leukoaraiosis neuropathological mechanisms of ischemic injury and neuroimaging studies

Title: leukoaraiosis neuropathological mechanisms of ischemic injury and neuroimaging studies Author: Lin Lang Degree-granting units: The Third Military Medical University Keywords: leukoaraiosis;; low perfusion;; small disease;; angiogenesis;; blood-brain barrier Abstract: Background and purpose: leukoaraiosis is a common imaging findings in older people, means deep periventricular white matter and diffuse white matter regions
Distribution of high signal on Magnetic lifter MRI or CT on the low signal change. Understand a lot of evidence that osteoporosis and cognitive impairment, movement and step
Abnormal state, depression, difficulty urinating symptoms are closely related. In addition, white matter stroke and osteoporosis is an independent predictor of stroke recurrence, while
Leukoaraiosis and community groups in mortality, morbidity are closely related. Therefore, leukoaraiosis of the elderly population's life and quality of life
One of the important threats. A large number of vascular risk factors such as hypertension, stroke, diabetes and leukoaraiosis close
Tip cerebral ischemia is caused by an important reason for leukoaraiosis. Small lacunar brain lesions is common in the elderly population of brain imaging findings,
Refers to the basal ganglia and white matter regions of 3-10mm diameter holes around the cavity kind of like cerebrospinal fluid signal is often not accompanied by a clear loss of nerve function
Harm. At present, many believe that leukoaraiosis and lacunar brain small stove have a common pathological basis, that is, cerebral small vessel disease, small lacunar brain mainly
Complete ischemia and leukoaraiosis was not entirely caused by ischemia. But there are also many studies suggest that large vessel disease are equally involved in white matter
The incidence of osteoporosis. Ischemic white matter damage caused by osteoporosis occur pathological mechanism is not yet clear. The research projects aimed at the slave
Animal experiments http://www.999magnet.com/products/131-magnetic-lifter and clinical aspects of imaging the pathological basis of leukoaraiosis and clinical characteristics, with a view to an initial understanding of ischemic injury caused by white
The pathogenesis of osteoporosis. Materials and Methods: The subjects are divided into animal studies and clinical imaging studies in two parts.
Some animal studies is divided into two phases, the first stage of male Wistar rats as experimental subjects, the rats were divided into ischemic 1w, ischemic
2w, 4w and ischemic control group in four groups of 24 rats, a total of 96 rats. Ischemia using bilateral carotid artery ligation build forebrain
Chronic hypoperfusion model, control rats given sham treatment. By Kluver-Barrera myelin staining of white matter in rats
Injury, FITC-Dextran injection determination of three-dimensional reconstruction of vascular develop vascular network density, Brdu-laminin double-labeled fluorescent immunohistochemistry
Staining determined the number of neovascular endothelial cells, after intravenous injection of Evans blue quantitative determination of the concentration of brain tissue assessment of blood-brain barrier of Evans blue
Transparent case, the use of reverse transcription-polymerase chain reaction detection of vascular endothelial growth factor and its receptor mRNA expression and other indicators to assess
Assessment of chronic low perfusion states at different times and circumstances in different parts of white matter damage, angiogenesis and blood-brain barrier damage, which
Analysis of angiogenesis and angiogenesis in the ischemic blood-brain barrier damage in the role of white matter damage. Part of the second stage of animal experiments
Segment to male Wistar rats as experimental subjects, the rats were divided into sham operation group, ischemia control group and three groups of Sorafenib in the intervention group,
N = 24 rats, 72 rats. Sorafenib ischemia group and intervention group with bilateral carotid artery ligation to build the forebrain of chronic low
Perfusion model, sham-operated control rats given sham treatment. Sorafenib intervention group were given the suppression of vascular endothelial growth factor receptor
Sorafenib preparations to intervene in chronic hypoperfusion rat angiogenesis. Modeling in January after the rats were killed by Kluver
-Barrera myelin staining, FITC-Dextran injection of vascular imaging three-dimensional reconstruction, Brdu-laminin double-labeled immunohistochemical staining,
After intravenous injection of Evans blue-quantitative determination of the concentration of Evans blue in brain tissue, reverse transcription-polymerase chain reaction method is to be rats in each group
White matter injury, the regional vascular network density, the number of neovascular endothelial cells, blood-brain barrier permeability, vascular endothelial growth factor
And its receptor mRNA expression differences and other related indicators in order to identify angiogenesis inhibitor in chronic low perfusion state blood-brain barrier damage
And white matter injury in rats, and to further explore the nature of angiogenesis and angiogenesis, blood-brain barrier damage of white matter damage in ischemic
Role. Clinical imaging research consists of two parts. The first part of the study from January 2007 to June 2008 in Beijing Military Region General Hospital
Institute of Neurology, diagnosis and treatment of patients over the age of 40 for the study. All patients entered the study received, including T1, T2, fluid recovery
Reverse sequence (Fluid attenuated inversion recovery, FLAIR), diffusion-weighted MRI imaging sequence, the root
According to the FLAIR images in patients with white matter changes in the situation according to Fazekas classification divided into 0 (no change), 1 (mild), 2 (moderate) and 3 (severe) four
Level 2 and above white matter change is defined as leukoaraiosis. High signal white matter using computer-assisted quantitative method, the patient
Bilateral hemispheric white matter high signal volume for quantitative analysis, re-side / light side of the hemisphere white matter high signal volume ratio greater than 1.5 leukoaraiosis
Patients and that the asymmetry associated with leukoaraiosis. According to magnetic resonance imaging in patients with skull, the brain of patients with small lacunar lesions were counted. All
Patients entered the study underwent neck vascular ultrasound to analyze the common carotid artery, carotid artery blood flow velocity index and the arterial wall plaques
With stenosis of the block. Leukoaraiosis in patients with leukoaraiosis asymmetric heavy side and light side of the hemisphere to hemisphere, matching and analysis of white matter high
Signal distribution asymmetry and neck hemodynamic status, the occurrence of brain lesions such as small lacunar links among the indicators to explore the causes white
Reasonable basis for the disease osteoporosis. The second part of clinical imaging studies to January 2007 to June 2008 of 323 acute brain
Infarction consecutive patients for the study. All patients entered the study underwent MRI and white matter according to Fazekas classification assessment
Whether patients with leukoaraiosis situation. According to magnetic resonance imaging in patients with skull, the brain of patients with small lacunar lesions were counted. Made for all patients
Disease within 3 months after the occurrence of complications and stroke outcome assessed the situation. Univariate statistical analysis and assessment of leukoaraiosis Brain
Department of small lacunar lesions and poor outcome after stroke and complications associated with, and the use of Logistic regression analysis to further assess the stroke is not
Good outcome and independent predictors of complications. In addition, in order to facilitate a more precise analysis of patient images, we study the design
A computer-aided semi-automatic high-signal white matter quantitative methods and a superimposed image analysis method and applied to image analysis.
