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Mismatch of MRI White Matter Hyperintensities and Gait Function in Patients With Cerebral Small Vessel Disease

Lingshan Wu1, Ziyue Wang1, Xirui Zhou1

  • 1Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Journal of Magnetic Resonance Imaging : JMRI
|November 3, 2023
PubMed
Abstract

Insights

Microstructural damage in specific white matter tracts may explain why some individuals with severe white matter hyperintensities (WMH) experience gait disorders, while others do not. This finding highlights potential mechanisms linking WMH severity to gait impairment.

Area of Science:

  • Neuroimaging
  • Neurology
  • Gerontology

Background:

  • Cerebral small vessel disease (CSVD) is linked to gait disorders, with white matter hyperintensities (WMH) on MRI correlating negatively with gait speed.
  • However, not all individuals with WMH develop gait issues, suggesting underlying mechanisms beyond WMH severity.

Purpose of the Study:

  • To investigate the mechanisms behind the discrepancy between WMH severity and gait impairment in individuals with severe WMH (Fazekas 3).
  • To identify specific microstructural white matter differences between severe WMH patients with and without gait disorders.

Main Methods:

  • A cohort study compared 54 subjects with severe WMH and gait disorder (WMH-GD) to 114 subjects with severe WMH but no gait disorder (WMH-nGD).
  • Diffusion tensor imaging (DTI) and trace-based spatial statistics (TBSS) were used to analyze white matter microstructure (fractional anisotropy - FA).
  • Conventional MRI markers of CSVD and gait parameters (e.g., Time-Up-and-Go test) were assessed.

Main Results:

  • The WMH-nGD group showed significantly reduced FA in specific white matter tracts, including the corpus callosum and superior longitudinal fasciculus, compared to the WMH-GD group.
  • Reduced FA values were independently associated with poorer performance on the Time-Up-and-Go test, slower gait speed, and shorter stride length.
  • These microstructural changes were observed even after adjusting for conventional CSVD markers.

Conclusions:

  • This study demonstrates microstructural white matter damage in specific fiber tracts in individuals with severe WMH and gait disorders.
  • These findings offer a potential explanation for the observed mismatch between WMH severity and gait impairment in CSVD patients.
Keywords:
cerebral small vessel diseasesdiffusion tensor imaginggait disordertract‐based spatial statisticswhite matter hyperintensities

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