Pericortical Enhancement on Delayed Postgadolinium Fluid-Attenuated Inversion Recovery Images in Normal Aging, Mild Cognitive Impairment, and Alzheimer Disease
Pericortical Enhancement on Delayed Postgadolinium Fluid-Attenuated Inversion Recovery Images in Normal Aging, Mild Cognitive Impairment, and Alzheimer Disease
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DOI：
10.3174/ajnr.a5273
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发表时间：
2017-09-01
影响因子：
3.5
通讯作者：
Backes, W. H.
中科院分区：
文献类型：
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作者：
Freeze, W. M.;Schnerr, R. S.;Backes, W. H.
背景和目的：血脑屏障完整性的破坏发生在痴呆症中，并可能导致神经退行性变和认知能力下降。我们评估是否可以看到钆螯合物外渗延迟对比后FLAIR图像在老年人和无cognitive impairment.MATERIALS和METHODS：74个人参加了这项研究（15阿尔茨海默病，33轻度认知障碍，26正常认知）。我们评估了对比剂注射后皮质周围增强的表现、脑血管损伤的MR成像标志物和内侧颞叶萎缩。对3名皮质周围增强阳性的参与者（1名认知正常，2名轻度认知障碍）进行了约2年的随访。在体外实验中，一系列的钆浓度，以阐明机制的postcontrast FLAIR signals.RESULTS：Postcontrast皮质周围增强观察21名参与者（28%），包括6个人与阿尔茨海默病（40%），10个轻度认知障碍（30%），和5个正常的认知（19%）。皮质周围增强与年龄（P <0.02）和缺血性卒中（P <0.05）呈正相关，但与认知状态无关（P = 0.3）。在所有随访病例中，信号增强的病灶随时间推移保持稳定。在体外测量证实，FLAIR成像是高度敏感的低钆浓度的检测在CSF中，但不是在脑tissue.CONCLUSIONS：对比后皮层周围增强FLAIR图像发生在老年人认知功能正常，轻度认知障碍，痴呆症。它可能代表慢性局灶性浅表血脑屏障渗漏。需要进一步的纵向研究来确定其临床意义。
BACKGROUND AND PURPOSE: Breakdown of BBB integrity occurs in dementia and may lead to neurodegeneration and cognitive decline. We assessed whether extravasation of gadolinium chelate could be visualized on delayed postcontrast FLAIR images in older individuals with and without cognitive impairment.MATERIALS AND METHODS: Seventy-four individuals participated in this study (15 with Alzheimer disease, 33 with mild cognitive impairment, and 26 with normal cognition). We assessed the appearance of pericortical enhancement after contrast administration, MR imaging markers of cerebrovascular damage, and medial temporal lobe atrophy. Three participants who were positive for pericortical enhancement (1 with normal cognition and 2 with mild cognitive impairment) were followed up for approximately 2 years. In vitro experiments with a range of gadolinium concentrations served to elucidate the mechanisms underlying the postcontrast FLAIR signals.RESULTS: Postcontrast pericortical enhancement was observed in 21 participants (28%), including 6 individuals with Alzheimer disease (40%), 10 with mild cognitive impairment (30%), and 5 with normal cognition (19%). Pericortical enhancement was positively associated with age (P < .02) and ischemic stroke (P < .05), but not with cognitive status (P = .3). Foci with enhanced signal remained stable across time in all follow-up cases. The in vitro measurements confirmed that FLAIR imaging is highly sensitive for the detection of low gadolinium concentrations in CSF, but not in cerebral tissue.CONCLUSIONS: Postcontrast pericortical enhancement on FLAIR images occurs in older individuals with normal cognition, mild cognitive impairment, and dementia. It may represent chronic focal superficial BBB leakage. Future longitudinal studies are needed to determine its clinical significance.