Sasannia Sarvin, Leigh Richard, Bastani Pouya B, Shin Hyeong-Geol, van Zijl Peter, Knutsson Linda, Nyquist Paul
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, United States.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Neurotherapeutics. 2025 Jan;22(1):e00516. doi: 10.1016/j.neurot.2024.e00516. Epub 2024 Dec 21.
Brain ischemia is a major cause of neurological dysfunction and mortality worldwide. It occurs not only acutely, such as in acute ischemic stroke (AIS), but also in chronic conditions like cerebral small vessel disease (cSVD). Any other conditions resulting in brain hypoperfusion can also lead to ischemia. Ischemic events can cause blood-brain barrier (BBB) disruption and, ultimately, white matter alterations, contributing to neurological deficits and long-term functional impairments. Hence, understanding the mechanisms of BBB breakdown and white matter injury across various ischemic conditions is critical for developing effective interventions and improving patient outcomes. This review discusses the proposed mechanisms of ischemia-related BBB breakdown. Moreover, magnetic resonance imaging (MRI) based perfusion-weighted imaging (PWI) techniques sensitive to BBB permeability changes are described, including dynamic contrast-enhanced (DCE-MRI) and dynamic susceptibility contrast MRI (DSC-MRI), two perfusion-weighted imaging (PWI). These PWI techniques provide valuable insights that improve our understanding of the complex early pathophysiology of brain ischemia, which can lead to better assessment and management. Finally, in this review, we explore the implications of the mentioned neuroimaging findings, which emphasize the potential of neuroimaging biomarkers to guide personalized treatment and inform novel neuroprotective strategies. This review highlights the importance of investigating BBB changes in brain ischemia and the critical role of advanced neuroimaging in improving patient care and advancing stroke research.
脑缺血是全球神经功能障碍和死亡的主要原因。它不仅急性发生，如在急性缺血性卒中（AIS）中，也发生于慢性疾病，如脑小血管病（cSVD）。任何导致脑灌注不足的其他情况也可导致缺血。缺血事件可引起血脑屏障（BBB）破坏，并最终导致白质改变，进而导致神经功能缺损和长期功能障碍。因此，了解各种缺血情况下血脑屏障破坏和白质损伤的机制对于开发有效的干预措施和改善患者预后至关重要。本综述讨论了缺血相关血脑屏障破坏的推测机制。此外，还描述了基于磁共振成像（MRI）的对血脑屏障通透性变化敏感的灌注加权成像（PWI）技术，包括动态对比增强（DCE-MRI）和动态磁敏感对比MRI（DSC-MRI）这两种灌注加权成像（PWI）。这些PWI技术提供了有价值的见解，有助于我们更好地理解脑缺血复杂的早期病理生理学，从而实现更好的评估和管理。最后，在本综述中，我们探讨了上述神经影像学发现的意义，这些发现强调了神经影像学生物标志物在指导个性化治疗和为新型神经保护策略提供信息方面的潜力。本综述强调了研究脑缺血中血脑屏障变化的重要性以及先进神经影像学在改善患者护理和推动卒中研究方面的关键作用。
