Neurosonology Laboratory, Coimbra University and Hospital Centre, Coimbra 3000-075, Portugal.
BMC Neurol. 2014 Feb 5;14:24. doi: 10.1186/1471-2377-14-24.
Subcortical hypodensities of presumed vascular etiology (SHPVO) are a clinical, radiological and neuropathological syndrome with a still largely unexplained pathophysiology. Parallel to the clinical heterogeneity, there is also recognised cerebral topographical diversity with undetermined etiological implications. Our aim is to assess clinical and neurosonological predictors of SHPVO according to their location.
Cross sectional analysis of consecutive patients that underwent neurosonologic evaluation and head CT within one month, during a one year period. We excluded patients with absent temporal sonographic window, any pathology with a possible confounding effect on cerebral arterial pulsatility, atrial fibrillation and other etiologies of white matter diseases. The mean pulsatility index (PI) of both middle cerebral arteries was measured in the middle third of the M1 segment; intima media thickness was evaluated in the far wall of both common carotid arteries. SHPVO were rated by analysis of head CT in deep white matter (DWMH), periventricular white matter (PVWMH) and basal ganglia (BGH). We conducted a multivariate ordinal logistic regression model including all clinical, demographic and ultrasonographic characteristics to determine independent associations with SHPVO.
We included 439 patients, mean age 63.47 (SD: 14.94) years, 294 (67.0%) male. The independent predictors of SHPVO were age (OR = 1.067, 95% CI: 1.047-1.088, p < 0.001 for DWMH; OR = 1.068, 95% CI: 1.049-1.088, p < 0.001 for PVWMH; OR = 1.05, 95% CI: 1.03-1.071, p < 0.001 for BGH), hypertension (OR = 1.909, 95% CI: 1.222-2.981, p = 0.004 for DWMH; OR = 1.907, 95% CI: 1.238-2.938, p = 0.003 for PVWMH; OR = 1.775, 95% CI: 1.109-2.843, p = 0.017 for BGH) and PI (OR = 17.994, 95% CI: 6.875-47.1, p < 0.001 for DWMH; OR = 5.739, 95%CI: 2.288-14.397, p < 0.001 for PVWMH; OR = 11.844, 95% CI: 4.486-31.268, p < 0.001 for BGH) for all locations of SHPVO.
Age, hypertension and intracranial pulsatility are the main independent predictors of SHPVO across different topographic involvement and irrespective of extracranial atherosclerotic involvement.
假定血管病因的皮质下低密区（SHPVO）是一种临床、放射学和神经病理学综合征，其病理生理学在很大程度上仍未得到解释。与临床异质性平行的是，也存在着具有不确定病因学意义的大脑拓扑多样性。我们的目的是根据 SHPVO 的位置评估其临床和神经超声预测因子。
对在一年内的一个月内接受神经超声评估和头部 CT 的连续患者进行横断面分析。我们排除了颞窗缺失、任何可能对大脑动脉搏动产生混淆影响的病理、心房颤动和其他白质疾病病因的患者。在 M1 段的中部测量双侧大脑中动脉的平均搏动指数（PI）；在双侧颈总动脉的远壁评估内膜中层厚度。通过头部 CT 分析深部白质（DWMH）、脑室周围白质（PVWMH）和基底节（BGH）来评估 SHPVO。我们进行了多元有序逻辑回归模型，包括所有临床、人口统计学和超声特征，以确定与 SHPVO 相关的独立因素。
我们纳入了 439 名患者，平均年龄为 63.47（SD：14.94）岁，294 名（67.0%）为男性。SHPVO 的独立预测因子为年龄（DWMH 的 OR = 1.067，95%CI：1.047-1.088，p < 0.001；PVWMH 的 OR = 1.068，95%CI：1.049-1.088，p < 0.001；BGH 的 OR = 1.05，95%CI：1.03-1.071，p < 0.001）、高血压（DWMH 的 OR = 1.909，95%CI：1.222-2.981，p = 0.004；PVWMH 的 OR = 1.907，95%CI：1.238-2.938，p = 0.003；BGH 的 OR = 1.775，95%CI：1.109-2.843，p = 0.017）和 PI（DWMH 的 OR = 17.994，95%CI：6.875-47.1，p < 0.001；PVWMH 的 OR = 5.739，95%CI：2.288-14.397，p < 0.001；BGH 的 OR = 11.844，95%CI：4.486-31.268，p < 0.001），用于所有 SHPVO 的位置。
年龄、高血压和颅内搏动性是不同拓扑位置的 SHPVO 的主要独立预测因子，与颅外动脉粥样硬化的参与无关。
