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Dentate nucleus dilated perivascular spaces on magnetic resonance imaging in hypertensive arteriopathy

Dimitri Renard1, Teodora Parvu1, Anne Wacongne1

  • 1Department of Neurology, CHU Nîmes, Univ. Montpellier, Nîmes, France.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|March 1, 2026
PubMed
Abstract

Insights

Dilated perivascular spaces in the dentate nucleus (DN-DPVS) are more common in patients with hypertensive arteriopathy (HA) than in those with cerebral amyloid angiopathy (CAA). This finding aids in differentiating these small vessel diseases using MRI.

Area of Science:

  • Neurology
  • Radiology
  • Vascular Medicine

Background:

  • Small vessel disease (SVD) manifests as MRI abnormalities including cerebral microbleeds (CMB), intracerebral hemorrhage (ICH), and dilated perivascular spaces (DPVS).
  • In the cerebellum, deep CMB/ICH in the dentate nucleus (DN) is linked to hypertensive arteriopathy (HA), while superficial CMB/ICH is associated with cerebral amyloid angiopathy (CAA).
  • This study investigates DPVS within the DN (DN-DPVS) in patients diagnosed with HA or CAA.

Purpose of the Study:

  • To compare the presence and number of DN-DPVS on MRI between patients with HA and CAA.
  • To identify potential MRI markers for differentiating HA from CAA, particularly concerning cerebellar SVD.

Main Methods:

  • Retrospective analysis of T2-weighted 3T MRI scans from 29 HA and 43 CAA patients presenting with hemorrhage-related symptoms.
  • Assessment of DN-DPVS presence and number, alongside other SVD markers like CMB and supratentorial DPVS scores.
  • Statistical analysis including univariate and multivariate models to determine associations with HA or CAA pathology.

Main Results:

  • HA patients were younger, had higher rates of diabetes, fewer CMB, and distinct DPVS patterns in basal ganglia and centrum semiovale compared to CAA patients.
  • DN-DPVS were significantly more frequent (97% vs. 63%) and numerous (median 6.5 vs. 4) in HA patients compared to CAA patients.
  • Multivariate analysis confirmed DN-DPVS presence as a strong indicator of HA pathology (OR=19.15, p=0.001).

Conclusions:

  • DN-DPVS are frequently observed in both HA and CAA but are significantly more prevalent in HA.
  • MRI assessment of DN-DPVS can serve as a valuable tool for distinguishing between hypertensive arteriopathy and cerebral amyloid angiopathy.
Keywords:
Cerebral amyloid angiopathyDentate nucleusDilated perivascular spacesHypertensive arteriopathyMRISmall vessel disease

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