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界面的病理状态。这包括由血管闭塞引起的急性脑缺血，以及可能与痴呆相关的慢性脑缺血。具体来说，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。该现象正在18-N-0020方案中进行研究，《脑白质高信号卒中患者血脑屏障破坏的自然史（队列研究）》。这项研究目前正在招募中，并在https://clinicaltrials.gov/ct2/show/NCT03366129上列出。

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.