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Published on: November 6, 2017
Retinal Microvascular Calibers Are Associated With Enlarged Perivascular Spaces in the Brain
Unal Mutlu1, Hieab H H Adams1, Albert Hofman1
1From the Departments of Epidemiology (U.M., H.H.H.A., A.H., C.C.W.K., M.W.V., M.K.I., M.A.I.), Ophthalmology (U.M., C.C.W.K.), Radiology (H.H.H.A., A.v.d.L., M.W.V., M.A.I.), Neurology (M.A.I.), Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands (M.K.I.).
Background And Purpose:
Perivascular enlargement in the brain is a putative imaging marker for microvascular brain damage, but this link has not yet been confirmed using direct in vivo visualization of small vessels. We investigated the relation between microvascular calibers on retinal imaging and enlarged perivascular spaces (ePVSs) on brain magnetic resonance imaging.
Methods:
We included 704 participants from the Rotterdam study. Retinal arteriolar and venular calibers were measured semiautomatically on fundus photographs. ePVSs were counted in the centrum semiovale, basal ganglia, hippocampus, and mesencephalon, using a standardized rating method. We determined the association between retinal microvascular calibers and ePVSs with negative binomial regression models, adjusting for age, sex, the other vascular caliber, structural brain magnetic resonance imaging markers, and cardiovascular risk factors.
Results:
Both narrower arteriolar and wider venular calibers were associated with more ePVSs in the centrum semiovale and hippocampal region. Rate ratios (95% confidence interval) for arterioles in the centrum semiovale and hippocampus were 1.07 (1.01-1.14) and 1.13 (1.04-1.22), respectively, and for venules 1.08 (1.01-1.16) and 1.09 (1.00-1.18), respectively. These associations were independent from other brain magnetic resonance imaging markers and cardiovascular risk factors.
Conclusions:
Retinal microvascular calibers are related to ePVSs, confirming the putative link between microvascular damage and ePVSs.
Insights
Retinal microvascular changes are linked to enlarged perivascular spaces (ePVSs) in the brain. This confirms that retinal imaging can help detect microvascular brain damage.
Area of Science:
- Neuroimaging
- Ophthalmology
- Vascular Biology
Background:
- Enlarged perivascular spaces (ePVSs) are a potential marker for microvascular brain damage.
- Direct in vivo visualization has not confirmed the link between ePVSs and small vessel integrity.
Purpose of the Study:
- To investigate the relationship between retinal microvascular calibers and enlarged perivascular spaces (ePVSs) in the brain.
- To confirm the association between retinal imaging markers and in vivo brain microvascular damage.
Main Methods:
- Utilized data from 704 participants in the Rotterdam study.
- Measured retinal arteriolar and venular calibers from fundus photographs.
- Quantified ePVSs in specific brain regions using magnetic resonance imaging and determined associations via negative binomial regression, adjusting for confounders.
Main Results:
- Narrower retinal arterioles and wider venules were associated with increased ePVSs in the centrum semiovale and hippocampus.
- These associations remained significant after adjusting for other brain imaging markers and cardiovascular risk factors.
- Reported rate ratios for arterioles and venules in the centrum semiovale and hippocampus.
Conclusions:
- Retinal microvascular calibers are significantly related to enlarged perivascular spaces (ePVSs).
- This study confirms the putative link between microvascular damage observed in the retina and ePVSs in the brain.
