Advanced MR image analysis in sporadic and Dutch-type hereditary Cerebral Amyloid Angiopathy

Doctoral Thesis

Advanced magnetic resonance imaging (MRI) provides insights in the pathophysiological processes and disease progression in patients with Cerebral Amyloid Angiopathy (CAA), that cannot be inferred from conventional MRI. CAA is a cerebral small vessel disease that is characterized by vascular amyloid-beta accumulation, and it is one of the leading etiologies of cognitive decline and intracerebral hemorrhage in the elderly. This thesis describes the analysis of markers that are assessed through advanced MR imaging, covering the MRI-measurable stages of the previously proposed pathophysiological framework of CAA.

Part I covers changes in cerebrovascular reactivity as measured through visually stimulated functional MRI, in relation to microstructural white matter integrity (Chapter 2) and as longitudinal measure with one-year follow-up data (Chapter 3). In part II, perivascular spaces, the proposed 'highways' for brain clearance, are assessed with a newly developed segmentation...Show moreAdvanced magnetic resonance imaging (MRI) provides insights in the pathophysiological processes and disease progression in patients with Cerebral Amyloid Angiopathy (CAA), that cannot be inferred from conventional MRI. CAA is a cerebral small vessel disease that is characterized by vascular amyloid-beta accumulation, and it is one of the leading etiologies of cognitive decline and intracerebral hemorrhage in the elderly. This thesis describes the analysis of markers that are assessed through advanced MR imaging, covering the MRI-measurable stages of the previously proposed pathophysiological framework of CAA.

Part I covers changes in cerebrovascular reactivity as measured through visually stimulated functional MRI, in relation to microstructural white matter integrity (Chapter 2) and as longitudinal measure with one-year follow-up data (Chapter 3). In part II, perivascular spaces, the proposed 'highways' for brain clearance, are assessed with a newly developed segmentation pipeline, both cross-sectionally and longitudinally (Chapter 4). Part III focuses on the localization and clustering of cerebral microbleeds (CMBs), and the detection of acute CMBs. Chapter 5 covers the distribution of CMBs along the curvature of the cortex. In Chapter 6, flow-territory based interindividual clustering is assessed. Finally, Chapter 7 describes the detection of acute CMBs as imaged with 7 Tesla MRI.
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Cerebral Amyloid Angiopathy

Dutch-type hereditary Cerebral Amyloid Angiopathy

Amyloid-Beta

Perivascular spaces

Cerebrovascular reactivity

Cerebral microbleeds

Magnetic Resonance Imaging

Cerebral Small Vessel Disease