Ultra-high field (UHF) magnetic resonance (MR) refers to a main operating field strength of 7 teslas (T) or higher. UHF MR offers unique opportunities for revealing new insights into the microstructures and functions of the brain that are not available on conventional field strength MR. Recently, the U.S. Food and Drug Administration (FDA) has cleared the 7 T magnetic resonance imaging (MRI) device for clinical use, which has doubled the 7 T systems installed in the US. Central to this powerful evolution is the concomitant increase of signal-to-noise ratio (SNR) and susceptibility contrast at UHF MRI. Compared to 3 T, 7 T offers a 2 to 3-fold increase in image SNR, which will allow us to image high resolution with voxel volume of less than 0.1 mm3, while the largely increased susceptibility or T2* contrast at ultra-high field MRI will be the key benefit for brain imaging. Sequences sensitive to magnetic susceptibility include susceptibility-weighted imaging (SWI) and quantitative susceptibility mapping (QSM). Thanks to the susceptibility-induced blooming effect, small veins at a micro level (e.g. <50 µm) can be seen on 220 x 220 µm matrix size SWI.1 With the strengths being provided on UHF MR, several key clinical benefits are discussed. The perivenous lesion development or central vein sign in multiple sclerosis (MS) has been revealed in vivo for the first time,2 which has proved useful for a differential diagnosis of MS.3 Seven teslas MRI showed improved detection of cortical MS lesions that are consistent with histopathological patterns of cortical demyelinating lesions regarding their cortical layer involvement that are not seen on 3 T MRI.4 The visibility of small venous architecture, including small cortical and medullary veins, has an important implication for tissue oxygen utilization and neuronal degeneration.5 By introducing an ultrasmall-superparamagnetic-iron-oxide (USPIO) contrast agent (e.g., ferumoxytol), the small arterioles can also be seen on 7 T SWI, which allows the detection of small arterial tortuosity in the elderly, likely the major cause of small vessel disease. Seven teslas markedly increased the sensitivity in detecting iron deposition and microbleeds associated with brain structures and lesions, and this provides critical insights on brain pathology, in particular in age-related neurodegenerative diseases. Seven teslas MRI improves the characterization of age-related choroid plexus degeneration, including both volume and signal changes, which may have an impact on waste clearance and cerebrospinal fluid (CSF) production. Figure 1 demonstrates a few representative examples of the potential of 7 T. In summary, seeing the unseen on 7 T provides opportunities not only for an early diagnosis, but also for clinical research of disease mechanisms and treatment strategy development.
{"title":"Seeing is believing: ultra-high field magnetic resonance imaging in vascular and neurodegeneration research","authors":"Y. Ge","doi":"10.4081/vl.2022.10941","DOIUrl":"https://doi.org/10.4081/vl.2022.10941","url":null,"abstract":"Ultra-high field (UHF) magnetic resonance (MR) refers to a main operating field strength of 7 teslas (T) or higher. UHF MR offers unique opportunities for revealing new insights into the microstructures and functions of the brain that are not available on conventional field strength MR. Recently, the U.S. Food and Drug Administration (FDA) has cleared the 7 T magnetic resonance imaging (MRI) device for clinical use, which has doubled the 7 T systems installed in the US. Central to this powerful evolution is the concomitant increase of signal-to-noise ratio (SNR) and susceptibility contrast at UHF MRI. Compared to 3 T, 7 T offers a 2 to 3-fold increase in image SNR, which will allow us to image high resolution with voxel volume of less than 0.1 mm3, while the largely increased susceptibility or T2* contrast at ultra-high field MRI will be the key benefit for brain imaging. Sequences sensitive to magnetic susceptibility include susceptibility-weighted imaging (SWI) and quantitative susceptibility mapping (QSM). Thanks to the susceptibility-induced blooming effect, small veins at a micro level (e.g. <50 µm) can be seen on 220 x 220 µm matrix size SWI.1 With the strengths being provided on UHF MR, several key clinical benefits are discussed. The perivenous lesion development or central vein sign in multiple sclerosis (MS) has been revealed in vivo for the first time,2 which has proved useful for a differential diagnosis of MS.3 Seven teslas MRI showed improved detection of cortical MS lesions that are consistent with histopathological patterns of cortical demyelinating lesions regarding their cortical layer involvement that are not seen on 3 T MRI.4 The visibility of small venous architecture, including small cortical and medullary veins, has an important implication for tissue oxygen utilization and neuronal degeneration.5 By introducing