Myelin contrast across lamina at 7T, ex-vivo and in-vivo dataset

In this article we report the complete data obtained in-vivo for the paper: “Lines of Baillarger in vivo and ex-vivo: myelin contrast across lamina at 7T MRI and histology” (Fracasso et al., 2015) 1. Single participant data (4 participants) from the occipital lobe acquisition are reported for axial, coronal and sagittal slices; early visual area functional localization and laminar profiles are reported. Data from whole brain images are reported and described (5 participants), for axial, coronal and sagittal slices. Laminar profiles from occipital, parietal and frontal lobes are reported. The data reported in this manuscript complements the paper (Fracasso et al., 2015) 1 by providing the full set of results from the complete pool of participants, on a single-participant basis. Moreover, we provide histological images from the ex-vivo sample reported in Fracasso et al. (2015) 1

Blood-brain barrier leakage and microvascular lesions in cerebral amyloid angiopathy

Background and Purpose-Cerebral amyloid angiopathy (CAA) is a common small vessel disease that independently effects cognition in older individuals. The pathophysiology of CAA and CAA-related bleeding remains poorly understood. In this postmortem study, we explored whether blood-brain barrier leakage is associated with CAA and microvascular lesions.Methods-Eleven CAA cases (median [IQR] age=69 years [65-79 years], 8 males) and 7 cases without neurological disease or brain lesions (median [IQR] age=77 years [68-92 years], 4 males) were analyzed. Cortical sections were sampled from each lobe, and IgG and fibrin extravasation (markers of blood-brain barrier leakage) were assessed with immunohistochemistry. We hypothesized that IgG and fibrin extravasation would be increased in CAA cases compared with controls, that this would be more pronounced in parietooccipital brain regions compared with frontotemporal brain regions in parallel with the posterior predilection of CAA, and would be associated with CAA severity and number of cerebral microbleeds and cerebral microinfarcts counted on ex vivo magnetic resonance imaging of the intact brain hemisphere.Results-Our results demonstrated increased IgG positivity in the frontotemporal (P=0.044) and parietooccipital (P=0.001) cortex in CAA cases compared with controls. Within CAA cases, both fibrin and IgG positivity were increased in parietooccipital brain regions compared with frontotemporal brain regions (P=0.005 and P=0.006, respectively). The percentage of positive vessels for fibrin and IgG was associated with the percentage of amyloid-beta-positive vessels (Spearman.=0.71, P=0.015 and Spearman.=0.73, P=0.011, respectively). Moreover, the percentage of fibrin and IgGpositive vessels, but not amyloid-beta-positive vessels, was associated with the number of cerebral microbleeds on magnetic resonance imaging (Spearman.=0.77, P=0.005 and Spearman.=0.70, P=0.017, respectively). Finally, we observed fibrin deposition in walls of vessels involved in cerebral microbleeds.Conclusions-Our results raise the possibility that blood-brain barrier leakage may be a contributory mechanism for CAArelated brain injury

Off-label use of aducanumab for cerebral amyloid angiopathy

Neuro Imaging Researc

Cortical microinfarcts in memory clinic patients are associated with reduced cerebral perfusion

Cerebral cortical microinfarcts (CMIs) are small ischemic lesions associated with cognitive impairment and dementia. CMIs are frequently observed in cortical watershed areas suggesting that hypoperfusion contributes to their development. We investigated if presence of CMIs was related to a decrease in cerebral perfusion, globally or specifically in cortex surrounding CMIs. In 181 memory clinic patients (mean age 72 9 years, 51% male), CMI presence was rated on 3-T magnetic resonance imaging (MRI). Cerebral perfusion was assessed from cortical gray matter of the anterior circulation using pseudo-continuous arterial spin labeling parameters cerebral blood flow (CBF) (perfusion in mL blood/ 100 g tissue/min) and spatial coefficient of variation (CoV) (reflecting arterial transit time (ATT)). Patients with CMIs had a 12% lower CBF (beta ¼ .20) and 22% higher spatial CoV (beta ¼ .20) (both p <.05) without a specific regional pattern on voxel-based CBF analysis. CBF in a 2 cm region-of-interest around the CMIs did not differ from CBF in a reference zone in the contralateral hemisphere. These findings show that CMIs in memory clinic patients are primarily related to global reductions in cerebral perfusion, thus she

