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Paulien Voorter¹, Maud van Dinther², Michael Stringer³, Danielle Kerkhofs², Anna Dewenter⁴, Gordon Blair³, Daniela Jaime Garcia³, Francesca Chappell³, Anna Kopczak⁴, Julie Staals², Michael Ingrisch⁴, Marco Duering⁴, Michael Thrippleton³, Fergus Doubal³, Martin Dichgans⁴, Joanna Wardlaw³, Robert van Oostenbrugge², Jacobus Jansen¹, and Walter Backes^1
1Department of Radiology and Nuclear Medicine, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands, ²Department of Neurology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands, ³Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Institute Centre at the University of Edinburgh, Edinburgh, United Kingdom, ⁴Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany

Keywords: Stroke, Stroke, small vessel disease

The pathophysiology underlying white matter hyperintensities (WMHs) and changes in perilesional white matter are not fully understood in cerebral small vessel disease (SVD). Using multi-shell diffusion tensor imaging (DTI), we studied the mean (parenchymal) diffusivity (MD) and microvascular perfusion (f) inside and outside WMHs in sporadic and monogenetic (CADASIL) SVDs. The microstructure (expressed by MD) was most damaged inside WMHs and extended beyond the WMHs. Furthermore, f was highest at the WMH border, decreased towards the WMH center, and decreased outside WMHs, possibly reflecting multiple SVD-related alterations in the microvasculature, such as dilated microvessels, capillary rarefaction, and reduced microvascular integrity. 

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Zih-Rong Lai¹, Yu-Ping Kang², Chia-Feng Lu¹, Bao-Yu Hsieh^3,4, Yi-Hsuan Lee^2,5, and Yu-Chieh Jill Kao^1
1Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, ²Department and Institute of Physiology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ³Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ⁴partment of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, ⁵Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Keywords: Stroke, Preclinical, Transgenic mice

To explore how the FK506 binding protein 5 (FKBP5) affect the ischemic stroke outcome, we employed Fkbp5-knock out (KO) mice and evaluated the ADC- and CBF-deficit volume, as well as angiography in the acute phase and the final lesion volume at 24 hours after the occlusion of middle cerebral artery (MCAO). The discent lesion volume and loss of collaterals after MCAO in the Fkbp5-KO animals suggested the early determination of the stroke outcome in the Fkbp5-KO animals after ischemic insult.

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Emilie Sleight^1,2, Michael S Stringer^1,2, Una Clancy^1,2, Carmen Arteaga^1,2, Daniela Jaime Garcia^1,2, Will Hewins^1,2, Angela CC Jochems^1,2, Rachel Penman^1,2, Yajun Cheng^1,2,3, Dillys Liu^1,2,4, Junfang Zhang^1,2,5, Iona Hamilton⁶, Charlotte Jardine⁶, Rosalind Brown^1,2, Eleni Sakka^1,2, Agniete Kampaite^1,2, Stewart Wiseman^1,2, Maria Valdes-Hernandez^1,2, Francesca Chappell^1,2, Fergus Doubal^1,2, Ian Marshall^1,2, Michael J Thrippleton^1,2,6, and Joanna M Wardlaw^1,2,6
1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom, ²UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom, ³Department of Neurology, West China Hospital of Sichuan University, Chengdu, China, ⁴Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong, ⁵Department of Neurology, Shanghai Jiao Tong University, Shanghai, China, ⁶Edinburgh Imaging Facility RIE, University of Edinburgh, Edinburgh, United Kingdom

Keywords: Stroke, Blood vessels, Cerebrovacular reactivity

Small vessel disease (SVD) causes stroke and dementia, but its pathogenesis remains poorly understood. We measured cerebrovascular reactivity (CVR) in SVD patients with minor stroke using 3T BOLD MRI and investigated its relation to baseline and progression of SVD features after one year adjusting for age and vascular risk factors. Patients with lower CVR had higher baseline white matter hyperintensity (WMH) volume, more lacunes and microbleeds and lower brain volume. After one year, patients with lower baseline CVR had increased WMH burden. In conclusion, CVR impairment in SVD patients is associated with higher SVD burden and predicts worsening of SVD.

