University Paris Diderot, INSERM UMR 740, and Department of Neurology, Lariboisière Hospital, 2 rue Ambroise Paré, 75010 Paris, France.
Stroke. 2012 Dec;43(12):3252-7. doi: 10.1161/STROKEAHA.112.664854.
The extent of white matter hyperintensities (WMH) is associated with cerebral atrophy in elderly people. WMH is a radiological hallmark of cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), but their relationship with brain volume remains poorly understood. The association between WMH and brain volume was analyzed in a large population of patients with CADASIL.
Demographic and MRI data of 278 patients recruited from a prospective cohort study were analyzed. Volumes of WMH and lacunar infarcts, number of cerebral microbleeds, and brain parenchymal fraction were measured. Multivariate analysis was used to study the impact of WMH on brain volume at baseline.
In univariate analyses, brain parenchymal fraction was negatively associated with age, male sex, and all MRI markers. Multiple regression modeling showed that brain parenchymal fraction was inversely related to age, number of cerebral microbleeds, and normalized volume of lacunar infarcts but positively related to normalized volume of WMH (P<0.001). This positive relationship was independent of the presence/absence of lacunar infarcts or of cerebral microbleeds. Subgroup analysis showed that this association was significant in subjects having normalized volume of WMH ≥6.13 or brain parenchymal fraction ≥86.37% (median values, both P≤0.001).
The results of the present study suggest that extensive WMH may be associated with increase of brain volume in CADASIL. In this disorder, WMH may be related not only to loss of white matter components, but also to a global increase of water content in the cerebral tissue.
脑白质高信号（WMH）的程度与老年人的脑萎缩有关。WMH 是伴有皮质下梗死和白质脑病的脑常染色体显性动脉病（CADASIL）的放射学标志，但它们与脑容量的关系仍知之甚少。本研究分析了大量 CADASIL 患者的 WMH 与脑容量之间的关系。
分析了一项前瞻性队列研究中招募的 278 例患者的人口统计学和 MRI 数据。测量了 WMH 和腔隙性梗死的体积、脑微出血的数量以及脑实质分数。采用多元分析来研究 WMH 对基线时脑容量的影响。
在单变量分析中，脑实质分数与年龄、性别以及所有 MRI 标志物呈负相关。多元回归模型显示，脑实质分数与年龄、脑微出血数量以及腔隙性梗死的标准化体积呈负相关，与 WMH 的标准化体积呈正相关（P<0.001）。这种正相关与腔隙性梗死或脑微出血的存在与否无关。亚组分析显示，当 WMH 的标准化体积≥6.13 或脑实质分数≥86.37%（中位数，两者均 P≤0.001）时，这种相关性具有统计学意义。
本研究结果表明，广泛的 WMH 可能与 CADASIL 中脑容量的增加有关。在这种疾病中，WMH 不仅与白质成分的丧失有关，还与脑组织中水分的整体增加有关。
