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Distribution of cerebral microbleeds in the East and West: Individual participant meta-analysis
Yusuke Yakushiji1, Duncan Wilson1, Gareth Ambler1
1From the Stroke Research Center, Department of Brain Repair & Rehabilitation, Institute of Neurology (Y.Y., D.W., A.C., D.J.W.), and Department of Statistical Science (G.A.), UCL, London, UK; Division of Neurology (Y.Y., H.H.), Department of Internal Medicine, Saga University Faculty of Medicine, Japan; Department of Neurology (A.B., S.R.P., J.R.R., S.S., P.A.W.), Boston University and the NHLBI's Framingham Heart Study; Department of Biostatistics (A.B., S.R.P.), Boston University, MA; Department of Radiology (M.A.v.B.), Leiden University Medical Center, the Netherlands; Department of Neurology (C.D.), University of California Davis; Department of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai, China; Icelandic Heart Association (V.G.), Kopavogur; University of Iceland (V.G.), Reykjavik; Department of Neurosurgery (T.I.), Kushiro City General Hospital; Faculty of Collaborative Regional Innovation (K.K.), Ehime University, Matsuyama, Japan; Department of Neurology (H.-M.K.), SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Intramural Research Program (L.J.L.), National Institute on Aging, Bethesda, MD; Therese Pei Fong Chow Research Center for Prevention of Dementia (V.M., Z.W., Y.X.), Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China; Stroke and Aging Research Group, Department of Medicine, School of Clinical Science at Monash Health (T.P., V.S.), and Department of Medicine, Peninsula Health and Clinical School, Central Clinical School (V.S.), Monash University, Melbourne, Australia; Center for Emotional and Behavioral Disorders (Y. Takashima), Hizen Psychiatric Center, Saga, Japan; Department of Diagnostic Radiology and Nuclear Medicine (Y. Tsushima), Gunma University Graduate School of Medicine; Research Program for Diagnostic and Molecular Imaging (Y. Tsushima), Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research, Maebashi; and Department of Neurology (S.Y.), Faculty of Medicine, Shimane University, Izumo, Japan.
Objective:
We investigated differences in the anatomical distribution of cerebral microbleeds (CMBs) on MRI, hypothesized to indicate the type of underlying cerebral small vessel disease (SVD), between Eastern and Western general populations.
Methods:
We analyzed data from 11 studies identified by a PubMed search between 1996 and April 2014 according to the Preferred Reporting Items for a Systematic Review and Meta-analysis of Individual Participant Data. Study quality measures indicated low or medium risk of bias. We included stroke-free participants from populations aged between 55 and 75 years, categorized by geographic location (Eastern or Western). We categorized CMB distribution (strictly lobar, deep and/or infratentorial [D/I], or mixed [i.e., CMBs located in both lobar and D/I regions]). We tested the hypothesis that Eastern and Western populations have different anatomical distributions of CMBs using multivariable mixed effects logistic regression analyses adjusted for age, sex, and hypertension and clustering by institution.
Results:
Among 8,595 stroke-free individuals (mean age [SD] 66.7 [5.6] years; 48% male; 42% from a Western population), 624 (7.3%) had CMBs (strictly lobar in 3.1%; D/I or mixed in 4.2%). In multivariable mixed effects models, Eastern populations had higher odds of D/I or mixed CMBs (adjusted odds ratio 2.78, 95% confidence interval [CI] 1.77-4.35) compared to Western populations. Eastern populations had a higher number of D/I or mixed CMBs (adjusted prevalence ratio 2.83, 95% CI 1.27-6.31).
Conclusions:
Eastern and Western general populations have different anatomical distributions of CMBs, suggesting differences in the spectrum of predominant underlying SVDs, with potential implications for SVD diagnosis and treatment.
Insights
Eastern populations show significantly different patterns of cerebral microbleeds (CMBs) compared to Western populations, indicating diverse underlying small vessel diseases (SVDs). This finding has implications for SVD diagnosis and treatment strategies.
Area of Science:
- Neurology
- Radiology
- Epidemiology
Background:
- Cerebral microbleeds (CMBs) on MRI are indicators of cerebral small vessel disease (SVD).
- The anatomical distribution of CMBs may reflect different types of underlying SVD.
- Investigating geographical differences in CMB distribution can provide insights into SVD heterogeneity.
Purpose of the Study:
- To investigate differences in the anatomical distribution of cerebral microbleeds (CMBs) between Eastern and Western general populations.
- To explore whether CMB distribution patterns can indicate distinct types of underlying cerebral small vessel disease (SVD).
- To assess the implications of these differences for SVD diagnosis and treatment.
Main Methods:
- Systematic review and meta-analysis of individual participant data from 11 studies (1996-2014).
- Inclusion of 8,595 stroke-free individuals aged 55-75 years, categorized by geographic location (Eastern/Western).
- Analysis of CMB distribution (strictly lobar, deep/infratentorial [D/I], or mixed) using multivariable mixed effects logistic regression.
Main Results:
- Among 624 individuals with CMBs, Eastern populations showed higher odds of D/I or mixed CMBs (aOR 2.78) compared to Western populations.
- Eastern populations exhibited a higher prevalence ratio for D/I or mixed CMBs (aPR 2.83).
- These differences persisted after adjusting for age, sex, and hypertension.
Conclusions:
- Significant differences exist in the anatomical distribution of cerebral microbleeds between Eastern and Western populations.
- These variations suggest differing spectra of underlying small vessel diseases (SVDs) in these populations.
- Findings highlight potential implications for the diagnosis and treatment of SVDs globally.
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