The need to unify neuropathological assessments of vascular alterations in the ageing brain Multicentre survey by the BrainNet Europe consortium
The need to unify neuropathological assessments of vascular alterations in the ageing brain Multicentre survey by the BrainNet Europe consortium
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DOI：
10.1016/j.exger.2012.06.001
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发表时间：
2012-11-01
影响因子：
3.9
通讯作者：
Kretzschmar, Hans
中科院分区：
文献类型：
--
作者：
Alafuzoff, Irina;Gelpi, Ellen;Kretzschmar, Hans
在这里，我们总结了在实验室间环境中进行关于血管改变评估的大型调查后的结果，包括血管变化和血管病变。来自22个中心的32名神经病理学家（大多数是BrainNet Europe（BNE）的成员）通过填写问卷参与了研究，重点是评估老年受试者大脑中常见的血管改变。与Pantoni及其同事2006年进行的调查相比，BNE成员在大脑切片、采集脑组织进行组织学和染色方面已经达到了一定程度的协调。在血管变化的严重程度和临床意义的评估方面，观察到最显着的变异性。两种策略最近已被推荐关于评估血管的变化，在老年和痴呆症的主题。国家老年研究所-阿尔茨海默氏症协会（NIA-AA）建议评估12个区域的海马硬化、血管性脑损伤和微血管病变。虽然这种策略很容易遵循，但建议并没有告知应如何评估观察到的改变的负荷以及观察到的病变何时具有意义。Deramecourt和他的同事建议对4个脑区的各种病理进行评估和半定量分级。该策略产生0至20的总分作为病理负荷的估计值。然而，尚不清楚哪个评分被认为具有临床意义。此外，在几项BNE试验中，半定量评估的一致率很低;这一观察结果可能对Deramecourt及其同事提出的策略产生负面影响。与NIA-AA一致，BNE建议在一组标准化的脑区域中采用易于识别的病变的二分方法进行神经病理学评估，并应用可重复的采样和染色策略。然而，迫切需要一个简单的策略，评估负荷的变化，以产生可重复的，并在同一时间，中心之间的可比性结果。(C)2012 Elsevier Inc. All rights reserved.
Here, we summarise the results after carrying out a large survey regarding the assessment of vascular alterations, both vessel changes and vascular lesions in an inter-laboratory setting. In total, 32 neuropathologists from 22 centres, most being members of BrainNet Europe (BNE), participated by filling out a questionnaire with emphasis on assessment of common vascular alterations seen in the brains of aged subjects. A certain level of harmonisation has been reached among BNE members regarding sectioning of the brain, harvesting of brain tissue for histology and staining used when compared to the survey carried out in 2006 by Pantoni and colleagues. The most significant variability was seen regarding the assessment of severity and of clinical significance of vascular alterations. Two strategies have recently been recommended regarding the assessment of vascular alterations in aged and demented subjects. The National Institute on Aging - Alzheimer's Association (NIA-AA) recommends the assessment of hippocampal sclerosis, vascular brain injury and microvascular lesions in 12 regions. Although this strategy will be easy to follow, the recommendations do not inform how the load of observed alterations should be assessed and when the observed lesions are of significance. Deramecourt and his colleagues recommend an assessment and semiquantitative grading of various pathologies in 4 brain regions. This strategy yielded a total score of 0 to 20 as an estimate of pathology load. It is, however, not clear which score is considered to be of clinical significance. Furthermore, in several BNE trials the semiquantitative assessment has yielded poor agreement rates; an observation that might negatively influence the strategy proposed by Deramecourt and his colleagues. In line with NIA-AA, a dichotomised approach of easily recognisable lesions in a standardised set of brain regions harvested for neuropathological assessment and applying reproducible sampling and staining strategies is recommended by BNE. However, a simple strategy regarding assessment of load of alteration is urgently needed to yield reproducible, and at the same time, comparable results between centres. (C) 2012 Elsevier Inc. All rights reserved.