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Eva Elisabeth van Grinsven¹, Marielle Philippens², Jeroen Siero^3,4, and Alex Bhogal^3
1Department of Neurology & Neurosurgery, UMC Utrecht, Utrecht, Netherlands, ²Department of Radiation Oncology, UMC Utrecht, Utrecht, Netherlands, ³Department of Radiology, UMC Utrecht, Utrecht, Netherlands, ⁴Spinoza Center for Neuroimaging, Amsterdam, Netherlands

Keywords: Blood vessels, Neuroscience

This study compared baseline ASL with BOLD cerebrovascular reactivity (BOLD-CVR) parameters in  the brain under different hemodynamic circumstances in patients with brain metastases. There was a strong relationship between baseline cerebral blood flow and BOLD-CVR measurements and the temporal metrics of ASL and BOLD-CVR. However, the relationship between baseline ASL and BOLD-CVR  does not hold in tissue with exhausted cerebral autoregulation (i.e. vascular steal regions). Thereby, BOLD-CVR may be able to flag at-risk areas with depleted vascular reserve capacity before they become visible on ASL MRI.

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Jan Kufer¹, Jens Göttler^1,2, Gabriel Hoffmann¹, Lena Schmitzer¹, Claus Zimmer¹, Fahmeed Hyder², Christine Preibisch^1,3, and Stephan Kaczmarz^1,2,4
1Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany, ²MRRC, Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, United States, ³Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany, ⁴Philips GmbH Market DACH, Hamburg, Germany

Keywords: Blood vessels, Oxygenation

Asymptomatic internal carotid artery stenosis (ICAS) is linked with increased stroke risk and cognitive decline. Physiological MRI of cerebral hemodynamic changes in ICAS patients is promising to inform treatment decisions. Here, we investigated the complex pathophysiology of ICAS using principal component analysis of cerebral perfusion and oxygenation changes to establish disease-specific patterns of CBF, OEF, CMRO₂ and the effective oxygen diffusivity of the capillary bed. Regression models revealed the association of pattern expression with sonography-based degree of stenosis and flow velocity in the carotid artery, as well as systemic blood pressure.

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Keywords: White Matter, fMRI (resting state), Cerebrovascular reactivity

We explored cerebrovascular reactivity (CVR) of white matter in patients with evidence for micro- and macrovascular disease using our previously described Blood Oxygen Level Dependent – acetazolamide paradigm. Subjects consistently demonstrated lower CVR in voxels with microangiopathic white matter when present in hemispheres with coexistent proximal, large-vessel steno-occlusive disease (SOD). The relationship of CVR values in normal appearing white matter and contralateral white matter lesions in patients with unilateral SOD is more complex and warrants further investigation.

Ling Li¹, Xiaoling Zhang¹, Min Tang¹, Xiaoyan Lei¹, Jing Zhang¹, Xuejiao Yan¹, Yu Wen¹, and Kai Ai^2
1Department of MRI, Shaanxi Provincial People's Hospital, Xi’an, China, ²Philips Healthcare, Xi’an, China

Keywords: Stroke, Arterial spin labelling, Arterial transit artifacts, transient ischemic attack, stroke

High-resolution magnetic resonance imaging (HRMRI) can be used to characterize the differences in plaque characteristics between transient ischemic attack (TIA) and stroke populations, but it is a time consuming and complicated method.. In this study, we compared the diagnostic performance of HRMRI and arterial spin labeling (ASL) with two post labeling delay times (PLD) combined with clinical risk factors to distinguish TIA and stroke in intracranial stenosis. The results showed that there was no statistical difference between the two methods. In addition, combined model has a good diagnostic performance in predicting stroke occurrence in TIA patients.

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Hongwei Li¹, Ying-Hua Chu², Yu Luo³, and He Wang^1,4,5
1Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China, ²MR Collaboration, Siemens Healthineers Ltd., Shanghai, China, ³Department of Radiology, Shanghai Fourth People's Hospital Affiliated to TongjiUniversity School of Medicine, Shanghai, China, ⁴Human Phenome Institute, Fudan University, Shanghai, China, ⁵Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China

Keywords: Stroke, Oxygenation

Multi-parametric quantitative BOLD (Mq-BOLD), a biophysical model-based technology, has shown promising results for measuring brain oxygenation in healthy subjects. Our purpose is to explore Mq-BOLD in evaluating the changes of oxygen metabolism in early stage of acute ischemic stroke. There is compensatory elevated oxygen extraction fraction (OEF) in the hypoperfused tissue, but decreased cerebral metabolic rate of oxygen (CMRO2) present in the central part of the infarct core. These alternative biomarkers may provide intuitive diagnostic information of ischemic penumbra in stroke. Moreover, Mq-BOLD only depends on standard clinical imaging protocols, which has a great potential for future routine application.

