Background
The growing geriatric population (49.2 million individuals in the USA in 2016 [
1]) poses a significant social, economic, and health care burden with growing costs [
2]. As life expectancy increases in developed countries, the development of the major debilitating and life-threatening conditions with age as the primary major risk factor increase in prevalence, including cardiovascular disease and neurodegeneration [
3]. Of intense concern is the aging brain, with Alzheimer’s disease (AD) and related dementias, including vascular dementia, becoming ever more common and requiring substantial resources to prevent, diagnose, treat, and manage [
4]. Small vessel disease, a particular cause of subcortical vascular dementia affecting the small cerebral blood vessels, may account for an estimated ~ 50% of all dementias worldwide [
5].
Since AD or vascular dementia is currently untreatable, research has focused on differentiating healthy brain aging from early disease processes. Magnetic Resonance Imaging (MRI) is a clinically applicable tool that can be used to gain insights into brain aging or neurological disease progression [
6]. In particular, structural MRI is established as a baseline measure of brain integrity and may eliminate other etiologies in combination with neurological presentation. During aging, regions of the brain involving memory and cognition shrink, with age related differences being largest for total brain, frontal lobe, and medial temporal brain volumes [
7‐
9] followed by further neocortical neuronal loss occurring with late-stage disease [
10]. Multimodal MRI, the coordinated use of multiple mutually informative probes to understand brain structure and function, [
9,
11,
12] including diffusion-weighted imaging (DWI) and gradient-recalled echo (GRE) MRI with T2*W, offers additional insights into the progression and mechanisms of brain aging.
In neural tissue, water diffusion is restricted by axonal bundles and myelin sheaths, resulting in diffusion patterns that are predictable along the direction of white matter fiber tracts [
13‐
15]. During the aging process, the breakdown of ordered myelinated neural structures occurs, resulting in less restricted water diffusion in DWI. Diffusion tensor imaging (DTI) is a related acquisition and analysis MRI technique that can measure white matter disease by detecting increasing anisotropy and unrestricted water diffusion with AD disease progression [
16]. Although another structural technique, Fluid Attenuated Inversion Recovery (FLAIR), exhibits the presence of edematous events in white matter, DTI is quantitative, offering improved pathological specificity for assessing early degenerative stages [
6,
9].
AD and dementia progression is a multifactorial process and can progress with a cerebrovascular phenotype. Such vascular changes are visible with MRI. For example, CMBs, also known as microhemorrhages, are biomarkers of aging, hypo-intense on GRE MRI, associated with geriatrics, cognitive impairment, and risk of stroke [
17‐
20]. As the stiffness of the proximal aorta increases with age, [
21‐
23] high pulses of pressure are sent to the small delicate blood vessels downstream. These pulses could damage the cerebral vessel walls in a way that increases leaking of blood into vulnerable brain regions, a possible mechanism for CMBs formation [
24,
25]. Depending on the location, CMBs may indicate neurovascular or neurologic disease. Lobar CMBs are associated with cerebral amyloid angiopathy, [
26] while deep or mixed CMBs are associated with hypertensive arteriopathy [
20,
27,
28]. While CMBs are chronic biomarkers of neurovascular disruption, their direct role in AD is still a matter of debate. A recent study by Nation et al. found that acute blood–brain barrier (BBB) breakdown in MRI is an early predictor of human cognitive dysfunction that may be a unique component of AD progression independent of p-Tau or Aβ [
29].
The mouse is an established model appropriate for investigating brain aging using MRI [
30,
31]. A comparison of age-related changes in cognition in laboratory animals can help disambiguate the boundary between normal and pathological states of aging in humans [
32] with aged rodents being commonly used in cognitive research [
33]. As in humans, grey matter rich regions decline with age, white matter changes occur, and increases in ventricle cerebrospinal fluid (CSF) are observed [
31]. Laboratory animals are used routinely because age related cognitive decline and behavioral alterations mimic similar pathophysiology of human AD, albeit at a more rapid time scale, particularly with the use of genetically modified animals [
34]. However, (1) there is a lack of rodent studies aged-matched to human counterparts [
30], and (2) the presence of CMBs in vivo, in the context of age-matched vascular aging, has not been shown in mice. For these reasons, identification of a rodent model of CMBs formation in normal aging is novel and representative of human cerebrovascular disease.
