Using MRI to Understand Disease States that Occur at the Interface of the Brain and the Cerebral Circulation

神经血管脑成像(NVBI)单元研究发生在血管和大脑之间的界面上的病理状态。这包括由闭塞的血管引起的急性脑缺血，以及可能与痴呆症相关的慢性脑缺血。具体地说，NVBI部门正在调查为什么一些中风患者随后会出现认知能力下降和痴呆症，这与他们的MRI变化有关。这一现象正在18-N-0020方案《中风患者血脑屏障破坏的自然史》(队列研究)中进行研究。这项研究目前正在注册中，并在https://clinicaltrials.gov/ct2/show/NCT03366129.上列出 人们早就知道，MRI上看到的变化，通常被称为白质高信号(WMH)，是血管性认知障碍和痴呆(VCID)的标志。然而，目前还不完全了解这些病变发生的原因，因此我们目前还没有办法阻止它们的进展。很明显，WMH的进展(扩大)与认知能力的恶化有关。 NVBI正在研究是什么导致了WMH的进步。具体地说，一种新的用于成像血脑屏障(BBB)的生物标记物正被用来确定血脑屏障的破坏是否先于WMH的进展。血脑屏障是细胞和细胞结构复杂相互作用的结果，是血管和大脑之间的门户。当它功能失调时，细胞和分子可以进入大脑，否则它们就不会穿过血脑屏障；此外，功能失调的血脑屏障可能会阻止促进运输离开大脑。 我们研究的主要目的是确定有既往中风病史和MRI上WMH的患者是否会经历WMH的进展，其进展可以通过在进展之前使用MRI检测到的BBB中断来预测。这将使我们能够识别有认知能力下降风险的患者，并可能阐明其机制，这可能有助于确定治疗的目标。通过阐明WMH的发病机制，我们旨在降低与脑血管疾病相关的发病率和死亡率。

The Neuro Vascular Brain Imaging (NVBI) unit studies pathologic states that occur at the interface between blood vessels and the brain. This encompasses acute cerebral ischemia caused by an occluded blood vessel as well as chronic cerebral ischemia that can be associated with dementia. Specifically, the NVBI unit is investigating why some patients who have had a stroke subsequently develop cognitive decline and dementia in association with changes on their MRI. This phenomenon is being studied in protocol 18-N-0020, The Natural History of Blood-Brain Barrier Disruption in Stroke Patients with White Matter Hyperintensities (A Cohort Study). This study is currently enrolling and is listed on https://clinicaltrials.gov/ct2/show/NCT03366129. It has long been known that changes seen on MRI, often referred to as white matter hyperintensities (WMH), are a hallmark for vascular cognitive impairment and dementia (VCID). However, it is not fully understood why these lesions develop, and thus we do not currently have a way to stop their progression. It is clear that progression (expansion) of WMH is associated with worsening cognition. The NVBI is studying what causes WMH to progress. Specifically, a novel biomarker for imaging the bloods-brain barrier (BBB) is being employed to determine if disruption of the BBB precedes the progression of WMH. The BBB results from a complex interaction of cells and cell structures and serves as the gateway between the blood vessels and the brain. When it becomes dysfunctional, cells and molecules can enter the brain that otherwise would not cross the BBB; additionally, a dysfunctional BBB may prevent facilitated transport out of the brain. The primary objective of our research is to determine if patients with a history of previous stroke and WMH on MRI will experience progression of their WMH in a manner that can be predicted by disruption of their BBB detected using MRI prior to the progression. This would allow us to identify patients at risk for cognitive decline and may shed light on its mechanisms which could help identify targets for treatment. By elucidating the genesis of WMH, we aim to reduce the morbidity and mortality associated with cerebrovascular disease.