From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK.
Neurology. 2021 Apr 20;96(16):e2048-e2057. doi: 10.1212/WNL.0000000000011790. Epub 2021 Mar 2.
Cerebral microbleeds (MBs) are a common finding in patients with cerebral small vessel disease (CSVD) and Alzheimer disease as well as in healthy elderly people, but their pathophysiology remains unclear. To investigate a possible role of veins in the development of MBs, we performed an exploratory study, assessing in vivo presence of MBs with a direct connection to a vein.
7-Tesla (7T) MRI was conducted and MBs were counted on quantitative susceptibility mapping (QSM). A submillimeter resolution QSM-based venogram allowed identification of MBs with a direct spatial connection to a vein.
A total of 51 people (mean age [SD] 70.5 [8.6] years, 37% female) participated in the study: 20 had CSVD (cerebral amyloid angiopathy [CAA] with strictly lobar MBs [n = 8], hypertensive arteriopathy [HA] with strictly deep MBs [n = 5], or mixed lobar and deep MBs [n = 7], 72.4 [6.1] years, 30% female) and 31 were healthy controls (69.4 [9.9] years, 42% female). In our cohort, we counted a total of 96 MBs with a venous connection, representing 14% of all detected MBs on 7T QSM. Most venous MBs (86%, n = 83) were observed in lobar locations and all of these were cortical. Patients with CAA showed the highest ratio of venous to total MBs (19%) (HA = 9%, mixed = 18%, controls = 5%).
Our findings establish a link between cerebral MBs and the venous vasculature, pointing towards a possible contribution of veins to CSVD in general and to CAA in particular. Pathologic studies are needed to confirm our observations.
脑微出血（MBs）是脑小血管病（CSVD）和阿尔茨海默病患者以及健康老年人的常见现象，但它们的病理生理学仍不清楚。为了研究静脉在 MBs 发展中的可能作用，我们进行了一项探索性研究，评估了与静脉直接相连的 MBs 的体内存在情况。
进行了 7 特斯拉（7T）MRI 检查，并通过定量磁化率映射（QSM）计数 MBs。基于亚毫米分辨率 QSM 的静脉造影术允许识别与静脉有直接空间连接的 MBs。
共有 51 人（平均年龄[标准差]70.5[8.6]岁，37%为女性）参与了这项研究：20 人患有 CSVD（脑淀粉样血管病[CAA]，具有严格的脑叶 MBs[8 例]，高血压性血管病[HA]，具有严格的深部 MBs[5 例]，或混合性脑叶和深部 MBs[7 例]，72.4[6.1]岁，30%为女性），31 人是健康对照组（69.4[9.9]岁，42%为女性）。在我们的队列中，我们总共计数了 96 个有静脉连接的 MBs，占 7T QSM 上所有检测到的 MBs 的 14%。大多数静脉性 MBs（86%，n=83）位于脑叶部位，且均为皮质性。CAA 患者静脉性 MBs 与总 MBs 的比例最高（19%）（HA=9%，混合性=18%，对照组=5%）。
我们的发现建立了脑 MBs 与静脉血管之间的联系，表明静脉可能对 CSVD 特别是 CAA 有一定的贡献。需要进行病理学研究来证实我们的观察结果。