The objective of this study was to use a murine model to relate structural changes that occur in the brain during aging with other features in multimodal MRI, including tissue microstructural properties and the presence of CMBs in older mice. These multimodal MRI methods supplement standard T1W or T2W MRI measurements with alternate approaches that provide high specificity for the diffusion microarchitectural features of the brain and iron content, using DTI and T2*W, respectively. Following the identification of CMBs in vivo, ex vivo T2*W high resolution MR-microscopy was used with subsequent histopathology characterization. DTI was collected ex vivo and then used to calculate diffusion tensors that were either analyzed directly or modeled across the entire brain with tractography. The small size of the mouse brain and the availability of post-mortem tissues offers optimal conditions to characterize brain microstructural features and CMBs with ex vivo imaging, while also providing a valuable model of age-related neurovascular biomarkers for future routine investigations.
Methods
In vivo MRI
Mice were imaged with a multimodal MRI protocol on a Bruker 500 MHz 11.7T system (MRI; Bruker Co., Billerica, MA) at the Boston University Medical Campus MRI/NMR High Field Imaging Core. We acquired T2W (RARE; TR = 2500 ms, TE = 26 ms, flip angle = 180°, 0.1 × 0.1 mm
2 in plane resolution with 1 mm slice thickness) and T2*W (FISP; TR = 1528.02, ms TE = 4 ms, excitation pulse angle = 15°, 140 µm
3 isotropic voxels) images in vivo. Three age groups of male C57BL/6J (Jackson Laboratory, Farmington, CT, USA) mice were used for the in vivo study: 3 mo, 17–18 mo, and 24–25 mo. These groups were defined as young, middle-aged, and old groups [
30] with 4 young, 3 middle-aged, and 3 old mice used for MRI. The mice were anesthetized with 0.5–2% isoflurane gas under oxygen flow and stabilized in the central area of the magnetic field with a 30 cm RF volume coil devoted to mouse imaging.
Ex vivo MRI
After completion of the in vivo imaging protocol, the mice were sacrificed under anesthesia and perfused transcardially with 0.01 M phosphate buffered saline (PBS) through the left ventricle for 3 min at a rate of 2 ml/min (Rainin peristaltic pump) followed by 4% paraformaldehyde (PFA) solution. The brain was then isolated from each mouse. High resolution imaging was repeated overnight in a 15 cm RF volume coil with freshly excised brains. For ex vivo DTI, a total of 91 diffusion sampling directions were acquired (3D-EPI; TR = 750 ms, TE = 19.6 ms, number of segments = 5, diffusion duration = 2.4 ms, diffusion separation = 9 ms, 175 µm3 isotropic voxels) at a constant b-value of 2000 s/mm2.
Additional old-aged (21–24 mo) female C57BL/6 J mice were included for high resolution ex vivo imaging emphasizing the T2*W protocol for detection of CMBs with brains placed in MRI signal inert fomblin Y (Sigma-Aldrich, Saint Louis, MO). For these additional ex vivo only mice, brains were soaked in 1% (v/v) Magnevist in saline for 5 days prior to ex vivo imaging [
35]. High resolution MR-microscopy with T2*W was performed using the same in vivo GRE sequence of 3D fast imaging with steady-state free precession (FISP) only at higher resolution ex vivo (55 µm
3). A particularly important feature of GRE imaging is that gradient reversal only affects those spins that have been dephased by the action of the gradient itself, so magnetic field inhomogeneities, including those from CMBs, are not cancelled. For validation of CMBs presence, N = 16 brains total were included in the ex vivo T2*W study.
Image analysis
Cortical thickness was measured superior to the corpus callosum (Cc) and the hippocampus (Hi) within coronal in vivo T2W MR images, starting at the most caudal location where the Cc was visible, with 12 linear measurements in multiple locations and across multiple slices per animal. Ventricle area was calculated by generating a maximum intensity projection (MaxIP) from slices that contained the lateral ventricles (5 to 6 slices) with in vivo T2W MRI. Use of the MaxIP prevented the overestimation of ventricle size due to partial volume effects. Quantification was carried out by drawing a region of interest (ROI) in the bright areas of the two lateral ventricles on the projection image resulting in readings from the left and right sides for each mouse. Quantification of these brain structures was carried out in ImageJ software (NIH, Bethesda, MD).
