Assessment of Small Vessel Density Changes in Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and
Zidong Yang1,2, Fanhua Guo1, Steve Mendoza1,2
1Laboratory of FMRI Technology (LOFT), Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Insights
Black-blood MRI revealed reduced cerebral small vessel density in CADASIL patients, correlating with cognitive decline and increased disease burden. This imaging technique offers a new noninvasive tool for understanding CADASIL
Area of Science:
- Neuroimaging
- Vascular Neurology
- Genetics
Background:
- Direct assessment of cerebral small vessels in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is challenging.
- CADASIL is a genetic disorder characterized by cerebrovascular abnormalities.
Purpose of the Study:
- To investigate cerebral small vessel changes in CADASIL using high-resolution black-blood MRI.
- To assess the relationship between vessel density and cognitive function and disease burden in CADASIL patients.
Main Methods:
- A case-control study involving 36 CADASIL patients and 35 healthy controls.
- 3T MRI with a T1-weighted turbo spin-echo sequence was used to acquire vessel density images (VDIs).
- Statistical analyses included t-tests, generalized linear mixed-effect models, and voxel-wise analyses with FDR correction.
Main Results:
- CADASIL patients exhibited significantly reduced mean vessel density in gray matter compared to controls.
- Reduced vessel density was associated with lower Montreal Cognitive Assessment (MoCA) scores and higher cerebral small vessel disease (cSVD) burden.
- Voxel-wise analysis identified reduced regional VDI in specific brain areas, including the temporal pole, insula, cingulate cortex, and orbitofrontal cortex.
Conclusions:
- High-resolution black-blood MRI-derived VDI effectively detects regional cerebral small vessel changes in CADASIL.
- This noninvasive imaging approach enhances the understanding of the underlying mechanisms of cSVD in CADASIL.
- VDI may serve as a valuable tool for future research and clinical assessment in CADASIL.
Background:
Direct assessments of cerebral small vessels in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) remain a challenge.
Purpose:
To investigate changes of cerebral small vessels in CADASIL using iso-0.5 mm black-blood MRI.
Study Type:
Case control study.
Population:
Thirty-six genetically confirmed CADASIL patients (23 female, 43 ± 12.48 years) and 35 matched healthy controls (27 female, 40 ± 11.57 years).
Field Strength/Sequence:
3T using a T1-weighted turbo spin-echo with variable flip angles sequence.
Assessment:
Vessel density images (VDIs) were derived from black-blood MRI by using a semi-automatic pipeline with a Jerman filter. The differences in VDI were assessed between CADASIL and control groups. The relationships between changes in VDI and cognitive performance and disease burden were studied in the CADASIL group.
Statistical Tests:
Two-tailed independent samples t-tests were employed to assess the difference in VDI between CADASIL and control groups. Generalized linear mixed-effect models were used to assess the associations of VDI with cognitive performance and disease burden. Voxel-wise analyses were performed to further explore the associations of regional VDI with cognitive performance and disease burden after FDR correction.
Results:
Reduced mean VDI was found in gray matter of CADASIL patients (1.31 ± 0.06) compared to controls (1.35 ± 0.03), which was significantly associated with lower MoCA scores (β = 52.89, SE = 12.99, 95% CI [26.38, 79.40]), and higher cerebral small vessel disease (cSVD) burden scores (β = -14.34, SE = 3.22, 95% CI [-20.91, -7.76]) in CADASIL patients. Voxel-wise analyses revealed reduced regional VDI in regions of the temporal pole, insula, cingulate cortex, and orbitofrontal cortex in CADASIL patients.
Data Conclusion:
The VDI technique based on high-resolution black-blood MRI demonstrated changes in regional VDI in CADASIL patients and offers a noninvasive imaging tool to advance the understanding of the mechanisms underlying cSVD.
Evidence Level:
3.
Technical Efficiency:
Stage 2.
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