Yukun Zhang¹, Peipei Chang¹, Na Liu¹, Yiming Wang², Liangjie Lin³, Qingwei Song¹, and Yanwei Miao^1
1the First Affiliated Hospital of Dalian Medical University, Dalian, China, ²Clinical and Technical Support, Philips Healthcare, shanghai, China, ³Clinical and Technical Support, Philips Healthcare, beijing, China

Keywords: Stroke, White Matter, Cerebral Small Vessel Disease

In this study, according to the number of lenticulostriate arteries (LSAs), cerebral small blood vessel disease (CSVD) was divided into three groups. Differences of typical CSVD markers and whole brain analysis based on diffusion tensor imaging (DTI) were explored among three groups. It was found that with the decrease of the number of LSAs, the volume of WMH and the scope and extent of fiber tract damage increased. Results show that the change of LSAs have the potential to represents extensive subcortical microvascular damage of brain tissues in CSVD.

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Mohammed Salman Shazeeb¹, Robert King¹, Zeynep Vardar¹, Josephine Kolstad¹, Anna Kuhn¹, Vania Anagnostakou¹, Christopher Raskett¹, Jonathan Winger², Ana Krtolica³, Nils Henninger¹, and Matthew Gounis^1
1University of Massachusetts Chan Medical School, Worcester, MA, United States, ²Omniox, Inc., Palo Alto, CA, United States, ³Oryn Therapeutics, Redwood City, CA, United States

Keywords: Stroke, Diffusion/other diffusion imaging techniques

In acute ischemic stroke due to large vessel occlusion (LVO), information about the penumbral tissue can be vital in making decisions on how to treat ischemic stroke patients in the clinic. This study investigated the use of intravoxel incoherent motion (IVIM) MRI in a canine LVO model to quantify the perfusion information in penumbral tissue of fast and slow progressors that received an oxygen carrier drug. The IVIM parameters were assessed to predict the onset of penumbral tissue death. The IVIM parameters showed a better utility in predicting penumbral tissue death in fast progressors compared to slow progressors.

Chia-Wen Chiang¹, Ezequiel Farrher², Kuan-Hung Cho¹, Sheng-Min Huang¹, N. Jon Shah^2,3,4,5,6, Chang-Hoon Choi², and Li-Wei Kuo^1,7
1Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli, Taiwan, ²Institute of Neuroscience and Medicine – 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany, ³Department of Neurology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany, ⁴JARA – BRAIN – Translational Medicine, RWTH Aachen University, Aachen, Germany, ⁵Institute of Neuroscience and Medicine – 11, Forschungszentrum Jülich, Jülich, Germany, ⁶Monash University, Melbourne, Australia, ⁷National Taiwan University College of Medicine, Taipei, Taiwan

Keywords: Stroke, Treatment

Cerebral edema occurs after stroke. Mannitol is commonly used dehydrating agent for effectively improving cerebral edema. However, the edema state after mannitol administration and its effectiveness at the post-acute stages remain unclear. Recently, we have demonstrated free-water elimination and mapping (FWET₂) can be used to characterize vasogenic edema in stroke animal models. The aim of this study was to quantitatively evaluate mannitol-induced effects on ischemic rat brains at different time points by using FWET₂. We attempted to examine if free water fraction change could reflect mannitol-induced effects on infraction and correlate free water fraction change with total infarct volume.

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Jacqueline Chen¹, Ajay Nemani¹, Julio Cesar de Almeida^2,3, Xuemei Huang¹, Leonardo Favi Bocca⁴, Kenneth B Baker¹, Mark J Lowe¹, Stephen E Jones¹, and Andre G Machado^1
1Cleveland Clinic, Cleveland, OH, United States, ²Santa Casa de Belo Horizonte Hospital, Belo Horizonte, Brazil, ³Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, ⁴Universidade Federal de Sao Paulo, Sao Paulo, Brazil

Keywords: Stroke, fMRI (resting state), deep brain stimulation

To improve reproducibility of positive outcomes from cerebellar dentate stimulation for chronic stroke, we hypothesized that the volume of tissue activated (VTA) (dentate_VTA) proximity to the volume functionally connected to ipsilesional motor-associated cortices (dentate_{FC-ipsi-motor}) would be associated with improved arm impairment/function metrics. Dentate_VTA was estimated using computed tomography and T1-weighted MRI. Dentate_{FC-ipsi-motor} was estimated from fMRI (resting state). Significant correlations with arm metric improvement were not found for dentate_VTA proximity to dentate_{FC-ipsi-motor}, but were found for dentate_VTA size, distance from center, and percentage VTA in the inferior-lateral-posterior region. These findings suggest stimulating a small target at the inferior-posterior-lateral dentate edge.   

