hilde van den Brink
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, the Netherlands
| | - Anna Kopczak
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Tine Arts
- Department of Radiology, Center for Image Sciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Laurien Onkenhout
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, the Netherlands
| | - Jeroen C.W. Siero
- Department of Radiology, Center for Image Sciences, University Medical Center Utrecht, Utrecht, the Netherlands
- Spinoza Centre for Neuroimaging Amsterdam, Amsterdam, the Netherlands
| | - Jaco J.M. Zwanenburg
- Department of Radiology, Center for Image Sciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marco Duering
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Disease (DZNE), Munich, Germany
| | - Gordon W. Blair
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, Edinburgh, United Kingdom
| | - Fergus N. Doubal
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, Edinburgh, United Kingdom
| | - Michael S. Stringer
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, Edinburgh, United Kingdom
| | - Michael J. Thrippleton
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, Edinburgh, United Kingdom
| | - Hugo J. Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alberto de Luca
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, the Netherlands
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, Edinburgh, United Kingdom
| | - Jeroen Hendrikse
- Department of Radiology, Center for Image Sciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joanna M. Wardlaw
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, Edinburgh, United Kingdom
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Disease (DZNE), Munich, Germany
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, the Netherlands
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