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Published on: November 20, 2015
MRI-Based Investigation of Association Between Cerebrovascular Structural Alteration and White Matter Hyperintensity
Boyu Zhang1,2, Yingzhe Wang3,4, Bei Wang1,2
1Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
Insights
High blood pressure (BP) is linked to changes in brain blood vessels, which may explain its connection to white matter hyperintensity (WMH) disease in older adults.
Area of Science:
- Neuroimaging
- Vascular Biology
- Gerontology
Background:
- High blood pressure (BP) is a significant risk factor for cerebral small vessel disease, including white matter hyperintensity (WMH).
- The precise mechanisms by which elevated BP exacerbates WMH, particularly through alterations in cerebral vascular morphology, are not well understood.
Purpose of the Study:
- To investigate the relationships between high BP, cerebrovascular morphology, and WMH in an elderly population.
- To elucidate the role of vascular changes as a mediator between hypertension and WMH.
Main Methods:
- A cohort of 863 elderly individuals from the Taizhou Imaging Study was analyzed.
- Cerebrovascular morphology (vessel density, radius, tortuosity, branch number) was quantified using 3.0T time-of-flight magnetic resonance angiography (TOF MRA).
- White matter hyperintensity lesion volumes (WMHV) and counts (WMHC) were assessed using T2 fluid-attenuated inversion recovery (FLAIR) images. Multivariable linear regression and path analyses were employed.
Main Results:
- Higher BP, particularly diastolic BP, was significantly associated with reduced cerebrovascular density and fewer branches.
- While BP correlated with vessel tortuosity and radius, these relationships were not significant in smaller vessels.
- Increased WMHV and WMHC were linked to decreased vessel density and tortuosity, and increased vessel radius.
- Path analysis indicated that cerebrovascular morphologic changes mediate the association between high BP and WMHs.
Conclusions:
- Structural alterations in cerebral vessels due to high BP are correlated with WMH.
- Elevated BP may contribute to the co-occurrence of cerebrovascular alterations and small vessel disease through these vascular changes.
Background:
High blood pressure (BP) is a common risk factor for cerebral small vessel disease including white matter hyperintensity (WMH). Whether increased BP exacerbates WMH by impacting cerebral vascular morphologies remains poorly studied.
Purpose:
To determine the relationships among high BP, cerebrovascular morphologies, and WMH in elderly individuals.
Study Type:
Cohort.
Subjects:
Eight hundred sixty-three participants (54.2% female) from the Taizhou Imaging Study without clinical evidence of neurologic disorders were included in the analyses.
Field Strength/Sequence:
3.0 T; time-of-flight magnetic resonance angiography (TOF MRA); T2 fluid-attenuated inversion recovery (FLAIR); T1 magnetization-prepared rapid gradient-echo; gradient echo T2*-weighted; diffusion tensor imaging; pulsed arterial spin labeling.
Assessment:
Cerebrovascular morphologic measurements were quantified based on the TOF MRA images, including vessel density, radius, tortuosity, and branch number. WMH lesion volumes (WMHV) and WMH lesion counts (WMHC) were calculated automatically based on the T2 FLAIR images.
Statistical Tests:
Multivariable linear regression analysis and path analysis with a linear single-mediator model were employed. A P value <0.05 was considered statistically significant.
Results:
Higher BP, especially diastolic BP, was significantly correlated with lower cerebrovascular density (β = -104) and lower branch numbers (β = -0.02). Although decreased tortuosity (β = -1.25) and increased radius (β = 93.8) were correlated with BP, no significant relationship of tortuosity (β = -4.6 × 10-4 , P = 0.58) or radius (β = 0.03, P = 0.08) with BP in small vessels was found. The proportion of small vessels decreased as BP increased (SBP: β = -6.6 × 10-4 ; DBP: β = -9.0 × 10-4 ). Similarly, increased WMHV and WMHC were associated with decreased vessel density (volumes: β = -24, counts: β = -127), decreased tortuosity (volumes: β = -0.08, counts: β = -0.53), and increased radius (volumes: β = 12.6, counts: β = 86.6). Path analyses suggested an association between high BP and WMHs that were mediated by cerebrovascular morphologic changes.
Data Conclusion:
Structural alterations of cerebral vessels induced by high BP are correlated with WMH. This result suggested that elevated BP might be one of the pathophysiological mechanisms involving in the co-occurrence of cerebrovascular alteration and small vessel disease.
Level Of Evidence:
1 Technical Efficacy Stage: 1.
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