an ultrasmall-superparamagnetic-iron-oxide (USPIO) contrast agent (e.g., ferumoxytol), the small arterioles can also be seen on 7 T SWI, which allows the detection of small arterial tortuosity in the elderly, likely the major cause of small vessel disease. Seven teslas markedly increased the sensitivity in detecting iron deposition and microbleeds associated with brain structures and lesions, and this provides critical insights on brain pathology, in particular in age-related neurodegenerative diseases. Seven teslas MRI improves the characterization of age-related choroid plexus degeneration, including both volume and signal changes, which may have an impact on waste clearance and cerebrospinal fluid (CSF) production. Figure 1 demonstrates a few representative examples of the potential of 7 T. In summary, seeing the unseen on 7 T provides opportunities not only for an early diagnosis, but also for clinical research of disease mechanisms and treatment strategy development.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130660545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher G. Janson, K. Hauser, Scott Muller, J. Kordower, Liudmila G Romanova
Background. The blood-brain barrier has been the focus of most prior work examining intracranial vasculature in the context of various brain diseases.1 Recently, meningeal vasculature has become more widely recognized as a key contributor to brain clearance and its immune function.2 Meninges are highly vascularized and complex tissue. Vessels of the outer dural layer comprise an extensive, parallel intracranial vascular bed, which lies outside the brain and subarachnoid space. In addition to the blood vasculature, meninges harbor lymphatic channels that potentially provide extra capacity for clearance of proteinaceous fluid and immune cell trafficking. Most of our knowledge of the meningeal vasculature, including lymphatics, comes from rodent models. Rodent meninges are readily available, small, thin and optically transparent. These characteristics permit imaging in whole-mount flat preparations.3 Technical barriers, however, remain high for imaging studies of the meninges of larger mammals. This is especially true for primates, and ultimately humans. Non-human primate (NHP) and human dura is large, thick and opaque, with a high content of connective tissue. These characteristics limit options for routine high-resolution imaging and leave unanswered questions about the architecture of blood and lymphatic vessels in primate dura. So far, the presence of lymphatic vessels in primates has been demonstrated by non-invasive techniques like magnetic resonance imaging (MRI) or on sections of paraffin-embedded specimens. Neither of the techniques fully addresses spatial and phenotypical features of the vascular networks. In our work, we provide solutions for these technical barriers using new clearing and imaging protocols to successfully visualize blood and lymphatic vessels in NPH dura in their entirety. Methods. Here we used novel approaches to tissue clearing and resonance scanning confocal imaging of large areas with sickness over 1000 M. Results. Our approach revealed extensive and dense vascular networks in NHP dura probed with vascular marker CD31 (Figure 1). Image clarity and resolution is sufficient for visualization of the smallest vessels. In the dura, blood vessels are mostly represented by veins. Vascular networks can be further analyzed with semi-automated tracing and quantitative metrics in 3D space. We showed that lymphatic vessels in NPH dura are located similarly to that in rodents: in the area of the superior sagittal sinus (SSS) and along the middle meningeal artery (MMA). They are also present in the major dural fold, tentorium cerebelli, which is underdeveloped in rodents. Unlike previously described in mice, these vessels are negative for LYVE-1 lymphatic marker but strongly positive for podoplanin. In the area of SSS, there is a large plexus of branching irregular blind-ended sacs with a wide range of diameters. Vessels in the MMA region have a different appearance. Two vessels always run along the veins flanking MMA that foll
{"title":"Mapping meningeal vasculature in non-human primates","authors":"Christopher G. Janson, K. Hauser, Scott Muller, J. Kordower, Liudmila G Romanova","doi":"10.4081/vl.2022.10956","DOIUrl":"https://doi.org/10.4081/vl.2022.10956","url":null,"abstract":"Background. The blood-brain barrier has been the focus of most prior work examining intracranial vasculature in the context of various brain diseases.1 Recently, meningeal vasculature has become more widely recognized as a key contributor to brain clearance and its immune function.2 Meninges are highly vascularized and complex tissue. Vessels of the outer dural layer comprise an extensive, parallel intracranial vascular bed, which lies outside the brain and subarachnoid space. In addition to the blood vasculature, meninges