Division of Medical Imaging and Technology, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.
J Am Heart Assoc. 2017 Sep 22;6(9):e006279. doi: 10.1161/JAHA.117.006279.
Magnetic resonance imaging-visible perivascular spaces (PVS) are related to interstitial fluid clearance pathways (including amyloid-β) in the brain and are suggested to be a marker of cerebral small vessel disease. We investigated the role, topography, and possible implications of PVS in cognitive impairment.
A total of 1504 patients undergoing memory clinic investigation and an associated brain magnetic resonance imaging scan were included in this cross-sectional study. Magnetic resonance images were assessed for markers of small vessel disease. Additionally, 1039 patients had cerebrospinal fluid analysis of amyloid-β 42, total tau (T-tau), and phosphorylated tau (-tau); 520 patients had apoE genotyping done. Results were analyzed with generalized linear models. A total of 289 (19%; 95% confidence interval, 17-21) had a high-grade PVS in the centrum semiovale (CSO) and 65 (4%; 95% confidence interval: 3%-5%) in the basal ganglia (BG). Centrum semiovale- and BG-PVS were both associated with high age (<0.001), hypertension (<0.001), probable cerebral amyloid angiopathy (<0.05), moderate-to-severe white matter hyperintensities (<0.001), cortical superficial siderosis (<0.001), cerebral microbleeds (<0.001), and PVS. centrum semiovale-PVS was separately associated with strictly lobar cerebral microbleeds (=0.057). BG-PVS was associated with strictly deep cerebral microbleeds (<0.001), lacunes (<0.001), and vascular dementia (=0.04). BG-PVS showed a tendency to be associated with high cerebrospinal fluid tau (B=0.002, =0.04) in the whole cohort and in Alzheimer's disease (B=0.005; =0.02). No other associations with cerebrospinal fluid or the apoE e4 allele was observed.
Centrum semiovale-PVS and BG-PVS have different underlying etiology, being associated with cerebral amyloid angiopathy and hypertensive vasculopathy, respectively, although a significant overlap between these pathologies is likely to exist.
磁共振成像可见的血管周围间隙（PVS）与脑内的间质液清除途径（包括淀粉样蛋白-β）有关，被认为是脑小血管疾病的标志物。我们研究了 PVS 在认知障碍中的作用、分布和可能的影响。
本横断面研究共纳入 1504 名接受记忆诊所检查和相关脑部磁共振成像扫描的患者。对磁共振图像进行小血管疾病标志物评估。此外，1039 名患者进行了脑脊液分析，检测淀粉样蛋白-β42、总 tau（T-tau）和磷酸化 tau（-tau）；520 名患者进行了载脂蛋白 E 基因分型。使用广义线性模型进行分析。共有 289 名（19%；95%置信区间，17-21）患者在半卵圆中心（CSO）有高等级的 PVS，65 名（4%；95%置信区间：3%-5%）患者在基底节（BG）有高等级的 PVS。CSO 和 BG-PVS 均与高龄（<0.001）、高血压（<0.001）、可能的脑淀粉样血管病（<0.05）、中重度脑白质高信号（<0.001）、皮质表浅铁质沉着（<0.001）、脑微出血（<0.001）和 PVS 相关。CSO-PVS 还与单纯性皮质下脑微出血（=0.057）相关。BG-PVS 与单纯性深部脑微出血（<0.001）、腔隙（<0.001）和血管性痴呆（=0.04）相关。在整个队列和阿尔茨海默病患者中，BG-PVS 与脑脊液 tau 升高呈趋势相关（B=0.002，=0.04），而与载脂蛋白 E e4 等位基因无其他相关性。
CSO-PVS 和 BG-PVS 具有不同的潜在病因，分别与脑淀粉样血管病和高血压性血管病变相关，尽管这两种病变之间可能存在显著的重叠。
