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Published on: April 23, 2021
Quantitative and qualitative MRI evaluation of cerebral small vessel disease in an elderly population: a longitudinal
Ruta Nylander1, Markus Fahlström1, Egill Rostrup2
11 Department of Surgical Sciences, Radiology, Uppsala University, Sweden.
Abstract:
Background Cerebral white matter hyperintensities (WMHs), lacunes, and microbleeds are seen on magnetic resonance imaging (MRI) in small vessel disease (SVD). Purpose To assess SVD on MRI and its evolution over five years in an elderly population and to investigate whether relative cerebral blood flow (rCBF) at baseline was related to the progression of white matter (WM) lesions. Material and Methods In a population-based study, 406 participants aged 75 years underwent morphological MRI of the brain and 252 of them again at age 80 years. At age 75 years, a perfusion scan was also done. WMHs were evaluated qualitatively (visual scoring) and quantitatively (CASCADE software). Lacunes and microbleeds were counted. Results A significant progression of the WMH score and WMH volume occurred over five years ( P < 0.0001). New lacunes were seen in 10%. Participants with new lacunes at age 80 years showed a more pronounced increase in WMHs (P < 0.0001). Microbleeds were present in 14% at age 75 years. The visual WMH score was significantly associated with the presence of microbleeds ( P < 0.0001). There was no relationship between total WM rCBF and WMH volume at age 75 years, and no significant associations between regional or total rCBF at age 75 years and changes in WMH volume over five years. The total WM and GM volume decreased significantly between the ages of 75 and 80 years ( P < 0.0001). Conclusion MRI manifestations of SVD progressed over five years in an elderly population (age range = 75-80 years). rCBF was not associated with WMH volume or progression of WMH volume.
Insights
Small vessel disease (SVD) on MRI, including white matter hyperintensities (WMHs) and lacunes, significantly progressed in elderly individuals over five years. Baseline cerebral blood flow did not predict WMH progression.
Area of Science:
- Neurology
- Radiology
- Gerontology
Background:
- Small vessel disease (SVD) is characterized by MRI findings such as cerebral white matter hyperintensities (WMHs), lacunes, and microbleeds.
- Understanding the progression of SVD and its potential relationship with cerebral blood flow is crucial for managing cognitive decline in aging populations.
Purpose of the Study:
- To evaluate the five-year progression of SVD markers on MRI in an elderly cohort.
- To investigate the association between baseline relative cerebral blood flow (rCBF) and the progression of white matter (WM) lesions.
Main Methods:
- Population-based study involving 406 participants aged 75 years, with 252 undergoing a follow-up MRI at age 80.
- Brain MRI included morphological scans and perfusion scans at age 75.
- WMHs were assessed using visual scoring and quantitative CASCADE software; lacunes and microbleeds were counted.
Main Results:
- Significant progression in WMH score and volume was observed over five years (P < 0.0001).
- New lacunes appeared in 10% of participants, associated with more pronounced WMH increase (P < 0.0001).
- Baseline rCBF was not significantly associated with WMH volume or its progression; total WM and GM volumes decreased significantly.
Conclusions:
- MRI-evident SVD manifestations, including WMHs and lacunes, show significant progression in individuals aged 75-80 years over a five-year period.
- Baseline relative cerebral blood flow does not appear to be a predictor of white matter lesion volume or its progression in this elderly cohort.
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