Progression of cerebral amyloid angiopathy: a pathophysiological framework

Cerebral amyloid angiopathy, which is defined by cerebrovascular deposition of amyloid 13, is a common age-related small vessel pathology associated with intracerebral haemorrhage and cognitive impairment. Based on complementary lines of evidence from in vivo studies of individuals with hereditary, sporadic, and iatrogenic forms of cerebral amyloid angiopathy, histopathological analyses of affected brains, and experimental studies in transgenic mouse models, we present a framework and timeline for the progression of cerebral amyloid angiopathy from subclinical pathology to the clinical manifestation of the disease. Key stages that appear to evolve sequentially over two to three decades are (stage one) initial vascular amyloid deposition, (stage two) alteration of cerebrovascular physiology, (stage three) non-haemorrhagic brain injury, and (stage four) appearance of haemorrhagic brain lesions. This timeline of stages and the mechanistic processes that link them have substantial implications for identifying disease-modifying interventions for cerebral amyloid angiopathy and potentially for other cerebral small vessel diseases.Radiolog

Cortical microinfarcts in memory clinic patients are associated with reduced cerebral perfusion

Cerebral cortical microinfarcts (CMIs) are small ischemic lesions associated with cognitive impairment and dementia. CMIs are frequently observed in cortical watershed areas suggesting that hypoperfusion contributes to their development. We investigated if presence of CMIs was related to a decrease in cerebral perfusion, globally or specifically in cortex surrounding CMIs. In 181 memory clinic patients (mean age 72 ± 9 years, 51% male), CMI presence was rated on 3-T magnetic resonance imaging (MRI). Cerebral perfusion was assessed from cortical gray matter of the anterior circulation using pseudo-continuous arterial spin labeling parameters cerebral blood flow (CBF) (perfusion in mL blood/100 g tissue/min) and spatial coefficient of variation (CoV) (reflecting arterial transit time (ATT)). Patients with CMIs had a 12% lower CBF (beta = −.20) and 22% higher spatial CoV (beta =.20) (both p <.05) without a specific regional pattern on voxel-based CBF analysis. CBF in a 2 cm region-of-interest around the CMIs did not differ from CBF in a reference zone in the contralateral hemisphere. These findings show that CMIs in memory clinic patients are primarily related to global reductions in cerebral perfusion, thus shedding new light on the etiology of vascular brain injury in dementia

Microvascular brain pathology on high resolution MRI

Cerebral small vessel disease (SVD) is a common finding in the aging human brain and is associated with stroke, cognitive decline, and dementia. On autopsy, SVD encompasses pathological processes affecting small arteries and arterioles. Magnetic resonance imaging (MRI) detects the consequences of these pathological processes on the brain parenchyma, such as white matter hyperintensities, lacunar infarcts, and microbleeds. However, conventional MRI does not allow the detection of the whole spectrum of SVD, including the smaller parenchymal manifestations, such as cerebral microinfarcts (CMIs), and the vessel pathology itself. Moreover, parenchymal lesions on MRI considered to reflect SVD are not always the result of underlying changes to the small vessels. Ultra-high field strength (i.e. 7 tesla (T)) in vivo MRI and post-mortem MRI of brain tissue may overcome some of these issues and shed new light on cerebral SVD. The aim of the work described in this thesis was to zoom in on SVD and related brain changes, using both in vivo and post-mortem 7T MRI, and histopathology. A particular focus was to establish if CMIs could be detected in vivo and assess the clinical correlates of these microvascular lesions. In this thesis we showed that CMIs can indeed be detected in vivo. These findings were validated with post-mortem 7T MRI and histopathology. We proposed rating criteria for the identification of cortical CMIs on both 7T and 3T MRI, which allowed, for the first time, the study of CMIs in living patients and to track their impact on cognition and disease over time. The first results are promising and have already provided valuable clues on the role of cortical CMIs in cerebrovascular disease and dementia. Future studies should be directed towards understanding the longitudinal implications of CMIs in vivo, and to the pathophysiological mechanisms that drive CMI formation. Integrating insights from neuropathology and MRI will direct studies towards a better understanding of SVD and the development of new treatment options and prevention strategies of cognitive decline and dementia

Heterogeneous histopathology of cortical microbleeds in cerebral amyloid angiopathy

OBJECTIVE: To investigate the histopathologic substrate of microbleeds detected on 7T postmortem MRI in autopsy cases with severe cerebral amyloid angiopathy (CAA) and Alzheimer pathology. METHODS: Five decedents (mean age at death 79.6 +/- 5.7 years) with documented severe CAA and Alzheimer pathology on standard neuropathologic examination were selected from a local database. Formalin-fixed coronal brain slices were scanned at 7T MRI, including high-resolution T2- and T2*-weighted sequences. Representative microbleeds from each case were sampled for histopathologic analysis, including the presence of blood, blood breakdown products, and markers of ischemic tissue injury. RESULTS: On MRI, we identified >300 cortical and 4 subcortical microbleeds. Two out of 15 sampled cortical microbleeds corresponded histologically to erythrocytes (suggestive of recent hemorrhages), 4 to vasculopathies (fibrinoid necrosis in 3 and a cavernoma) without substantial parenchymal tissue injury, and 9 to accumulations of iron-positive siderophages without erythrocytes (suggestive of old hemorrhages) combined with mild to moderate degrees of chronic ischemic tissue injury. CONCLUSIONS: This study provides evidence for heterogeneous pathologic substrates and possibly different pathophysiologic mechanisms underlying MRI-observed cortical microbleeds in the context of advanced CAA and Alzheimer disease