CMBs were manually counted in terms of the volume and number. Hemosiderin in blood deposits from chronic brain microhemorrhages (another name for CMBs) and is a strong paramagnetic material that can be imaged in GRE MRI with T2*W. CMBs appeared as hypo-intense round or ovoid objects in the T2*W images in specific anatomic brain regions, as described previously [
36]. Images were displayed as either single slices for quantification and comparison with histology, or as projections using a minimum-intensity projection (MinIP) for visualization of multiple slices. Counting was performed using ImageJ software in individual slices within the principle imaging planes to confirm the CMBs 3D shape and to rule out misidentification of normal blood vessels that are linear and present across multiple slices.
Advanced Normalization Tools (ANTs) software was used on ex vivo T2*W images for voxel based morphometry, a whole-brain technique for characterizing regional brain volume differences and differences in tissue concentration, particularly grey matter, across subjects [
37]. Image analysis was performed with pre-processing (
N3BiasFieldCorrection) and linear co-registration (
antsRegistration), followed by non-linear registration (
antsRegistrationSyN), and study template generation (
buildtemplateparallel). Segmentation of grey matter and white matter (
Atropos) and calculation of Jacobian determinants (
ANTSJacobian) was performed on individual brain images. Statistical analysis was carried out in FMRIB Software Library (FSL) on concatenated 4D datasets (
fslmerge) followed by an unpaired
T test comparison (
randomize).
Diffusion tensor imaging (DTI) processing methods were used to produce voxel-based measurements of fractional anisotropy (FA), mean diffusion (MD), and radial diffusion (RD) using ex vivo brains. ROI placed in multiple slices of the thalamus and parietal–temporal cortex were used to quantify DTI metrics. Generalized Q-space imaging (GQI), a model-free diffusion data processing method, was used for data visualization and tractography generation with DSI studio software (Fang-Cheng Yeh; University of Pittsburgh) with the color of tracts encoded to local DTI measurement values [
38].
Histology
Following ex vivo MRI, brains were post-fixed with 4% PFA over two nights, then placed in 15% and then 30% sucrose. The brains were frozen in isopentane with dry ice and cryo-sectioned with 50 µm thickness at the coronal plane. Brain tissues were then stained with a mixture of 4% potassium ferrocyanide and 4% hydrochloric acid (Iron Stain Kit, Millipore-Sigma, Burlington, MA) for Prussian Blue staining and then co-stained with Nuclear Fast Red for tissue structure and background.
Ex vivo MRI and microCT vascular atlas
The brain MRI and microCT vascular atlas was analyzed from ex vivo data acquired by Dorr et al. [
39] in male CBA mice. For MRI, a 7.0-T MRI scanner (Varian Inc., Palo Alto, CA, USA) was used with skulls placed into proton-free susceptibility-matching fluid (Fluorinert FC-77, 3M Corp., St. Paul, MN, USA). The parameters used in the scans were optimized for grey/white matter contrast: T2W, 3D fast spin-echo sequence, with TR/TE = 325/32 ms, four averages, field-of-view 12 × 12 × 25 mm
3 and matrix size = 780 × 432 × 432 resulting in an image with 32 μm isotropic voxels. For microCT (GE Healthcare, Chicago, IL, USA) the brains were removed from the skulls and mounted in 1% agar. Each vascular image volume was acquired with 20 μm isotropic resolution using the GE eXplore Locus SP specimen scanner. Images were obtained from 720 views over a 360° rotation in 2 h with an X-ray tube current of 80 μA and voltage of 80 kVp.
Statistical methods
Statistical analyses were carried out with the T-test for pairwise comparison and with other statistical models. For statistical analysis involving multiple groups, RStudio was used to perform a one-way ANOVA test, where a significant p-value indicated that some of the group means are different. This was followed by Tukey Honest Significant Differences in R for performing multiple pairwise-comparison between the means of groups.
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