harbor lymphatic channels that potentially provide extra capacity for clearance of proteinaceous fluid and immune cell trafficking. Most of our knowledge of the meningeal vasculature, including lymphatics, comes from rodent models. Rodent meninges are readily available, small, thin and optically transparent. These characteristics permit imaging in whole-mount flat preparations.3 Technical barriers, however, remain high for imaging studies of the meninges of larger mammals. This is especially true for primates, and ultimately humans. Non-human primate (NHP) and human dura is large, thick and opaque, with a high content of connective tissue. These characteristics limit options for routine high-resolution imaging and leave unanswered questions about the architecture of blood and lymphatic vessels in primate dura. So far, the presence of lymphatic vessels in primates has been demonstrated by non-invasive techniques like magnetic resonance imaging (MRI) or on sections of paraffin-embedded specimens. Neither of the techniques fully addresses spatial and phenotypical features of the vascular networks. In our work, we provide solutions for these technical barriers using new clearing and imaging protocols to successfully visualize blood and lymphatic vessels in NPH dura in their entirety. \u0000Methods. Here we used novel approaches to tissue clearing and resonance scanning confocal imaging of large areas with sickness over 1000 M. \u0000Results. Our approach revealed extensive and dense vascular networks in NHP dura probed with vascular marker CD31 (Figure 1). Image clarity and resolution is sufficient for visualization of the smallest vessels. In the dura, blood vessels are mostly represented by veins. Vascular networks can be further analyzed with semi-automated tracing and quantitative metrics in 3D space. We showed that lymphatic vessels in NPH dura are located similarly to that in rodents: in the area of the superior sagittal sinus (SSS) and along the middle meningeal artery (MMA). They are also present in the major dural fold, tentorium cerebelli, which is underdeveloped in rodents. Unlike previously described in mice, these vessels are negative for LYVE-1 lymphatic marker but strongly positive for podoplanin. In the area of SSS, there is a large plexus of branching irregular blind-ended sacs with a wide range of diameters. Vessels in the MMA region have a different appearance. Two vessels always run along the veins flanking MMA that foll","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123686889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Increasing evidence suggests detecting the subtle changes in blood-brain barrier (BBB) permeability in normal aging and in Alzheimer’s disease by using dynamic contrast-enhanced MRI (DCE-MRI) (Figure 1).1,2 However, measuring these subtle changes poses a great challenge for accurate measurement, resulting in inconsistent results among previous studies.1,2 Two major challenges are long scan times, as suggested by other studies, and the selection of the arterial input function (AIF). In this study, we aim to estimate the capillary level input function (CIF) using a deep learning network to overcome these two challenges. Methods: Healthy volunteers (n=12, age 21-78) were recruited for DCE-MRI scan for 28 min. Golden-angle radial sampling parallel (GRASP) sequence was used to obtain the dynamic images at ~5s/frame. Individual AIF was sampled from the superior sagittal sinus of the brain. FSL3 was used to segment the gray and white matter. Each voxel was fitted using the graphical Patlak model4 to assess the vascular permeability-surface area product (PS) for both 28-min data and 10-min truncated data. We used a 3x3 kernel sliding through the images, and feed each voxel’s dynamic as the input to our vision-transformer.5 Training data were generated using individual AIFs with a mathematical model and used to simulate dynamic patches using the extended Patlak model.4 Results: The conventional approach with AIF results in the majority of voxels exhibiting negative PS, regardless of scan time. This is not physiologically valid, as this indicates the contrast agent extravasates into the vessel. However, the proposed approach with the network-predicted CIF results in most voxels in positive PS, even with a scan-time of 10 min. The estimated PS levels are in good accordance with the previous studies.1 Due to the limited sample size, we could not find the difference in BBB permeability between young and old groups. Conclusions: Our approach showed promising quantification of subtle permeability. The results in this study suggest that our proposed CIF-based approach provides an appropriate input function for DCE analysis, allowing assessment of subtle permeability changes in the BBB even with a reduced scan time of 10 min. Future studies will include larger cohorts to investigate the BBB permeability changes in normal aging.
