脑淀粉样血管病和高血压性动脉病中磁共振成像可见的血管周围间隙
MRI-visible perivascular spaces in cerebral amyloid angiopathy and hypertensive arteriopathy.
作者信息
Charidimou Andreas, Boulouis Gregoire, Pasi Marco, Auriel Eitan, van Etten Ellis S, Haley Kellen, Ayres Alison, Schwab Kristin M, Martinez-Ramirez Sergi, Goldstein Joshua N, Rosand Jonathan, Viswanathan Anand, Greenberg Steven M, Gurol M Edip
机构信息
From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
出版信息
Neurology. 2017 Mar 21;88(12):1157-1164. doi: 10.1212/WNL.0000000000003746. Epub 2017 Feb 22.
OBJECTIVE
To assess MRI-visible enlarged perivascular spaces (EPVS) burden and different topographical patterns (in the centrum semiovale [CSO] and basal ganglia [BG]) in 2 common microangiopathies: cerebral amyloid angiopathy (CAA) and hypertensive arteriopathy (HA).
METHODS
Consecutive patients with spontaneous intracerebral hemorrhage (ICH) from a prospective MRI cohort were included. Small vessel disease MRI markers, including cerebral microbleeds (CMBs), cortical superficial siderosis (cSS), and white matter hyperintensities (WMH), were rated. CSO-EPVS/BG-EPVS were assessed on a validated 4-point visual rating scale (0 = no EPVS, 1 = <10, 2 = 11-20, 3 = 21-40, and 4 = >40 EPVS). We tested associations of predefined high-degree (score >2) CSO-EPVS and BG-EPVS with other MRI markers in multivariable logistic regression. We subsequently evaluated associations with CSO-EPVS predominance (i.e., CSO-EPVS > BG-EPVS) and BG-EPVS predominance pattern (i.e., BG-EPVS > CSO-EPVS) in adjusted multinomial logistic regression (reference group, BG-EPVS = CSO-EPVS).
RESULTS
We included 315 patients with CAA-ICH and 137 with HA-ICH. High-degree CSO-EPVS prevalence was greater in CAA-related ICH vs HA-related ICH (43.8% vs 17.5%, < 0.001). In multivariable logistic regression, high-degree CSO-EPVS was associated with lobar CMB (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.10-1.61, = 0.003) and cSS (OR 2.08, 95% CI 1.30-3.32, = 0.002). Deep CMBs (OR 2.85, 95% CI 1.75-4.64, < 0.0001) and higher WMH volume (OR 1.02, 95% CI 1.01-1.04, = 0.010) were predictors of high-degree BG-EPVS. A CSO-EPVS-predominant pattern was more common in CAA-ICH than in HA-ICH (75.9% vs 39.4%, respectively, < 0.0001). CSO-PVS predominance was associated with lobar CMB burden and cSS, while BG-EPVS predominance was associated with HA-ICH and WMH volumes.
CONCLUSIONS
Different patterns of MRI-visible EPVS provide insights into the dominant underlying microangiopathy type in patients with spontaneous ICH.
目的
评估两种常见微血管病，即脑淀粉样血管病（CAA）和高血压性动脉病（HA）中，MRI可见的血管周围间隙增宽（EPVS）负担及不同的拓扑学模式（半卵圆中心[CSO]和基底节区[BG]）。
方法
纳入来自前瞻性MRI队列的自发性脑出血（ICH）连续患者。对包括脑微出血（CMB）、皮质表面铁沉积（cSS）和白质高信号（WMH）在内的小血管病MRI标志物进行评分。采用经过验证的4分视觉评分量表评估CSO-EPVS/BG-EPVS（0 = 无EPVS，1 = <10，2 = 11 - 20，3 = 21 - 40，4 = >40个EPVS）。在多变量逻辑回归中，我们测试了预先定义的高度（评分>2）CSO-EPVS和BG-EPVS与其他MRI标志物的关联。随后，在调整后的多项逻辑回归中（参照组，BG-EPVS = CSO-EPVS），我们评估了与CSO-EPVS优势（即CSO-EPVS > BG-EPVS）和BG-EPVS优势模式（即BG-EPVS > CSO-EPVS）的关联。
结果
我们纳入了315例CAA-ICH患者和137例HA-ICH患者。与HA相关的ICH相比，CAA相关的ICH中高度CSO-EPVS患病率更高（分别为43.8%和17.5%，<0.001）。在多变量逻辑回归中，高度CSO-EPVS与脑叶CMB相关（比值比[OR] 1.33，95%置信区间[CI] 1.10 - 1.61，= 0.003）和cSS相关（OR 2.08，95% CI 1.30 - 3.32，= 0.002）。深部CMB（OR 2.85，95% CI 1.75 - 4.64，<0.0001）和更高的WMH体积（OR 1.02，95% CI 1.01 - 1.04，= 0.010）是高度BG-EPVS的预测因素。CSO-EPVS优势模式在CAA-ICH中比在HA-ICH中更常见（分别为75.9%和39.4%，<0.0001）。CSO-PVS优势与脑叶CMB负担和cSS相关，而BG-EPVS优势与HA-ICH和WMH体积相关。
结论
MRI可见的EPVS的不同模式为自发性ICH患者潜在的主要微血管病类型提供了见解。
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