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Review Post-mortem Magnetic Resonance Imaging as an Additional Tool of the Neuropathological Examination of Neurodegenerative and Cerebrovascular Diseases Jacques L De Reuck Université Lille 2, INSERM U1171, Lille, France Abstract Neuropathological examination of post-mortem brains of patients with dementia due to neurodegenerative and cerebrovascular changes remains important, as the family wants to be sure about the clinical diagnosis and the risk of a hereditary disease. 7.0-tesla magnetic resonance imaging (MRI) can be applied as an additional tool to examine post-mortem brains of patients with neurodegenerative and cerebrovasular diseases. It allows examination of serial coronal sections of a cerebral hemisphere and horizontal sections of brainstem and cerebellum and comparison with the neuropathological lesions. Post-mortem MRI can show the degree and the distribution of the cerebral atrophy. Additional small cerebrovascular lesions can be quantified. The degree of iron load, not due to microbleeds, can be evaluated in different basal ganglia and brainstem structures. Three to six serial sections of a cerebral hemisphere and one section of brainstem and cerebellum allow the evaluation of the most important brain changes and to select the small samples to be used for histological diagnostic purposes. These correlation studies are extremely important for the future, when more 7.0-tesla MRI machines will be available for in vivo clinical-radiological diagnosis. This article is a review of post-mortem MRI data in the brains of patients with neurodegenerative and vascular dementias. Keywords Post-mortem, 7.0-tesla magnetic resonance imaging (MRI), neurodegenerative diseases, cerebrovascular diseases, cerebral atrophy, white matter changes, lacunar infarcts, cortical micro-bleeds, cortical micro-infarcts, cortical superficial siderosis, iron deposition Disclosure: Jacques L De Reuck has nothing to declare in relation to this article. No funding was received for the publication of this article. Acknowledgements: The following persons have contributed to the present research project: Florent Auger, Nicolas Durieux, Vincent Deramecourt, Charlotte Cordonnier, Claude-Alain Maurage, Didier Leys, Florence Pasquier and Regis Bordet. This study was funded by the INSERM U 1172 (Universté Lille 2, Lille, France). Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Compliance with Ethics: This article involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors. Received: 15 February 2016 Accepted: 15 March 2016 Citation: European Neurological Review, 2016;11(1):22–5 Correspondence: Jacques De Reuck, Leopold II laan 96, 9000 Ghent, Belgium. E: dereuck.j@gmail.com Although post-mortem neuropathological examination is increasingly performed less often in most western countries, it is still needed in patients with dementia, due to neurodegenerative and cerebrovascular changes, It is important for the family to be sure about the clinical diagnosis and to exclude the risk of a hereditary disease. Clinical- neuropathological correlation studies actually show only a concordance rate around 65%. 1 A previously informed consent of the patients or from the nearest family must be obtained to allow an autopsy for diagnostic and scientific purposes. Neuroimaging during life with 1.5 and 3.0-tesla magnetic resonance imaging (MRI) contributes moderately to the clinical diagnosis. There is hope that 7.0-tesla MRI will be more helpful, but actually only a few neurological centres utilise this technique and only a few clinical- radiological correlation studies have been performed until now. 2 Post- mortem correlation studies combining MRI and histopathology are needed to validate the 7.0-tesla MRI findings in vivo when more centres will utilise of this technique. 3 This article reviews what is currently known about post-mortem MRI data in the brains of patients with neurodegenerative and vascular dementias. 22 Though a definitive post-mortem diagnosis still needs to be confirmed by an extensive macroscopic and microscopic examination of the brain using validated neuropathological criteria, 4 7.0-tesla MRI can be used as an additional tool to examine post-mortem brains of patients with neurodegenerative diseases. The degree and the distribution of the cerebral atrophy and white matter changes (WMCs) can be demonstrated. It also detects lesions that can be selected for histological examination. Additional small cerebrovascular lesions can be quantified. The degree of iron load can be evaluated in different basal ganglia and brainstem structures. A variety of post-mortem MRI techniques have been used including scanning of fixed whole brains or hemispheres, 5 coronal brain slices, 6 un-fixed whole brains 7 and brains in situ. 8 The number of detected small cerebrovascular lesions depends on the MRI characteristics, such as pulse sequence, sequence parameters, spatial resolution, magnetic field strength and image post-processing. 9 8.0-tesla MRI was shown to be significantly more sensitive to detect small cerebrovascular lesions than 1.5 and 3.0-tesla MRI in post- mortem brains. 10 TOU C H ME D ICA L ME D IA