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Differences in Cerebral Small Vessel Disease Magnetic Resonance Imaging Depending on Cardiovascular Risk Factors: A
Marta Ribera-Zabaco1, Carlos Laredo2, Emma Muñoz-Moreno2
1Faculty of Medicine and Health Sciences, University of Barcelona, Casanova 143, 08036 Barcelona, Spain.
Insights
Hypertension significantly impacts cerebral small vessel disease (cSVD) markers like lacunes and perivascular spaces (PVSs). Lesion distribution varies by vascular risk factor, highlighting cSVD complexity.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Vascular risk factors (VRFs) influence cerebral small vessel disease (cSVD) burden.
- The specific impact of VRFs on individual cSVD imaging markers and their spatial distribution is not fully understood.
Purpose of the Study:
- To investigate the association between common VRFs and the presence and distribution of cSVD imaging markers.
- To determine the independent impact of hypertension, hyperlipidemia, diabetes, and smoking on white matter hyperintensity (WMH), perivascular spaces (PVSs), lacunes, and cerebral microbleeds (CMBs).
Main Methods:
- Retrospective analysis of 93 lacunar stroke patients using 3T MRI.
- Semi-automatic segmentation of WMH and PVSs; manual segmentation of lacunes and CMBs.
- Univariable and multivariable regression analyses of VRFs, adjusted for age and sex; spatial lesion pattern analysis.
Main Results:
- Hypertension showed the strongest univariable association with cSVD markers.
- Multivariable analysis revealed hypertension associated with lacunes and PVSs in basal ganglia and white matter.
- Hypertension linked to higher WMH load in deep white matter and posterior periventricular regions; hyperlipidemia associated with hippocampal WMH.
Conclusions:
- Hypertension is the VRF with the most significant impact on cSVD load, particularly lacunes and PVSs.
- The spatial distribution of cSVD lesions varies depending on the specific VRF.
- Findings underscore the complex relationship between vascular health and cSVD manifestation.
Abstract:
Background: Vascular risk factors (VRFs) are known to influence cerebral small vessel disease (cSVD) burden and progression. However, their specific impact on the presence and distribution of each cSVD imaging marker (white matter hyperintensity [WMH], perivascular spaces [PVSs], lacunes, and cerebral microbleeds [CMBs]) and their spatial distribution remains unclear. Methods: We conducted a retrospective analysis of 93 patients with lacunar stroke with a standardized investigational magnetic resonance imaging protocol using a 3T scanner. WMH and PVSs were segmented semi-automatically, and lacunes and CMBs were manually segmented. We assessed the univariable associations of four common VRFs (hypertension, hyperlipidemia, diabetes, and smoking) with the load of each cSVD marker. Then, we assessed the independent associations of these VRFs in multivariable regression models adjusted for age and sex. Spatial lesion patterns were explored with regional volumetric comparisons using Pearson's coefficient analysis, which was adjusted for multiple comparisons, and by visually examining heatmap lesion distributions. Results: Hypertension was the VRF that exhibited stronger associations with the cSVD markers in the univariable analysis. In the multivariable analysis, only lacunes (p = 0.009) and PVSs in the basal ganglia (p = 0.014) and white matter (p = 0.016) were still associated with hypertension. In the regional analysis, hypertension showed a higher WMH load in deep structures and white matter, particularly in the posterior periventricular regions. In patients with hyperlipidemia, WMH was preferentially found in hippocampal regions. Conclusions: Hypertension was confirmed to be the VRF with the most impact on cSVD load, especially for lacunes and PVSs, while the lesion topography was variable for each VRF. These findings shed light on the complexity of cSVD expression in relation to factors detrimental to vascular health.
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