Small vessel dysfunction at 7T MRI locally predicts white matter damage progression in CADASIL

Area of Science:

• Neurology
• Vascular Biology
• Neuroimaging

Background:

• Cerebral small vessel diseases (cSVDs) are major contributors to stroke and dementia.
• Advanced 7T MRI reveals small vessel dysfunction in cSVD patients, linked to white matter damage.
• The predictive value of vascular deficits for progressive tissue damage in cSVDs remains unclear.

Purpose of the Study:

• To investigate the longitudinal relationship between local vascular function and white matter damage progression in CADASIL patients.
• To assess if baseline vascular function predicts future white matter changes.

Main Methods:

• Twenty-two CADASIL patients underwent baseline 7T MRI for blood-oxygen-level-dependent cerebrovascular reactivity (BOLD-CVR) assessment.
• White matter changes were evaluated over two years using 3T MRI, analyzing mean diffusivity and white matter hyperintensity (WMH) progression.
• Voxelwise analysis correlated baseline BOLD-CVR with subsequent white matter damage.

Main Results:

• Significant global white matter damage increase was observed over two years.
• Lower baseline BOLD-CVR magnitude and higher dispersion were associated with localized white matter damage and WMH progression.
• Global vascular function measures did not predict overall white matter changes.

Conclusions:

• Local vascular function is a key determinant of white matter damage progression in CADASIL.
• Regional vascular health is critical for managing cSVDs and preventing neurological decline.
• These findings underscore the need for spatially resolved assessments of vascular function in cSVD research.