{"title":"Improving the estimation of subtle blood-brain barrier permeability changes in aging using a deep learning approach","authors":"Jonghyun Bae, Y. Ge, S. Kim","doi":"10.4081/vl.2022.10943","DOIUrl":"https://doi.org/10.4081/vl.2022.10943","url":null,"abstract":"Background: Increasing evidence suggests detecting the subtle changes in blood-brain barrier (BBB) permeability in normal aging and in Alzheimer’s disease by using dynamic contrast-enhanced MRI (DCE-MRI) (Figure 1).1,2 However, measuring these subtle changes poses a great challenge for accurate measurement, resulting in inconsistent results among previous studies.1,2 Two major challenges are long scan times, as suggested by other studies, and the selection of the arterial input function (AIF). In this study, we aim to estimate the capillary level input function (CIF) using a deep learning network to overcome these two challenges. \u0000Methods: Healthy volunteers (n=12, age 21-78) were recruited for DCE-MRI scan for 28 min. Golden-angle radial sampling parallel (GRASP) sequence was used to obtain the dynamic images at ~5s/frame. Individual AIF was sampled from the superior sagittal sinus of the brain. FSL3 was used to segment the gray and white matter. Each voxel was fitted using the graphical Patlak model4 to assess the vascular permeability-surface area product (PS) for both 28-min data and 10-min truncated data. We used a 3x3 kernel sliding through the images, and feed each voxel’s dynamic as the input to our vision-transformer.5 Training data were generated using individual AIFs with a mathematical model and used to simulate dynamic patches using the extended Patlak model.4 \u0000Results: The conventional approach with AIF results in the majority of voxels exhibiting negative PS, regardless of scan time. This is not physiologically valid, as this indicates the contrast agent extravasates into the vessel. However, the proposed approach with the network-predicted CIF results in most voxels in positive PS, even with a scan-time of 10 min. The estimated PS levels are in good accordance with the previous studies.1 Due to the limited sample size, we could not find the difference in BBB permeability between young and old groups. \u0000Conclusions: Our approach showed promising quantification of subtle permeability. The results in this study suggest that our proposed CIF-based approach provides an appropriate input function for DCE analysis, allowing assessment of subtle permeability changes in the BBB even with a reduced scan time of 10 min. Future studies will include larger cohorts to investigate the BBB permeability changes in normal aging.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116680284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chenyang Li, Henry Nguyen, Jingyun Chen, H. Rusinek, Y. Ge
Background: Perivascular space (PVS), also known as Virchow-Robin space, has been recently recognized as one of the most important components in the glymphatic system of the brain,1 which is closely related to waste and toxins clearance in the brain. On T1- and T2-weighted images, PVS has similar signal intensities to cerebrospinal fluid (CSF), which are frequently observed in the centrum semiovale (CSO) and basal ganglia (BG) regions. A previous study2 has shown that PVS increases with age and enlarged PVS was deemed associated with neurodegenerative and vascular abnormalities in the elderly.3 Although the exact mechanism is still elusive, more evidence showed visible PVS in younger adults or even at the adolescent stage. In this study, we use the human connectome project (HCP) lifespan pilot cohort to characterize the relationship of neuronal tissue to PVS visibility across the normative lifespan. Methods: T1-weighted (0.8mm isotropic, TE/TR=2.12/2400 ms), T2-weighted (0.8mm isotropic, TE/TR=563/3200 ms), and diffusion magnetic resonance imaging (MRI) (1.5 mm isotropic, dir80) data were used from HCP lifespan pilot project (N=27, F/M: 12/15, age 8-75 years). PVS segmentation in white matter (WM) and BG was performed using the same method described in Sepehrband et al.4 (Figure 1). WM PVS volume fraction was calculated by dividing the total PVS volume by WM volume. Pearson correlation and one-way ANOVA were used for statistical analysis. Results: The grey matter (GM) volume fraction is negatively correlated with WM PVS volume (p<0.001, R2=0.374). In addition, we have observed an increase in PVS volume fraction in WM