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Cerebral microbleeds are related to loss of white matter structural integrity

Saloua Akoudad1, Marius de Groot, Peter J Koudstaal

  • 1From the Departments of Epidemiology (S.A., M.d.G., A.H., M.A.I., M.W.V.), Radiology (S.A., M.d.G., A.v.d.L., W.J.N., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), and Medical Informatics (M.d.G., W.J.N.), Erasmus MC, University Medical Center Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.

Neurology
|November 1, 2013
PubMed
Abstract

Insights

Cerebral microbleeds, even a single one, are linked to widespread white matter damage in the brain. This suggests microbleeds indicate broader brain pathology beyond focal lesions.

Area of Science:

  • Neuroimaging
  • Neurology
  • Cerebrovascular Disease

Background:

  • Cerebral microbleeds are focal lesions detected on brain imaging.
  • Their association with diffuse white matter integrity is not fully understood.

Purpose of the Study:

  • To determine if cerebral microbleeds correlate with reduced white matter microstructural integrity.
  • To investigate this association in a large, population-based cohort.

Main Methods:

  • Prospective, population-based Rotterdam Scan Study with 4,493 participants.
  • Brain MRI for microbleed status and diffusion tensor imaging (DTI) for white matter integrity (FA, MD).
  • Multiple linear regression models adjusted for confounders, stratified by APOE ε4 carriership.

Main Results:

  • Microbleed presence was dose-dependently associated with lower fractional anisotropy (FA) and higher mean diffusivity (MD) in normal-appearing white matter.
  • Even a single microbleed showed significant associations (FA: -0.13, MD: 0.12).
  • Lobar microbleed effects were driven by APOE ε4 carriers.

Conclusions:

  • Cerebral microbleeds are associated with poorer white matter microstructural integrity.
  • This association persists after adjusting for cardiovascular risk factors and other small vessel disease markers.
  • Microbleeds may represent diffuse brain pathology, even when isolated.

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