Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
Atherosclerosis. 2010 May;210(1):130-6. doi: 10.1016/j.atherosclerosis.2009.10.039. Epub 2009 Nov 10.
To estimate brain volumes, white matter lesion (WML) volume and asymptomatic infarcts on MRI in a large cohort of patients with atherosclerotic disease.
Within the SMART-MR (Second Manifestations of ARTerial disease-Magnetic Resonance) study, a prospective cohort study on determinants and course of brain changes on MRI, cross-sectional analyses were performed in 1044 patients (mean age 58+/-10 years, 80% male) with coronary artery disease, cerebrovascular disease, peripheral arterial disease, or abdominal aortic aneurysm. Brain segmentation was used to quantify volumes of cortical gray matter, white matter, sulcal and ventricular cerebrospinal fluid, and WML. All volumes were expressed relative to intracranial volume. Brain infarcts were rated visually and distinctions were made between cortical infarcts, large subcortical infarcts, lacunar infarcts, and infarcts in the cerebellum and brainstem.
With older age a nonlinear (quadratic) decrease in total brain volume was observed and a nonlinear increase in ventricular volume and WML. Cortical gray matter volume showed a linear decrease with age and was stronger in men than in women. WML volumes also increased more strongly in men than in women, while ventricular volume decrease showed no sex difference. Silent brain infarcts were present in 14% of men and women, and increased to 24% of subjects aged 65 years or older.
In a population with atherosclerotic diseases, decrease in brain volumes with increasing age is comparable with findings from the general population. However, vascular pathology on MRI, as indicated by white matter lesions and silent brain infarcts may be more common.
在一大群动脉粥样硬化疾病患者中，评估 MRI 上的脑容量、白质病变（WML）体积和无症状性梗死。
在 SMART-MR（动脉疾病的第二次表现-磁共振）研究中，一项关于 MRI 上脑变化的决定因素和过程的前瞻性队列研究，对 1044 名（平均年龄 58+/-10 岁，80%为男性）患有冠状动脉疾病、脑血管疾病、外周动脉疾病或腹主动脉瘤的患者进行了横断面分析。脑分段用于定量皮质灰质、白质、脑沟和脑室脑脊液以及 WML 的体积。所有体积均相对于颅内体积表示。脑梗死通过视觉评定，并区分皮质梗死、大皮质下梗死、腔隙性梗死和小脑及脑干梗死。
随着年龄的增长，总脑体积呈非线性（二次）下降，而脑室体积和 WML 呈非线性增加。皮质灰质体积随年龄呈线性下降，且男性比女性更为明显。WML 体积在男性中增加的幅度也大于女性，而脑室体积下降则无性别差异。男性和女性均有 14%存在无症状性脑梗死，年龄在 65 岁或以上的患者中，这一比例增加到 24%。
在动脉粥样硬化疾病患者中，随着年龄的增长脑容量减少与一般人群的发现相当。然而，MRI 上的血管病理学，如白质病变和无症状性脑梗死，可能更为常见。