across the lifespan, but there is no significant difference in PVS volume fraction before the age of 55. From an age group range of 8-35 years old, the visible PVS is mostly located in CSO, less PVS is observed in the BG region. However, on the other hand, in the elderly group (age >65 years), high-visibility of PVS is observed both in WM and BG regions. Conclusions: Across the normative lifespan, PVS appearance is negatively correlated with the GM atrophy index, indicating the potential usage of PVS as a marker of neurodegeneration. In WM, we reported that increased PVS is associated with advancing age, which is consistent with previous reports.2 Interestingly, we found that in adolescent populations, the PVS occurs mostly in CSO but not in the BG region. In CSO, as shown from fiber orientation distribution analysis, the PVS is mainly located in crossing fiber regions with lower fiber density. However, In BG regions, the PVS occurs in deep GM nuclei (caudate, putamen) and major fiber tracts such as internal capsules or cortical spinal tracts, which are more densely packed compared to crossing-fibers in CSO. Previous studies have reported that the WM blood flow is inversely correlated with FA,5 the tightly structured fibers tend to show lower blood flow if compared to loosened ones. The high visibility of PVS in CSO may also be due
{"title":"Relationship of grey matter and white matter changes the visibility of perivascular space across normative lifespan","authors":"Chenyang Li, Henry Nguyen, Jingyun Chen, H. Rusinek, Y. Ge","doi":"10.4081/vl.2022.10963","DOIUrl":"https://doi.org/10.4081/vl.2022.10963","url":null,"abstract":"Background: Perivascular space (PVS), also known as Virchow-Robin space, has been recently recognized as one of the most important components in the glymphatic system of the brain,1 which is closely related to waste and toxins clearance in the brain. On T1- and T2-weighted images, PVS has similar signal intensities to cerebrospinal fluid (CSF), which are frequently observed in the centrum semiovale (CSO) and basal ganglia (BG) regions. A previous study2 has shown that PVS increases with age and enlarged PVS was deemed associated with neurodegenerative and vascular abnormalities in the elderly.3 Although the exact mechanism is still elusive, more evidence showed visible PVS in younger adults or even at the adolescent stage. In this study, we use the human connectome project (HCP) lifespan pilot cohort to characterize the relationship of neuronal tissue to PVS visibility across the normative lifespan. \u0000Methods: T1-weighted (0.8mm isotropic, TE/TR=2.12/2400 ms), T2-weighted (0.8mm isotropic, TE/TR=563/3200 ms), and diffusion magnetic resonance imaging (MRI) (1.5 mm isotropic, dir80) data were used from HCP lifespan pilot project (N=27, F/M: 12/15, age 8-75 years). PVS segmentation in white matter (WM) and BG was performed using the same method described in Sepehrband et al.4 (Figure 1). WM PVS volume fraction was calculated by dividing the total PVS volume by WM volume. Pearson correlation and one-way ANOVA were used for statistical analysis. \u0000Results: The grey matter (GM) volume fraction is negatively correlated with WM PVS volume (p<0.001, R2=0.374). In addition, we have observed an increase in PVS volume fraction in WM across the lifespan, but there is no significant difference in PVS volume fraction before the age of 55. From an age group range of 8-35 years old, the visible PVS is mostly located in CSO, less PVS is observed in the BG region. However, on the other hand, in the elderly group (age >65 years), high-visibility of PVS is observed both in WM and BG regions. Conclusions: Across the normative lifespan, PVS appearance is negatively correlated with the GM atrophy index, indicating the potential usage of PVS as a marker of neurodegeneration. In WM, we reported that increased PVS is associated with advancing age, which is consistent with previous reports.2 Interestingly, we found that in adolescent populations, the PVS occurs mostly in CSO but not in the BG region. In CSO, as shown from fiber orientation distribution analysis, the PVS is mainly located in crossing fiber regions with lower fiber density. However, In BG regions, the PVS occurs in deep GM nuclei (caudate, putamen) and major fiber tracts such as internal capsules or cortical spinal tracts, which are more densely packed compared to crossing-fibers in CSO. Previous studies have reported