Ishikawa Hidehiro, Niwa Atsushi, Kato Shinya, Ii Yuichiro, Shindo Akihiro, Matsuura Keita, Nishiguchi Yamato, Tamura Asako, Taniguchi Akira, Maeda Masayuki, Hashizume Yoshio, Tomimoto Hidekazu
Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
Radioisotope Facilities for Medical Science, Advanced Science Research Promotion Center, Mie University, Tsu, Mie, 514-8507, Japan.
Brain Commun. 2021 Apr 8;3(2):fcab070. doi: 10.1093/braincomms/fcab070. eCollection 2021.
Even with postmortem pathological examination, only limited information is provided of the foci of clinical information. Cerebral small vessel disease, which is associated with ageing, dementia and stroke, highlights the difficulty in arriving at a definitive diagnosis of the lesions detected on radiological examination. We performed a radiological-pathological comparative study using MRI to examine small cerebral lesions. Four patients with small vessel disease lesions detected on MRI were studied. Exact pathological findings of MRI-detected lesions were revealed. The ischaemic lesion after 17 days from onset showed positivity for peroxiredoxin, cluster of differentiation 204 and glial fibrillary acidic protein, indicating sterile inflammation and neuroprotective reaction. Cortical microinfarcts beneath the cortical superficial siderosis were associated with inflammation from the superficial layer in a patient with cerebral amyloid angiopathy; in this patient, a bilinear track-like appearance of the cortical superficial siderosis on the MRI was compatible with iron deposition on the pia matter and within cortical layers II-III. An MRI-detected cerebral microbleed was revealed to be heterogeneous. An MRI-detected cerebral microbleed was revealed to be a venous angioma. Furthermore, a neuropathologically confirmed embolic cerebral microbleed was firstly detected using this method. Our results suggest that MRI-detected lobar cerebral microbleeds can be caused by non-cerebral amyloid angiopathy aetiologies, such as microembolism and venous angioma. Venous angioma and embolic microbleeds may mimic cerebral amyloid angiopathy markers on MRI. To clarify the clinical importance of these lesions, we should investigate their rate and frequency in a large cohort of healthy individuals and patients with cardiac risk factors. Thus, we provide evidence that micro-MRI improves the clinical diagnosis of small vessel diseases.
即使进行尸检病理检查，也只能提供有限的临床信息病灶。与衰老、痴呆和中风相关的脑小血管疾病凸显了对放射学检查中发现的病变做出明确诊断的困难。我们使用MRI进行了一项放射学-病理学对比研究，以检查脑小病灶。对4例MRI检测出小血管疾病病灶的患者进行了研究。揭示了MRI检测病灶的确切病理结果。发病17天后的缺血性病灶对过氧化物酶、分化簇204和胶质纤维酸性蛋白呈阳性，表明存在无菌性炎症和神经保护反应。脑淀粉样血管病患者皮质浅表铁沉积下方的皮质微梗死与表层炎症有关；在该患者中，MRI上皮质浅表铁沉积的双线性轨迹样表现与软脑膜和皮质II-III层内的铁沉积相符。MRI检测到的脑微出血显示为异质性。MRI检测到的脑微出血被证实为静脉血管瘤。此外，首次使用该方法检测到经神经病理学证实的栓塞性脑微出血。我们的结果表明，MRI检测到的脑叶微出血可能由非脑淀粉样血管病病因引起，如微栓塞和静脉血管瘤。静脉血管瘤和栓塞性微出血在MRI上可能模仿脑淀粉样血管病标志物。为了阐明这些病变在临床上的重要性，我们应该在一大群健康个体和有心脏危险因素的患者中研究它们的发生率和频率。因此，我们提供了证据表明微MRI改善了小血管疾病的临床诊断。
