Cerebral Microbleeds with a Venous Connection on 3 Tesla Susceptibility-Weighted Imaging in Persons with Alzheimer's
Ulf Jensen-Kondering1, Veronique Kuhn1, Hannes Schacht1
1Department of Neuroradiology, UKSH Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany.
Abstract:
Introduction: It has been recently demonstrated that some cerebral microbleeds (CMBs) are connected to cerebral veins in patients with cerebral small vessel disease (CSVD) including cerebral amyloid angiopathy (CAA). We sought to demonstrate the presence of CMB at 3 Tesla using susceptibility-weighted imaging and speculated that it was more prevalent in persons with Alzheimer's disease (AD), another amyloid-related disease, than in healthy ageing controls. Material and Methods: We included persons from the publicly available OASIS3-database. Persons were included if they had a structural MRI including a susceptibility-weighted sequence (SWI) and relevant clinical data. Two raters assessed the presence and location of CMBs and CMBs with a venous connection (CMBven). Results: A total of 571 persons (AD, n = 140, healthy controls, n = 431) were included. In total, 367 CMBs were detected, encompassing 26/571 persons (4.5%) who had a total of 40/367 (10.9%) CMBs with a CMBven, though there was no difference between persons with AD and healthy controls (AD 6.6%, healthy controls 7.4%, p = 0.773). Persons with CMBven had a higher total CMB load, were more likely female, displayed an APOE ε2/2 genotype and had antithrombotic treatment more often. Logistic regression revealed a higher number of CMB (OR (95% CI) = 1.351 (1.161-1.688), p < 0.0014) and a lower MoCA score (OR (95% CI) = 0.862 (0.762-0.982), p = 0.018), indicating a statistically significant association with the presence of CMBven. Discussion: CMBven are not an uncommon finding in persons with AD and healthy ageing controls. Our results highlight the potential venous contribution to CSVD. Histopathological studies will be needed to assess these further.
Insights
Cerebral microbleeds connected to veins (CMBven) were found in Alzheimer's disease patients and healthy controls. Higher CMB load and lower cognitive scores were associated with CMBven, suggesting a venous role in small vessel disease.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Cerebral microbleeds (CMBs) are linked to cerebral small vessel disease (CSVD).
- Some CMBs are connected to cerebral veins (CMBven), particularly in CSVD and cerebral amyloid angiopathy (CAA).
- Alzheimer's disease (AD) shares amyloid pathology with CAA, prompting investigation into CMBven prevalence in AD.
Purpose of the Study:
- To investigate the prevalence of CMBven using 3 Tesla susceptibility-weighted imaging (SWI).
- To compare the prevalence of CMBven in individuals with Alzheimer's disease (AD) versus healthy aging controls.
- To identify factors associated with the presence of CMBven.
Main Methods:
- Analysis of structural MRI including SWI from the OASIS3 database.
- Inclusion of 571 participants (140 AD, 431 controls) with relevant clinical data.
- Two raters assessed CMBs and CMBven presence and location.
Main Results:
- CMBven were detected in 4.5% of participants (10.9% of all CMBs).
- No significant difference in CMBven prevalence was found between AD patients (6.6%) and healthy controls (7.4%).
- CMBven presence was associated with higher total CMB load, female sex, APOE ε2/2 genotype, antithrombotic treatment, and lower MoCA scores.
Conclusions:
- CMBven are a notable finding in both AD patients and healthy aging individuals.
- The results suggest a potential contribution of venous factors to the pathophysiology of CSVD.
- Further histopathological studies are warranted to elucidate the mechanisms underlying CMBven.
