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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Impact of MRI markers in subcortical vascular dementia: a multi-modal analysis in CADASIL
Anand Viswanathan1, Ophelia Godin, Eric Jouvent
1Department of Neurology, CHU Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
Abstract:
CADASIL is an arteriopathy caused by mutations of the Notch3 gene. White matter hyperintensities (WMH), lacunar lesions (LL), cerebral microhemorrhages (CM), brain atrophy and tissue microstructural changes are detected on MRI. Using an integrated multi-modal approach, we examined the relative impact of lesion burden and location of these MRI markers on cognitive impairment and disability. Multi-modal imaging was performed on 147 patients from a two-center cohort study. Volume of LL, WMH and number of CM was determined. Whole brain mean apparent diffusion coefficient (mean-ADC) and brain parenchymal fraction (BPF) were measured. In multivariate models accounting for lesion burden and location, volume of LL, mean-ADC, and BPF each had an independent influence on global cognitive function and disability. BPF explained the largest portion of the variation in cognitive and disability scores (35-38%). Brain atrophy has the strongest independent influence on clinical impairment in CADASIL when all MRI markers in the disease are considered together. The results suggest that the clinical impact of cerebral tissue loss plays a principal role in this genetic model of subcortical ischemic vascular dementia.
Insights
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is linked to brain atrophy. Brain parenchymal fraction (BPF) significantly impacts cognitive function and disability in CADASIL patients.
Area of Science:
- Neurology
- Genetics
- Radiology
Background:
- CADASIL is a genetic arteriopathy caused by NOTCH3 gene mutations.
- MRI reveals white matter hyperintensities (WMH), lacunar lesions (LL), cerebral microhemorrhages (CM), and brain atrophy in CADASIL.
- Understanding the impact of these MRI markers on clinical outcomes is crucial.
Purpose of the Study:
- To investigate the relative impact of lesion burden and location of MRI markers on cognitive impairment and disability in CADASIL.
- To determine the independent influence of various MRI markers on clinical outcomes.
Main Methods:
- Multi-modal MRI was performed on 147 patients with CADASIL.
- Quantified lesion burden (LL, WMH, CM) and brain atrophy (brain parenchymal fraction - BPF).
- Measured whole-brain mean apparent diffusion coefficient (mean-ADC).
Main Results:
- Lacunar lesions (LL), mean-ADC, and BPF independently influenced cognitive function and disability.
- Brain parenchymal fraction (BPF) explained the largest variation in cognitive and disability scores (35-38%).
- Brain atrophy demonstrated the strongest independent influence on clinical impairment.
Conclusions:
- Brain atrophy, specifically measured by BPF, plays a principal role in clinical impairment in CADASIL.
- Cerebral tissue loss is a key factor in this genetic model of subcortical ischemic vascular dementia.
- Integrated multi-modal MRI analysis provides critical insights into CADASIL pathophysiology.
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