Hirohiko Kimura^1,2, Makoto Isozaki³, Shota Ishida⁴, Naoyuki Takei⁵, Yasuhiro Fujiwara⁶, Yuki Matta⁷, HIdehikko Okazawa⁸, and Tetsuya Tsujikawa^9
1Faculty of Medical Sciences, University of Fukui, Eiheiji, Japan, ²Radiology, National Health Insurance Echizen-cho Ota Hospital, Fukui, Japan, ³Neurosurgery, University of Fukui, Eiheiji, Japan, ⁴Department of Radiological Technolog, Kyoto College of Medical Science, Kyoto, Japan, ⁵GE Healthcare, Hino, Japan, ⁶Kumamoto University, Kumamoto, Japan, ⁷University of Fukui Hospital, Eiheiji, Japan, ⁸Biomedical Imaging Research Center, University of Fukui, Eiheiji, Japan, ⁹Department of Radiology, University of Fukui, Eiheiji, Japan

Keywords: Stroke, Perfusion, Arterial spin labeling, CBF, CBV

Positron emission computed tomography (PET) has been used for evaluating cerebral blood flow (CBF) in moyamoya disease to diagnose and assess revascularization result for the patient. Using Hadamard encoded method and DANTE vascular suppression, arterial transit time (ATT) and delay corrected both CBF and aCBV could be obtained in clinical setting. This study aimed to clarify whether ASL- aCBV hemodynamically related to PET-V0 obtained from PET data. There was a significant correlation between PET and CBF both on CBF and aCBV. This may suggest that aCBV could become an additional hemodynamic parameter related to aCBV in completely non-invasive way.

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Jinhao Lyu¹, Qi Duan², Caohui Duan², Xiangbing Bian², Danny JJ Wang³, Chenyang Zhao³, Jianxun Qu⁴, and Lou Xin^2
1Radiology, Chinese PLA General Hospital, Beijing, China, ²Chinese PLA General Hospital, Beijing, China, ³Mark & Mary Stevens Neuroimaging and Informatics Institute Keck School of Medicine University of Southern California (USC), Los Angeles, CA, United States, ⁴MR Collaboration, Siemens Healthineers Ltd., Beijing, China

Keywords: Stroke, Perfusion

We compared the performance of pseudo-continuous arterial spin labeling (ASL) between ultrahigh field 7T MRI and 3T MRI in evaluating collateral circulation based on arterial transit artifact (ATA) in Moyamoya disease (MMD). 7T ASL shows more subtle hypoperfusion and more prominent ATA as compared with 3T ASL. The performance of collateral circulation assessment is more favorable by 7T ASL. These findings render 7T ASL a competing none-invasive approach in the management of MMD.

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Chenyang Li^1,2, Li Jiang¹, Zhe Sun^1,2, Marco Muccio¹, Yongsheng Chen³, Sagar Buch³, E.Mark Haacke⁴, Jiangyang Zhang¹, and Yulin Ge^1
1Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States, ²Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, New York, NY, United States, ³Department of Neurology, Wayne State University School of Medicine, Detroit, MI, United States, ⁴Department of Radiology, Wayne State University School of Medicine, Detroit, MI, United States

Keywords: Blood vessels, Susceptibility, Cerebral blood volume

In this work, we use high resolution susceptibility weighted imaging (SWI) and ΔR2* to investigate the cerebral blood volume (CBV) in white matter tracts and basal ganglia after the administration of blood-pool contrast agent Ferumoxytol. Utilizing the merit of ultrahigh field and strong T1 and T2* shortening contrast agent, we further probe the effect of microvascular density on capillary CBV in white matter tracts and basal ganglia, which provides additional insights to the vascular reserve at capillary level in white matter and basal ganglia.