that the WM blood flow is inversely correlated with FA,5 the tightly structured fibers tend to show lower blood flow if compared to loosened ones. The high visibility of PVS in CSO may also be due","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128677523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. As the US population becomes increasingly older and more diverse, the number of Americans with dementia is expected to rise substantially, particularly the number of those with concomitant vascular disease. Moreover, the impact of vascular disease on dementia risk may be exacerbated in African Americans and Hispanics, who are at greater risk for vascular disease and for whom vascular disease may play a larger role in clinical dementia. As public health awareness of dementia increases, it is becoming common to see individuals presenting for clinical assessment with minor cognitive complaints. Neuroimaging studies of these individuals frequently identify “incidental” white matter hyperintensities (WMH), usually ascribed to “microvascular disease” by radiologists, raising concerns in patients about their brain health and future risk for dementia. Methods. To date, however, we are not aware of any studies designed to examine the baseline and future impact of white matter (WM) injury in the clinical setting, particularly among diverse populations where age-related WMH volumes are known to be higher1 or comprehensively examined the impact of individual and combined magnetic resonance imaging (MRI) measures of white matter injury on cognitive performance among a diverse, non-demented, stroke-free population with cognitive complaints over an extended period of observation. For this presentation, I summarized the available evidence of the impact of WMH and cognition and reviewed the design of a new study to prospectively assess this outcome in a diverse population and develop a risk factor profile to assist in the diagnosis of those at risk for dementia. Results. There is substantial evidence that WMH are common, increase in amount and prevalence with age,2 impact cognition and dementia,3 and are a measure of vascular brain injury. The significance of studying WM injury is buoyed by the fact that dementia risk scales emphasize the role of vascular risk in dementia prediction4 and that institution of effective treatment could lessen the burden of dementia on population.5 Yet, a complete understanding of WMH as markers of vascular brain injury contributing to cognitive complaints and possibly vascular cognitive impairment (VCI) requires a comprehensive determination of the full spectrum of WM injury associated with vascular risk, potential mechanisms of WMH formation and progression, ethnoracial, other genetic influences and how WMH interact with neurodegenerative pathologies, in particular Alzheimer’s disease (AD). Evidence of the importance of “asymptomatic” vascular brain injury on present cognition and future cognitive decline led to the design of a new multi-site study of diverse individuals with cognitive complaints and WMH, that aims to develop a predictive risk factor score that can be widely used in future treatment trials called diverse VCID. Diverse VCID is a multi-site study of 2250 individuals of non-Hispanic Whites, Hispanic/Lati
{"title":"Update on diverse vascular cognitive impairment (VCID)","authors":"C. DeCarli","doi":"10.4081/vl.2022.10948","DOIUrl":"https://doi.org/10.4081/vl.2022.10948","url":null,"abstract":"Background. As the US population becomes increasingly older and more diverse, the number of Americans with dementia is expected to rise substantially, particularly the number of those with concomitant vascular disease. Moreover, the impact of vascular disease on dementia risk may be exacerbated in African Americans and Hispanics, who are at greater risk for vascular disease and for whom vascular disease may play a larger role in clinical dementia. As public health awareness of dementia increases, it is becoming common to see individuals presenting for clinical assessment with minor cognitive complaints. Neuroimaging studies of these individuals frequently identify “incidental” white matter hyperintensities (WMH), usually ascribed to “microvascular disease” by radiologists, raising concerns in patients about their brain health and future risk for dementia. \u0000Methods. To date, however, we are not aware of any studies designed to examine the baseline and future