Blood-brain barrier breakdown in brain ischemia: Insights from MRI perfusion imaging
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 is...
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Elsevier
2025-01-01
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| Series: | Neurotherapeutics |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1878747924002034 |
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| author | Sarvin Sasannia Richard Leigh Pouya B. Bastani Hyeong-Geol Shin Peter van Zijl Linda Knutsson Paul Nyquist |
| author_facet | Sarvin Sasannia Richard Leigh Pouya B. Bastani Hyeong-Geol Shin Peter van Zijl Linda Knutsson Paul Nyquist |
| author_sort | Sarvin Sasannia |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-c8668a8e332b4fd994934c655eed01f1 |
| institution | Kabale University |
| issn | 1878-7479 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Neurotherapeutics |
| spelling | doaj-art-c8668a8e332b4fd994934c655eed01f12025-02-01T04:11:54ZengElsevierNeurotherapeutics1878-74792025-01-01221e00516Blood-brain barrier breakdown in brain ischemia: Insights from MRI perfusion imagingSarvin Sasannia0Richard Leigh1Pouya B. Bastani2Hyeong-Geol Shin3Peter van Zijl4Linda Knutsson5Paul Nyquist6Department 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; Corresponding author. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesF.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, United States; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesF.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, United States; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDepartment 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 Medical Radiation Physics, Lund University, Lund, SwedenDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Neurocritical Care Division, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, MD, United States; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesBrain 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.http://www.sciencedirect.com/science/article/pii/S1878747924002034Brain ischemiaAcute ischemic strokeCerebral small vessel diseaseMagnetic resonance imagingDynamic contrast-enhancedDynamic susceptibility contrast |
| spellingShingle | Sarvin Sasannia Richard Leigh Pouya B. Bastani Hyeong-Geol Shin Peter van Zijl Linda Knutsson Paul Nyquist Blood-brain barrier breakdown in brain ischemia: Insights from MRI perfusion imaging Neurotherapeutics Brain ischemia Acute ischemic stroke Cerebral small vessel disease Magnetic resonance imaging Dynamic contrast-enhanced Dynamic susceptibility contrast |
| title | Blood-brain barrier breakdown in brain ischemia: Insights from MRI perfusion imaging |
| title_full | Blood-brain barrier breakdown in brain ischemia: Insights from MRI perfusion imaging |
| title_fullStr | Blood-brain barrier breakdown in brain ischemia: Insights from MRI perfusion imaging |
| title_full_unstemmed | Blood-brain barrier breakdown in brain ischemia: Insights from MRI perfusion imaging |
| title_short | Blood-brain barrier breakdown in brain ischemia: Insights from MRI perfusion imaging |
| title_sort | blood brain barrier breakdown in brain ischemia insights from mri perfusion imaging |
| topic | Brain ischemia Acute ischemic stroke Cerebral small vessel disease Magnetic resonance imaging Dynamic contrast-enhanced Dynamic susceptibility contrast |
| url | http://www.sciencedirect.com/science/article/pii/S1878747924002034 |
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