Advancing microstructural and vascular neuroimaging in perinatal stroke

围产期卒中的显微结构和血管神经成像进展 本研究的总体目标是显著提高围产儿的早期诊断和预后。 为预后较差的患者确定最佳治疗方案和治疗目标。 磁共振成像(MRI)被认为是一种安全而敏感的诊断和评估 围产期中风和快速成长的年轻大脑对这种损伤的反应。先进的核磁共振技术， 特别是，弥散室成像(DCI)、磁化率加权磁共振(SWI)和磁共振 血管造影(MRA)被认为是评估卒中和中风的临床成像方案的重要组成部分 脑部受伤。然而，这些技术在胎儿期的应用是极具挑战性的，因为 从小的胎儿神经和血管结构以及间歇性胎儿和 母体运动扰乱了这些通常冗长的核磁共振扫描所需的空间编码。产后 磁共振成像提出了类似的挑战，特别是在小头运动方面，这会产生显著的 更长时间的收购中的艺术品。镇静剂是用来固定婴儿和非常年幼的儿童的， 侵入性和潜在的危害；因此，不能用于研究研究。有一种迫切的需求， 因此，对于运动健壮、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大大限制了临床评估。 和预后，以及围产期中风的研究。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、 和磁共振血管成像评估神经血管微结构、脑血管畸形和脑网络损伤 围产期中风后。本项目的三个具体目标是：1)开发运动健壮的DCI以评估 围产期卒中时脑微结构和连接性的改变；2)为SWI开发运动健壮技术 用于胎儿和新生儿；以及3)为胎儿和新生儿开发运动健壮的MRA。这些贡献 是很重要的，因为它们将1)实现对神经血管结构、大脑的体内高分辨率成像 网络，以及胎儿和新生儿大脑的损伤；以及2)显著改进先进MRI的使用 在临床和临床中评估围产期中风和围产期中风后脑发育的技术 在研究环境中。从这项研究中开发的技术和获得的知识将导致改进 围产期中风的诊断和预后，并将显著改善旨在减少 及时治疗脑瘫、癫痫等相关神经疾病的负担 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.