Peking University - Juntendo University Joint Symposium on Brain and Skin Diseases

New MRI Techniques for the Evaluation of the Cerebrovascular Diseases

YINING HUANG＊

＊Department of Neurology, Peking University First Hospital, Beijing, China

Key words: magnetic resonance imaging (MRI), cerebrovascular disease, arterial spin laveling,

microbleeds

Stroke is one of the leading causes of mortality in

China. Recent decades, the mortality and mobility

have decreased in the urban area of China from

127.98/100,000 population in 2000, to 125.15/

100,000 population in 2010. In contrast, these

numbers are elevated obviously in rural area from

115.00/100,000 to 145.70/100,000, respectively in

the same period. Chinese population presents the

highest recurrent rate of stroke: among 9M new

stroke cases and 30M survivors of stroke each year

globally, one-third of cases came from China. The

higher incidence of the intracranial arterial occlu-

sive lesions and predominant small vessel disease

are believed to be the one of main causes of the high

recurrent rate of stroke in Chinese population 1).

In clinical practice, the intracranial occlusive

lesions present a variety of outcomes. It is not rare

that the progressive occlusive lesion is not conse-

quentially destined to the occurrence of stroke,

while the appearance of intact vessel wall may

relate to a poor outcome. Therefore, it is critically

important in clinical to predict the outcome of the

occlusive lesion. Small vessel disease swings

between ischemic and hemorrhages, which makes

the clinical irresolution of the secondary prevention.

Recent years, we have developed the MRI software

for the purpose of evaluation of the degree of

perfusion deficiency, automatic counting of the

severity of the brain white matter lesions, and the

number of the cerebral microbleeds, and assess-

ment of the neuron function during ischemic lesion.

1. We evaluated the distal branches of the intracra-

nial arteries, such as the second and third

segment of the middle cerebral artery (MCA),

anterior cerebral artery (ACA) by use of the

targeted arterial spin leveling technique

(ASL) 2) 3). We were successful in selecting A2

and A3 segments of ACA and etc.

2. We used an extended FixHugh and Nagumo

reaction diffusion mode to calculate the volume

of the white matter lesion 4) 5). The result is

well-matched with the manual measurement;

therefore, it can be used for comparison between

cohort studies during the follow-up period.

3. The software of autonomic quantity of cerebral

microbleeds (CMB) was developed in our

university based on T2 ＊ weighted-image. The

technique can be divided into different steps.

First, we selected the series of T1 and T2

weighted images to make a mask. Second, we

298

Whatʼs New fromJuntendoUniversity,Tokyo

Juntendo Medical Journal2016. 62(4), 298-299

Yining Huang

Department of Neurology, Peking University First Hospital

8 Xishiku St, Xicheng, Beijing 100871, China

TEL: +86-10-6655-1122 E-mail: bdyyweb@163.com

〔Received May 12, 2016〕

Copyright © 2016 The Juntendo Medical Society. This is an open access article distributed under the terms of Creative Commons Attribution Li-

cense (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original source is properly credited.

doi: 10.14789/jmj.62.298

made a global verse local statistical thresholding.

Then, third, we selected the roundness and

other 12 parameters to define the features

extraction of the CMB. We classified the CMB

and counted the numbers. With this method we

assessed the risk factor of the progress of CMB,

and found that it is valuable to predict the

cerebral infarction and hemorrhage.

4. We developed a system to assess the neuron

metabolism, based on the mechanism of volume

fraction of erythrocytes in the blood. It can be

used in dynamic assessment of the neuron

metabolism in the mitochondrial disease like

MELAS to predict the coming lesions

(Figure-1) 6).

This new technique provides a promising

method, although validation is necessary, for the

clinical utility for the analysis of brain small vessel

disease and the intracranial occlusive lesions,

especially for the optional assessment of the

severity of small branches occlusive, the deficiency

of regional perfusion, the quantity of the white

matter lesion and the CMBs, and the condition of

neuron metabolism.

References

1) Gorelick PB, Wong KS, Bae HJ, Pandey DK: Largeartery intracranial occlusive disease: a large worldwideburden but a relatively neglected frontier. Stroke, 2008;39: 2396-2399.

2) Lu X, Wang J, Zhang J, Hu X, Fang J: DC-CASL basedquantitative brain perfusion study with a portable RFtransmitter system. International Society of MagneticResonance in Medicine International Society of Mag-netic Resonance in Medicine (ISMRM) 2012, poster#2512.

3) Dang Y, Wu B, Sun Y, et al: Quantitative assessment ofexternal carotid artery territory supply with modifiedvessel-encoded arterial spin-labeling. AJNR, 2013; 33:1380-1386.

4) Ji S, Huang Y, Zhang J, Fang J: Automatic segmentationof white matter hyperintensities base on reactiondiffusion with local threshold. International Society ofMagnetic Resonance in Medicine (ISMRM) 2011,abstract #1493.

5) Ji S, Ye C, Li F, et al: Automatic segmentation of whitematter hyperintensities by an extended FitzHugh &Nagumo reaction diffusion model. J Mahn ResonImaging, 2013; 37: 343-350.

6) Wang Z, Xiao J, Xie S, et al: MR evaluation of cerebraloxygen metabolism and blood flow in stroke-likeepisodes of MELAS. J Neurol Sci, 2012; 323: 173-177.

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