Locus coeruleus pathology is associated with cerebral microangiopathy at autopsy

INTRODUCTIONWe investigated the link between locus coeruleus (LC) pathology and cerebral microangiopathy in two large neuropathology datasets. METHODSWe included data from the National Alzheimer's Coordinating Center (NACC) database (n = 2197) and Religious Orders Study and Rush Memory and Aging Project (ROSMAP; n = 1637). Generalized estimating equations and logistic regression were used to examine associations between LC hypopigmentation and presence of cerebral amyloid angiopathy (CAA) or arteriolosclerosis, correcting for age at death, sex, cortical Alzheimer's disease (AD) pathology, ante mortem cognitive status, and presence of vascular and genetic risk factors. RESULTSLC hypopigmentation was associated with higher odds of overall CAA in the NACC dataset, leptomeningeal CAA in the ROSMAP dataset, and arteriolosclerosis in both datasets. DISCUSSIONLC pathology is associated with cerebral microangiopathy, independent of cortical AD pathology. LC degeneration could potentially contribute to the pathways relating vascular pathology to AD. Future studies of the LC-norepinephrine system on cerebrovascular health are warranted. HighlightsWe associated locus coeruleus (LC) pathology and cerebral microangiopathy in two large autopsy datasets.LC hypopigmentation was consistently related to arteriolosclerosis in both datasets.LC hypopigmentation was related to cerebral amyloid angiopathy (CAA) presence in the National Alzheimer's Coordinating Center dataset.LC hypopigmentation was related to leptomeningeal CAA in the Religious Orders Study and Rush Memory and Aging Project dataset.LC degeneration may play a role in the pathways relating vascular pathology to Alzheimer's disease

Blood-brain barrier leakage and perivascular inflammation in cerebral amyloid angiopathy

Kozberg et al. examined blood-brain barrier leakage and perivascular inflammation at the individual vessel level in cerebral amyloid angiopathy. They report blood-brain barrier leakage at early stages of vascular pathology, a potential trigger for perivascular inflammation and vascular remodelling leading to haemorrhage.Cerebral amyloid angiopathy is a small vessel disease associated with cortical microbleeds and lobar intracerebral haemorrhage due to amyloid-beta deposition in the walls of leptomeningeal and cortical arterioles. The mechanisms of cerebral amyloid angiopathy-related haemorrhage remain largely unknown. Recent work has demonstrated that ruptured blood vessels have limited (or no) amyloid-beta at the site of bleeding and evidence of local vascular remodelling. We hypothesized that blood-brain barrier leakage and perivascular inflammation may be involved in this remodelling process. This study examined cortical arterioles at various stages of cerebral amyloid angiopathy-related vascular pathology (without evidence of microhaemorrhage) in autopsy tissue from seven cases with definite cerebral amyloid angiopathy. We included temporo-occipital sections with microbleeds guided by ex vivo MRI from two cases with severe cerebral amyloid angiopathy and systematically sampled occipital sections from five consecutive cases with varying cerebral amyloid angiopathy severity. Haematoxylin and eosin stains and immunohistochemistry against amyloid-beta, fibrin(ogen), smooth muscle actin, reactive astrocytes (glial fibrillary acidic protein) and activated microglia (cluster of differentiation 68) were performed. Arterioles were graded using a previously proposed scale of individual vessel cerebral amyloid angiopathy severity, and a blinded assessment for blood-brain barrier leakage, smooth muscle actin and perivascular inflammation was performed. Blood-brain barrier leakage and smooth muscle actin loss were observed in significantly more vessels with mild amyloid-beta deposition (Grade 1 vessels; P = 0.044 and P = 0.012, respectively) as compared to vessels with no amyloid-beta (Grade 0), and blood-brain barrier leakage was observed in 100% of vessels with evidence of vessel remodelling (Grades 3 and 4). Perivascular inflammation in the form of reactive astrocytes and activated microglia was observed predominantly surrounding arterioles at later stages of vessel pathology (Grades 2-4) and consistently around vessels with the same morphological features as ruptured vessel segments (Grade 4). These findings suggest a role for blood-brain barrier leakage and perivascular inflammation leading to arteriolar remodelling and haemorrhage in cerebral amyloid angiopathy, with early blood-brain barrier leakage as a potential trigger for subsequent perivascular inflammation.</p