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Updated: May 29, 2025
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Published on: April 23, 2021
Associations between cerebral blood flow and progression of white matter hyperintensities
Siriluk Thammasart1, Danielle J Harvey2, Pauline Maillard3
1Biological Engineering Program, Faculty of Engineering, King Mongkut's University of Technology Thonburi, Bangkok, Thailand.
Introduction:
In an aging population, white matter hyperintensities (WMHs), observed on FLAIR MRI sequences, are indicators of cognitive decline, motor impairment, and increased vascular risk. However, the pathophysiological mechanisms underlying WMHs, including dynamic changes in cerebral blood flow (CBF) within and adjacent to lesions, remain poorly understood.
Methods:
Our study examined a diverse cohort of 300 elderly participants through arterial spin labeling (ASL) on 3 Tesla MRI, analyzing both cross-sectional and longitudinal data. We characterized the relationship between CBF and WMH development in different lesion locations (based on distance from ventricles) and brain tissue types (WMH lesion, penumbra, and normal white matter).
Results:
Our findings reveal that WMHs exhibit significantly lower relative CBF (rCBF) compared to penumbra, normal-appearing white matter, and gray matter, with juxtaventricular WMHs (JVWMH) displaying the most substantial reductions. Longitudinally, WMHs that increased in size over a two-year period had lower baseline rCBF than those that remained stagnant, particularly in juxtaventricular and periventricular regions.
Discussion:
This study not only highlights the predictive value of rCBF in WMH progression but also provides location-specific hemodynamic information about WMHs that can guide clinical management of WMH-related brain changes and their clinical manifestations.
Insights
Reduced cerebral blood flow (CBF) is linked to white matter hyperintensities (WMHs) in older adults. Lower baseline CBF predicts WMH growth, offering insights into brain aging and vascular risk.
Area of Science:
- Neuroimaging
- Cerebrovascular Health
- Aging Research
Background:
- White matter hyperintensities (WMHs) are common in aging and linked to cognitive decline and vascular risk.
- The underlying pathophysiology of WMHs, especially dynamic changes in cerebral blood flow (CBF), is not fully understood.
Purpose of the Study:
- To investigate the relationship between CBF and WMH development in an elderly cohort.
- To analyze location-specific CBF alterations in WMHs and their progression.
Main Methods:
- Utilized 3 Tesla MRI with arterial spin labeling (ASL) on 300 elderly participants.
- Analyzed cross-sectional and longitudinal data, assessing CBF in WMHs, penumbra, and normal white matter.
- Characterized WMH development based on lesion location and tissue type.
Main Results:
- WMHs showed significantly lower relative CBF (rCBF) than other brain tissues, with juxtaventricular WMHs (JVWMH) having the greatest reduction.
- Longitudinally, WMHs that enlarged over two years had lower baseline rCBF than stable WMHs.
- Location, particularly juxtaventricular and periventricular regions, influenced rCBF reduction and WMH progression.
Conclusions:
- Baseline rCBF is a significant predictor of WMH progression in the aging brain.
- Location-specific hemodynamic data from ASL MRI can inform clinical management of WMH-related changes.