impact of white matter (WM) injury in the clinical setting, particularly among diverse populations where age-related WMH volumes are known to be higher1 or comprehensively examined the impact of individual and combined magnetic resonance imaging (MRI) measures of white matter injury on cognitive performance among a diverse, non-demented, stroke-free population with cognitive complaints over an extended period of observation. For this presentation, I summarized the available evidence of the impact of WMH and cognition and reviewed the design of a new study to prospectively assess this outcome in a diverse population and develop a risk factor profile to assist in the diagnosis of those at risk for dementia. \u0000Results. There is substantial evidence that WMH are common, increase in amount and prevalence with age,2 impact cognition and dementia,3 and are a measure of vascular brain injury. The significance of studying WM injury is buoyed by the fact that dementia risk scales emphasize the role of vascular risk in dementia prediction4 and that institution of effective treatment could lessen the burden of dementia on population.5 Yet, a complete understanding of WMH as markers of vascular brain injury contributing to cognitive complaints and possibly vascular cognitive impairment (VCI) requires a comprehensive determination of the full spectrum of WM injury associated with vascular risk, potential mechanisms of WMH formation and progression, ethnoracial, other genetic influences and how WMH interact with neurodegenerative pathologies, in particular Alzheimer’s disease (AD). Evidence of the importance of “asymptomatic” vascular brain injury on present cognition and future cognitive decline led to the design of a new multi-site study of diverse individuals with cognitive complaints and WMH, that aims to develop a predictive risk factor score that can be widely used in future treatment trials called diverse VCID. Diverse VCID is a multi-site study of 2250 individuals of non-Hispanic Whites, Hispanic/Lati","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133891649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brianna E. Damadian, J. Dworkin, Jay Butterman, A. Giambalvo, David Chu
Dr. Raymond Damadian, Father of the MRI, passed away on August 3, 2022. In this Letter to the Editor, we discuss Dr. Damadian’s seminal discovery, his path to making the first MRI machine, as well as the work he did in his later years on the dynamics of CSF flow in neurodegenerative disease. We hope to honor the legacy of such an influential character in radiology history and inspire others to continue to continue to explore, innovate, and cure disease with his technology for years to come.
{"title":"In Memoriam: Raymond V. Damadian, M.D.","authors":"Brianna E. Damadian, J. Dworkin, Jay Butterman, A. Giambalvo, David Chu","doi":"10.4081/vl.2022.10844","DOIUrl":"https://doi.org/10.4081/vl.2022.10844","url":null,"abstract":"Dr. Raymond Damadian, Father of the MRI, passed away on August 3, 2022. In this Letter to the Editor, we discuss Dr. Damadian’s seminal discovery, his path to making the first MRI machine, as well as the work he did in his later years on the dynamics of CSF flow in neurodegenerative disease. We hope to honor the legacy of such an influential character in radiology history and inspire others to continue to continue to explore, innovate, and cure disease with his technology for years to come.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134143102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ethics and rationale for sparing the saphenous vein","authors":"C. Franceschi","doi":"10.4081/vl.2022.10809","DOIUrl":"https://doi.org/10.4081/vl.2022.10809","url":null,"abstract":"Not available.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123691547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Superficial venous aneurysms are a very rare pathology. This case report describes a 21-years-old male patient, who developed a soft, slow-growing mass, in the lateral part of the dorsal foot. Based on clinical examination and EcocolorDoppler ultrasound exam, the diagnosis of venous aneurysm of the lateral marginal vein was confirmed. The treatment proposed was ultrasound-guided foam sclerotherapy. The purpose of this work is to describe for the first time a venous superficial aneurysm localized in the lateral marginal vein of the foot. It is the first case reported in English literature.