Results: The first phase of some animal studies showed that compared with the sham group, rats with chronic low perfusion in the corpus callosum, internal capsule, and
Deep white matter and other regions showed a significant white matter damage to deep white matter region is staggering, white matter damage with prolonged ischemia time increased. Chronic
Regional white matter hypoperfusion in rat vascular network density and the number of new endothelial cells than control group higher peaks of the density of blood vessels in the ischemic
After 2-4w, the number of new peaks occur in endothelial cells after ischemia and 1-2w. Chronic hypoperfusion in rat brain tissue Evans blue content than
Sham-operated rats was significantly higher peak occurs in ischemia 2w, on the gross specimen shows the deep white matter and in the vicinity of Evans blue infiltration
More apparent. Ischemic rat brain tissue vascular endothelial growth factor and its receptor mRNA expression, the peak occurs in ischemia 1-2w
. Chronic hypoperfusion rat vascular network density, the number of new endothelial cells, vascular permeability and white matter changes in the situation in time and space
Correspondence suggested that chronic low perfusion, angiogenesis, blood-brain barrier damage and white matter damage that may exist between closely linked.
Animal studies show that some of the results of the second stage, Sorafenib intervention in newborn rat vascular network density and the number of endothelial cells compared with ischemic
Control rats was significantly reduced Evans blue content in brain tissue than the ischemia control group also decreased, indicating that Sorafenib inhibits chronic low
Reperfusion in rat angiogenesis process, and ischemic blood-brain barrier permeability was inhibited. With the control group and rats with ischemic
Than, Sorafenib intervention rats deep white matter density was significantly lower, indicating that angiogenesis inhibitors not only fail to improve chronic low
Reperfusion in rat ischemic white matter damage, but also increase the effect. In the first part of the imaging studies, the results table to understand the high quality
Signal a higher incidence of asymmetry (14.12% of all patients), single-factor statistical analysis showed that systemic factors, age, brain
Volume of white matter high signal, hyperlipidemia, diabetes, smoking and alcohol consumption and high signal white matter asymmetry are closely linked
System, logistic regression analysis is prompted age, alcohol consumption and diabetes is high signal white matter asymmetries were independent risk factors. White
High signal quality heavy side and light side of the matching analysis showed a small lacunar number of different bilateral and hemispheric white matter high signal was significantly higher asymmetry has
Association (P <0.001); carotid artery stenosis and high signal white matter asymmetries associated with a significant but weak (P = 0.031).
The second part of the imaging study results show that, compared with no leukoaraiosis in patients with leukoaraiosis in patients with acute cerebral infarction is not higher
The incidence of good outcome, a higher pulmonary infection, urinary tract infection and progressing stroke incidence. Upper gastrointestinal tract of patients with acute cerebral infarction
Blood, symptoms such as diarrhea, bleeding complications and conversion and leukoaraiosis was no significant association. Logistic regression analysis table to understand osteoporosis
Poor prognosis in patients with acute cerebral infarction and stroke were independent predictors of pneumonia, and cerebral small lacunar lesions are associated with acute ischemic stroke
The patient's prognosis and the incidence of complications after stroke no significant associations. Conclusion: Our study reached the following conclusions:
⑴ chronic hypoperfusion can cause damage to blood-brain barrier and white matter damage; promotion, including vascular endothelial growth factor and its receptor expression
Tone, increased angiogenesis and a series of changes in the process of angiogenesis; ⑵ angiogenesis, blood-brain barrier damage and white matter damage
Time and space on the Contact Tip angiogenesis and blood-brain barrier damage may be involved in the pathogenesis of white matter damage; ⑶ chronic
Low perfusion state of VEGF and its receptors are involved in blood-brain barrier damage occurred; ⑷ chronic low perfusion state during angiogenesis
Ischemic white matter injury in a positive sense, inhibition of angiogenesis will increase the white matter damage; ⑸ cerebral white matter disease sparse small
Important for the formation of loose, large vessel disease in the formation of leukoaraiosis but the effect is relatively small; Although cerebral small lacunar lesions and leukoaraiosis
Cerebrovascular disease are mainly small, but small lacunar brain tumor itself may be involved in the formation of white matter in the pathogenesis of osteoporosis; ⑹ white matter
Osteoporosis in patients with acute ischemic stroke and poor outcome after stroke were independent predictors of pneumonia, brain lesions and small lacunar acute ischemic
Stroke patient outcomes and complications there was no significant association; leukoaraiosis and cerebral small lacunar lesions in patients with acute ischemic stroke pre-
After the different effects that a small brain disease as the main performance of this heterogeneity of the two states. Degree Year: 2009