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Published on: April 23, 2021
Relationship between inferior frontal sulcal hyperintensities on brain MRI, ageing and cerebral small vessel disease
Jun-Fang Zhang1, Hwee Fang Lim2, Francesca M Chappell3
1Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.
Abstract:
Raised signal in cerebrospinal fluid (CSF) on fluid-attenuated inversion recovery (FLAIR) may indicate raised CSF protein or debris and is seen in inferior frontal sulci on routine MRI. To explore its clinical relevance, we assessed the association of inferior frontal sulcal hyperintensities (IFSH) on FLAIR with demographics, risk factors, and small vessel disease markers in three cohorts (healthy volunteers, n=44; mild stroke patients, n=105; older community-dwelling participants from Lothian birth cohort 1936, n=101). We collected detailed clinical data, scanned all subjects on the same 3T MRI scanner and 3-dimensional FLAIR sequence and developed a scale to rate IFSH. In adjusted analyses, the IFSH score increased with age (per 10-year increase; OR 1.69; 95% CI, 1.42-2.02), and perivascular spaces score in centrum semiovale in stroke patients (OR 1.73; 95% CI, 1.13-2.69). Since glymphatic CSF clearance declines with age and drains partially via the cribriform plate to the nasal lymphatics, IFSH on 3T MRI may be a non-invasive biomarker of altered CSF clearance and justifies further research in larger, more diverse samples.
Insights
Inferior frontal sulcal hyperintensities (IFSH) on MRI scans are linked to aging and small vessel disease. This finding suggests IFSH may serve as a biomarker for altered cerebrospinal fluid (CSF) clearance.
Area of Science:
- Neuroimaging
- Cerebrospinal Fluid Dynamics
- Neurology
Background:
- Raised signal in cerebrospinal fluid (CSF) on fluid-attenuated inversion recovery (FLAIR) MRI, particularly in inferior frontal sulci, may indicate increased protein or debris.
- This finding, termed inferior frontal sulcal hyperintensities (IFSH), warrants investigation into its clinical significance.
Purpose of the Study:
- To explore the clinical relevance of IFSH on FLAIR MRI.
- To assess the association of IFSH with demographics, risk factors, and small vessel disease markers.
Main Methods:
- Investigated three cohorts: healthy volunteers (n=44), mild stroke patients (n=105), and older community-dwelling adults (n=101).
- Utilized 3T MRI with a 3-dimensional FLAIR sequence and developed a scale to quantify IFSH.
- Collected detailed clinical data and analyzed associations in adjusted models.
Main Results:
- IFSH scores significantly increased with age (OR 1.69 per 10-year increase).
- In stroke patients, IFSH scores were associated with perivascular spaces in the centrum semiovale (OR 1.73).
Conclusions:
- IFSH on 3T MRI may represent a non-invasive biomarker for altered CSF clearance, potentially linked to aging and cerebrovascular health.
- Further research in larger, diverse populations is justified to validate these findings.
