Advancing microstructural and vascular neuroimaging in perinatal stroke

围产期卒中的显微结构和血管神经影像学进展 本研究的总体目标是显着提高围产儿的早期诊断和预后 为预后不良的患者确定最佳的管理方案和治疗目标。 磁共振成像（MRI）被认为是诊断和评价 围产期中风和快速生长的年轻大脑对这种损伤的反应。先进的核磁共振成像技术， 特别是弥散室成像（DCI）、磁共振成像（SWI）和磁共振成像 血管造影（MRA）被认为是临床成像方案的重要组成部分，以评估中风， 脑损伤然而，这些技术在胎儿期的应用极具挑战性，因为 胎儿神经和血管结构以及间歇性胎儿和 母亲的运动破坏了这些通常冗长的MRI扫描所需的空间编码。产后 MRI提出了类似的挑战，特别是关于小的头部运动，其产生显著的 在较长时间的采集中出现伪影。镇静剂，这是用来安抚婴儿和非常年幼的儿童， 侵入性和潜在有害;因此，不能用于研究。有一种迫切的需要， 因此，对于运动鲁棒、高分辨率、先进的MRI技术来评估神经和神经血管， 胎儿和新生儿的结构。这种成像技术的缺乏极大地限制了临床评价 和预后，以及对围产期中风的研究。该项目旨在填补这些技术空白 通过开发创新的、运动稳健的、高分辨率MRI序列，特别是DCI、SWI， 和MRA评价神经血管显微结构、脑血管畸形和脑网络损伤 在围产期中风后该项目的三个具体目标是：1）开发运动鲁棒DCI，以评估 改变围产期中风的大脑微观结构和连接; 2）开发SWI的运动鲁棒技术 胎儿和新生儿;和3）开发用于胎儿和新生儿的运动鲁棒MRA。这些贡献 是重要的，因为它们将1）使神经血管结构、大脑 网络，并在胎儿和新生儿脑损伤;和2）显着提高先进的MRI的使用 技术，以评估围产期中风和脑发育后，围产期中风，无论是在临床和 in research研究settings设置.从这项研究中开发的技术和获得的知识将导致改善 诊断和预后的围产期中风，并将显着改善研究和试验，旨在减少 通过及时的治疗减轻相关神经系统疾病如脑瘫和癫痫的负担 干预措施，即，抗凝治疗，干细胞治疗，脑低温，脑刺激，和 发展和教育疗法。

Advancing microstructural and vascular neuroimaging in perinatal stroke The overall objective of this research is to dramatically improve early diagnosis and prognosis of perinatal stroke to identify the best management options and therapeutic targets for patients with a poor prognosis. Magnetic resonance imaging (MRI) is considered a safe and sensitive tool for the diagnosis and evaluation of perinatal stroke and the response of the rapidly growing young brain to this injury. Advanced MRI techniques, in particular, diffusion-compartment imaging (DCI), susceptibility-weighted MRI (SWI), and magnetic resonance angiography (MRA) are considered crucial components of a clinical imaging protocol to evaluate stroke and brain injury. The application of these techniques in the fetal period, however, is extremely challenging because of the small signal available from the small fetal neural and vascular structures and the intermittent fetal and maternal motion that disrupts the spatial encoding necessary for these typically lengthy MRI scans. Postnatal MRI poses similar challenges, particularly with respect to small head movements, which produce significant artifacts in longer acquisitions. Sedation, which is used to immobilize infants and very young children, is invasive and potentially harmful; and thus, cannot be used in research studies. There is a critical need, therefore, for motion-robust, high-resolution, advanced MRI technologies to evaluate neural and neurovascular structures in the fetus and neonate. The lack of such imaging technology significantly limits clinical evaluation and prognosis, as well as research on perinatal stroke. This project aims to fill these gaps in technology through the development of innovative, motion-robust, high-resolution MRI sequences, specifically, DCI, SWI, and MRA to evaluate neurovascular microstructure, cerebral vascular malformations, and brain network injury after perinatal stroke. The three specific aims of this project are to 1) develop motion robust DCI to evaluate altered brain microstructure and connectivity in perinatal stroke; 2) develop motion-robust technology for SWI for the fetus and newborn; and 3) develop motion-robust MRA for the fetus and newborn. These contributions are important because they will 1) enable in-vivo high-resolution imaging of the neurovascular structure, brain network, and injury in the fetal and newborn brain; and 2) significantly improve the use of advanced MRI technologies to assess perinatal stroke and brain development following perinatal stroke, both in the clinic and in research settings. The technology developed and knowledge obtained from this study will lead to improved diagnosis and prognosis of perinatal stroke, and will significantly improve studies and trials that aim to reduce the burden of related neurological disorders such as cerebral palsy and epilepsy through timely therapeutic interventions, i.e., anticoagulant therapy, stem cell therapies, brain hypothermia, brain stimulation, and developmental and educational therapies.