Enlarged Perivascular Spaces in Patients with Lacunar Infarctions

Lacunar infarction (LI) and enlarged perivascular spaces (EPVSs) are key MRI findings in cerebral small vessel disease. The underlying causes of LI and EPVS share similarities. To explore their relationship, we examined the association between lacunar infarction (LI) and enlarged perivascular spaces (EPVS).

We examined subjects with no history of brain disease (control) and patients with LIs requiring acute hospitalization. EPVS severity (graded 0-4) in the centrum semiovale (CSO) and basal ganglia (BG), along with other radiological findings such as white matter lesions (WML) and cerebral microbleeds (CMBs), and risk factors, were investigated using multivariate analyses.

A total of 210 control subjects and 67 LI patients were included in this study. LI was significantly and independently associated with age >73 years, diabetes mellitus (DM), strictly deep CMBs or mixed CMBs, and BG-EPVS ≥ grade 2. Another multivariate analysis revealed that BG-EPVS ≥ grade 2 was significantly and independently associated with age ≥73 years, hypertension, DM, symptomatic LIs, and CSO-EPVS ≥ grade 3. WML was not related to LI, BG-EPVS ≥ grade 2, or CSO-EPVS ≥ grade 3.

Although the risk factors may overlap, it was found that each of the four typical MRI findings of cerebral small vessel disease was not necessarily associated with the others.

This study suggests a strong association between LI and BG-EPVS, but not CSOEPVS. However, BG-EPVS was linked to CSO-EPVS. WML showed no association with LIs, BG-EPVS, or CSO-EPVS. While radiological markers of cerebral small vessel disease are interrelated, their relationships vary.