Detecting Small Vessel Pathology in Cocaine Use Disorder

Area of Science:

• Neurology
• Radiology
• Vascular Medicine

Background:

• Cocaine use elevates cerebrovascular accident risk.
• Small vessel pathology in cocaine users is difficult to detect with conventional MRI.
• Fluid-attenuated inversion recovery (FLAIR) MRI offers improved resolution for small vessel lesions.

Purpose of the Study:

• To evaluate the practice of using subjective judgment for FLAIR scan acquisition in cocaine use disorder (CUD) patients.
• To assess the added value of FLAIR scans in detecting microbleeds compared to standard MRI.
• To investigate if microbleeds are more pronounced in CUD patients, especially those selected for FLAIR scans.

Main Methods:

• Sixty-four CUD patients and 60 controls underwent brain MRI.
• A subgroup of CUD patients and controls with cerebral infarction indicators on MRI received follow-up FLAIR scans.
• Microbleed volumes were quantified, and associations with risk factors were analyzed.

Main Results:

• While MR scans showed significantly increased lesion volumes in CUD patients.
• No significant differences in lesion volume were observed in the subgroup that underwent FLAIR scans.
• Subjective selection for FLAIR scans may not accurately identify all affected individuals.

Conclusions:

• Current subjective assessment for FLAIR scan follow-up may overlook vulnerable CUD patients.
• FLAIR scans should be routinely incorporated into research studies involving CUD.
• This approach can improve the detection of vascular pathology in this population.