{"title":"Aneurysm of the lateral marginal vein of the foot","authors":"I. Massi, R. Ricci, Francesca Alesiani","doi":"10.4081/vl.2022.10584","DOIUrl":"https://doi.org/10.4081/vl.2022.10584","url":null,"abstract":"Superficial venous aneurysms are a very rare pathology. This case report describes a 21-years-old male patient, who developed a soft, slow-growing mass, in the lateral part of the dorsal foot. Based on clinical examination and EcocolorDoppler ultrasound exam, the diagnosis of venous aneurysm of the lateral marginal vein was confirmed. The treatment proposed was ultrasound-guided foam sclerotherapy. The purpose of this work is to describe for the first time a venous superficial aneurysm localized in the lateral marginal vein of the foot. It is the first case reported in English literature.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132714846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lymphedema is a chronic devastating disease characterized by the accumulation of fluid in the extremities, tissue progressive changes such as adipose tissue deposition and fibrosis. To restore the functionality and structural integrity of the damaged lymphatic vessels, autologous peripheral blood mononuclear cells (PBMNC) was implanted in 3 sessions, 4 weeks apart, in the affected limb. Each patient was followed for 6 months, monitoring changes in the limb volume. Lymphangiogenesis was evaluated by lymphoscintigraphy, and the monitoring of quality of life. A rapid reduction in the volume of the limbs was observed: 24.5% of volume reduction after the first implant, 18.5% after the second, and 15.3% at 6 months after the third (p<0.05 vs baseline). Lymphoscintigraphy showed a hyper fixation of the tracer along the ipsilateral iliac axis not appreciable at baseline. Implants of autologous PBMNC in patients with primary lower limb lymphedema seems to be a feasible, effective therapy option.
{"title":"Autologous peripheral blood mononuclear cells for the treatment of lower extremity lymphedema: a preliminary report","authors":"M. Bellisi","doi":"10.4081/vl.2021.10016","DOIUrl":"https://doi.org/10.4081/vl.2021.10016","url":null,"abstract":"Lymphedema is a chronic devastating disease characterized by the accumulation of fluid in the extremities, tissue progressive changes such as adipose tissue deposition and fibrosis. To restore the functionality and structural integrity of the damaged lymphatic vessels, autologous peripheral blood mononuclear cells (PBMNC) was implanted in 3 sessions, 4 weeks apart, in the affected limb. Each patient was followed for 6 months, monitoring changes in the limb volume. Lymphangiogenesis was evaluated by lymphoscintigraphy, and the monitoring of quality of life. A rapid reduction in the volume of the limbs was observed: 24.5% of volume reduction after the first implant, 18.5% after the second, and 15.3% at 6 months after the third (p<0.05 vs baseline). \u0000Lymphoscintigraphy showed a hyper fixation of the tracer along the ipsilateral iliac axis not appreciable at baseline. Implants of autologous PBMNC in patients with primary lower limb lymphedema seems to be a feasible, effective therapy option.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121682103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sciatic nerve varices (SNV) represent an infrequent presentation of varicose veins. They are usually not recognised and may present only with chronic sciatic pain with few varicosities. On clinical examination, sciatic pain can be reproduced by finger-pressing the superficial varicose veins at their point of connection with the SNV. These varices are then confirmed by duplex ultrasonography. We herein report a case of a 78-years-old woman affected by symptomatic SNV, treated by echo-guided Tessari foam sclerotherapy (EGFSCL) with immediate relief of the sciatic pain. Reflux through the sciatic veins, as the connected superficial varicose veins, disappeared completely and not any complications have emerged. EGFSCL seems to be both safe and effective, so representing a reliable and minimally invasive treatment for this disturb.
{"title":"Sclerotherapy of sciatic nerve varices","authors":"M. Bressan","doi":"10.4081/vl.2021.10166","DOIUrl":"https://doi.org/10.4081/vl.2021.10166","url":null,"abstract":"Sciatic nerve varices (SNV) represent an infrequent presentation of varicose veins. They are usually not recognised and may present only with chronic sciatic pain with few varicosities. On clinical examination, sciatic pain can be reproduced by finger-pressing the superficial varicose veins at their point of connection with the SNV. These varices are then confirmed by duplex ultrasonography. We herein report a case of a 78-years-old woman affected by symptomatic SNV, treated by echo-guided Tessari foam sclerotherapy (EGFSCL) with immediate relief of the sciatic pain. Reflux through the sciatic veins, as the connected superficial varicose veins, disappeared completely and not any complications have emerged. EGFSCL seems to be both safe and effective, so representing a reliable and minimally invasive treatment for this disturb.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115194949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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