Diffusion-weighted magnetic resonance spectroscopy (DW-MRS) can play a key role in understanding neurobiological mechanisms of diseases that affect the human brain. The specific changes that occur... Show moreDiffusion-weighted magnetic resonance spectroscopy (DW-MRS) can play a key role in understanding neurobiological mechanisms of diseases that affect the human brain. The specific changes that occur within neurons can be reflected as changes in the diffusivity of tNAA, whereas the changes in glial cells can cause pronounced changes in the diffusivities of tCr and tCho. This information combined with that obtained from diffusion tensor imaging (DTI) and other MRI tools can help elucidate various disease processes in the future. The main purposes of this thesis are (i) to investigate neuroanatomy in vivo with DW-MRS, (ii) to develop methodology to enable future clinical applications of the technique in human brain in vivo, and (iii) to characterize the microstructural deficit in neuropsychiatric systemic lupus erythematous (NPSLE) with DW-MRS and other microstructural tools such as DTI and magnetization transfer imaging. The studies presented in this thesis show the robustness and clinical relevance of microstructural information obtained via DW-MRS. The contributions of this thesis such as the optimized acquisition protocols for single volume DW-MRS, the robust DW-CSI and DW-MRS post-processing pipelines that comprise information from DTI, will all facilitate the applications of DW-MRS both for basic neuroscience research and clinical research studies. Show less
The focus of this thesis was to evaluate biomarkers of cardiovascular end organ damage in the metabolic syndrome and diabetes mellitus. We performed cross-sectional studies with biochemical and... Show moreThe focus of this thesis was to evaluate biomarkers of cardiovascular end organ damage in the metabolic syndrome and diabetes mellitus. We performed cross-sectional studies with biochemical and magnetic resonance imaging (MRI) techniques. We have demonstrated that insulin resistance is a strong risk predictor for CVD and we provided a novel link between inflammation and angiopoietin-like protein 4 (ANGPTL4) expression by showing that ANGPTL4 levels in humans are related to systemic inflammation and inflammatory stimuli increased ANGPTL4 expression using human macrophages in vitro. The imaging studies described in this thesis extend the knowledge of end organ damage and explored the relation with aortic stiffness. The impact of type 1 diabetes mellitus (T1DM) on regional grey matter was investigated and showed atrophy of all subcortical grey matter structures but the amygdala. By showing an association of aortic stiffness with subtle microstructural deficits in T1DM and kidney function in patients with hypertension the close link between aortic stiffness and the microcirculation is demonstrated. Furthermore regional and individual differences in response to an oral glucose load in MR assessed aortic stiffness were observed, which may open new future research paths possibly linking inter-individual variation in regional vascular response and CVD. Show less
The general objective of this thesis was to study the causes and consequences of ventricular dilatation in aging and dementia. For this purpose, we used ventricular shape analysis to study... Show moreThe general objective of this thesis was to study the causes and consequences of ventricular dilatation in aging and dementia. For this purpose, we used ventricular shape analysis to study potential new MRI markers of cognitive decline in aging, subjective memory complaints, mild cognitive impairment and Alzheimer's Disease. In addition, we designed a volumetric measure that may objectively quantify the disproportionate ventricular dilatation that is characteristic of Normal Pressure Hydrocephalus (NPH). We investigated the value of this measure for the selection of candidates with NPH for ventricular shunting, studied its association with NPH-like symptoms in the general population and used the measure to explore a possible cardiovascular origin of cerebral ventricular dilatation. Show less
In this thesis we evaluated several MRI/S methods as outcome parameters to assess muscle pathology in DMD and BMD patients. We applied 3-point Dixon MRI to compare levels of fatty infiltration in... Show moreIn this thesis we evaluated several MRI/S methods as outcome parameters to assess muscle pathology in DMD and BMD patients. We applied 3-point Dixon MRI to compare levels of fatty infiltration in muscle of DMD patients with a semi-quantitative method. Dixon MRI showed to be more sensitive to subtle changes. Implementation of a multipeak model to account for multiple lipid spectrum peaks in this method allowed even more sensitive measurements. We evaluated non-contractile and contractile cross-sectional areas in leg muscles of DMD patients. Combined with strength measurements we could measure muscle quality and showed muscle hypertrophy and fatty infiltration to be two distinct processes. We explored the relation between dystrophin levels and fat in BMD patients and found no such relation, but did find a relation between strength and age in a subgroup, demonstrating the location of the mutation to be a major determinant of disease severity. Using T2 MRI as inflammatory marker in DMD/BMD patients and healthy controls we showed an increased T2 in DMD patients. Finally we investigated the muscle energy metabolism in BMD patients with MRS and showed increased PDE/ATP ratios prior to onset of fatty infiltration, consequently 31P MRS could be another potential outcome parameter. Show less
This thesis evaluates morphological and functional vessel wall properties measured by magnetic resonance imaging techniques in healthy volunteers and patients with various diseases (i.e. Marfan... Show moreThis thesis evaluates morphological and functional vessel wall properties measured by magnetic resonance imaging techniques in healthy volunteers and patients with various diseases (i.e. Marfan syndrome patients (MFS), patients with thoracic aortic aneurysm and patients with a previous myocardial infarction.). This thesis shows that imaging of carotid vessel wall morphology can be reproducible assessed by high-field MRI and that carotid vessel wall imaging benefits from imaging at higher field strengths. For a functional imaging parameter, the aorta pulse wave velocity (PWV), improving spatial sampling density resulted in more accurate PWV-assessment, even when temporal resolution decreased. Moreover, a scan-time reduction was achieved. Aortic PWV showed a high specificity for predicting absence of regional aortic luminal growth for all aortic segments in MFS. In patients with thoracic aortic aneurysm, regional PWV showed high specificity in the descending thoracic to abdominal aorta and moderate results in the ascending aorta and aortic arch. Next, PWV-leveling between aorta and carotid artery at older age was associated with a reduction in blood flow volume towards the brain. Furthermore, vessel wall morphology and function were associated in healthy volunteers and in patients with established atherosclerotic disease. Finally, our findings might indicate a link between atherosclerotic large vessel disease and cerebral small vessel disease in patients with established atherosclerotic disease. Show less
People of South Asian origin have an increased risk of developing type 2 diabetes (T2D) and cardiovascular disease (CVD) compared to people of Western European descent. Not only is the prevalence... Show morePeople of South Asian origin have an increased risk of developing type 2 diabetes (T2D) and cardiovascular disease (CVD) compared to people of Western European descent. Not only is the prevalence of these diseases higher in South Asians, they also occur at a younger age and lower BMI, and have a more severe course. The high prevalence of T2D and CVD in South Asians, who comprise one fifth of the total world__s population, poses a major health and socioeconomic burden worldwide. The underlying cause of this excess risk is, however, still poorly understood. The studies described in this thesis were performed to gain more insight in the pathogenesis of T2D and CVD in South Asians and to provide new leads for preventive strategies and treatment options. For this purpose sophisticated techniques were used such as hyperinsulinemic-euglycemic clamp with stable isotopes, indirect calorimetry, skeletal muscle biopsies, MRI and spectroscopy, and brown fat quantification using PET-CT-imaging, combined with short-term dietary interventions, in healthy lean young adult men and overweight adult men. These studies have led to a number of promising areas for further research. It seems that not one, but multiple metabolic mechanisms have been affected, most likely due to gene-environment interactions. Show less
