Related Experiment Video
Updated: Jun 18, 2026
Symmetric Bihemispheric Postmortem Brain Cutting to Study Healthy and Pathological Brain Conditions in Humans
Published on: December 18, 2016
Spatial distribution of cerebral microbleeds reveals heterogeneous pathogenesis in CADASIL
Ya-Fang Chen1, Chih-Hao Chen2, Wen-Chau Wu3,4,5
1Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
Insights
The spatial distribution of cerebral microbleeds (CMBs) differs between cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) and cerebral amyloid angiopathy (CAA). Hypertension influences CMB volume in CADASIL patients, with region-dependent effects.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Cerebral small vessel diseases (CSVD) present diagnostic challenges.
- Distinguishing subtypes like CADASIL and CAA based on radiological findings is crucial.
- Cerebral microbleeds (CMBs) are a key imaging marker in CSVD.
Purpose of the Study:
- To investigate the spatial distribution of CMBs in CADASIL versus probable CAA within lobar regions.
- To explore the relationship between CMB distribution and hypertension in CADASIL patients.
Main Methods:
- Prospective inclusion of 32 CADASIL and 33 probable CAA patients.
- 3-Tesla susceptibility-weighted MRI for CMB analysis (incidence and volume).
- Atlas-based regions of interest and voxel-wise risk mapping were employed.
- Correlation analysis with hypertension status was performed.
Main Results:
- CADASIL showed larger CMB volume in hippocampus/amygdala and white matter compared to CAA.
- CADASIL exhibited smaller CMB volume in the parietal lobe and higher incidence in hippocampus/amygdala, white matter, and insula.
- CMB hot spots in CADASIL were identified in the putamen and posteromedial thalamus; hypertension correlated with increased CMB volume in specific regions.
Conclusions:
- The spatial distribution of lobar CMBs is a differentiable feature between CADASIL and CAA.
- Hypertension plays a region-dependent role in mediating CMB volume in CADASIL.
- CMB risk mapping is valuable for identifying specific high-risk areas for CMBs in CADASIL.
Objectives:
Radiological diagnosis of subtypes of cerebral small vessel diseases remains challenging. This study aimed to explore the spatial distribution of cerebral microbleeds (CMBs) in cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) in contrast to cerebral amyloid angiopathy (CAA) in the lobar regions.
Methods:
Thirty-two patients with CADASIL and 33 patients with probable CAA were prospectively and consecutively included. On 3-Tesla susceptibility-weighted magnetic resonance images, CMBs were analyzed for incidence and volume within atlas-based regions of interest, followed by voxel-wise analysis using risk mapping. The distribution of CMBs was correlated with the status of hypertension. Correlation and group differences with a p-value less than 0.05 were considered to be significant.
Results:
As compared with the CAA group, the CADASIL group presents a larger CMB volume in hippocampus/amygdala and white matter (nonparametric analysis of covariance, p = 0.014 and 0.037, respectively), a smaller CMB volume in parietal lobe (p = 0.038), and a higher incidence in hippocampus/amygdala, white matter, and insula (logistic regression, p = 0.019, 0.024, and 0.30, respectively). As part of the exclusion criteria of probable CAA, thalamus, basal ganglia, and pons exhibit greater CMB volume/incidence in the CADASIL group. In CADASIL patients, hot spots of CMBs are identified in the putamen and posteromedial thalamus; hypertension is associated with larger CMB volumes in insula, basal ganglia, and pons.
Conclusions:
The spatial distribution of CMBs is differentiable between CADASIL and CAA in lobar regions. In CADASIL patients, hypertension has a region-dependent mediating effect on the CMB volume.
Key Points:
• The topological distribution of lobar CMBs is differentiable between CADASIL and CAA. • In CADASIL patients, hypertension mediates CMB volume and the mediation is region dependent. • CMB risk mapping allows for voxel-wise exploration of CMB distribution and reveals hot spots in the putamen and posteromedial thalamus in CADASIL.
Related Concept Videos
01:17Hemorrhagic Stroke l: Introduction
01:29Hemorrhagic Stroke ll: Pathophysiology
01:22Cerebral Edema ll: Pathophysiology