Charidimou Andreas, Jäger Rolf H, Peeters Andre, Vandermeeren Yves, Laloux Patrice, Baron Jean-Claude, Werring David J
From the Stroke Research Group, Department of Brain Repair and Rehabilitation, National Hospital for Neurology and Neurosurgery (A.C., D.J.W.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery (R.H.J.), and Department of Brain Repair and Rehabilitation (R.H.J.), UCL Institute of Neurology, London, United Kingdom; Department of Neurology, Cliniques Universitaires UCL Saint Luc, Brussels, Belgium (A.P.); Department of Neurology, CHU Dinant Godinne (Y.V., P.L.) and Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.-C.B.); and UMR 894 INSERM-Université Paris 5, Sorbonne Paris Cité, Paris, France (J.-C.B.).
Stroke. 2014 Oct;45(10):2930-5. doi: 10.1161/STROKEAHA.114.005568. Epub 2014 Aug 12.
We set out to investigate whether MRI-visible centrum semiovale perivascular spaces (CSO-PVS), a potential biomarker of impaired interstitial fluid drainage in sporadic cerebral amyloid angiopathy, is associated with cortical superficial siderosis (cSS), reflecting recurrent hemorrhage from severe leptomeningeal and superficial cortical vascular amyloid.
Retrospective multicenter cohort study of possible/probable cerebral amyloid angiopathy according to the Boston criteria. PVS were rated in basal ganglia and CSO (CSO-PVS) on axial T2-weighted sequences, using a validated 4-point visual rating scale and were classified as high (score>2) or low degree (score≤2) for prespecified analyses. Independent risk factors for high CSO-PVS degree were investigated in logistic regression.
The final cohort consisted of 138 cerebral amyloid angiopathy patients (mean age, 71.8 years; 95% confidence interval, 70.2-73.4 years; 52.2% men). High CSO-PVS degree was present in 61.2% of cases. The prevalence of any cSS, and disseminated cSS (involving >3 sulci), was higher in patients with high versus low CSO-PVS degree (for any cSS 45.9% versus 13.5%; P<0.00005; for disseminated cSS 31.8% versus 0%; P<0.00005). In multivariable logistic regression analysis, cSS presence (odds ratio, 4.78; 95% confidence interval, 1.64-13.87; P=0.004) was an independent predictors of high CSO-PVS degree. We found no associations between basal ganglia PVS and cSS.
High degree of CSO-PVS is highly prevalent in sporadic cerebral amyloid angiopathy and is related to cSS. Our findings suggest that severe leptomeningeal and cortical vascular amyloid (causing cSS) is related to impaired interstitial fluid drainage from cerebral white matter, although determining the causal direction of this relationship requires prospective studies.
我们旨在研究磁共振成像（MRI）可见的半卵圆中心血管周围间隙（CSO-PVS），这是散发性脑淀粉样血管病中间质液引流受损的一种潜在生物标志物，是否与皮质表面铁沉积（cSS）相关，cSS反映了严重软脑膜和皮质浅层血管淀粉样变引起的反复出血。
根据波士顿标准对可能/很可能患有脑淀粉样血管病的患者进行回顾性多中心队列研究。在轴位T2加权序列上，使用经过验证的4分视觉评分量表对基底节和CSO中的血管周围间隙（CSO-PVS）进行评分，并为预先设定的分析将其分类为高度（评分>2）或低度（评分≤2）。在逻辑回归中研究CSO-PVS高度的独立危险因素。
最终队列由138例脑淀粉样血管病患者组成（平均年龄71.8岁；95%置信区间70.2-73.4岁；男性占52.2%）。61.2%的病例存在高度CSO-PVS。高度CSO-PVS患者中任何cSS以及播散性cSS（累及>3个脑沟）的患病率均高于低度CSO-PVS患者（任何cSS分别为45.9%对13.5%；P<0.00005；播散性cSS分别为31.8%对0%；P<0.00005）。在多变量逻辑回归分析中，cSS的存在（比值比4.78；95%置信区间1.64-13.87；P=0.004）是CSO-PVS高度的独立预测因素。我们发现基底节血管周围间隙与cSS之间无关联。
高度CSO-PVS在散发性脑淀粉样血管病中高度普遍，且与cSS相关。我们的研究结果表明，严重的软脑膜和皮质血管淀粉样变（导致cSS）与脑白质间质液引流受损有关，尽管确定这种关系的因果方向需要前瞻性研究。
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