磁共振成像上的大脑皮质微梗死及其与脑淀粉样血管病认知的关系。
Cerebral Cortical Microinfarcts on Magnetic Resonance Imaging and Their Association With Cognition in Cerebral Amyloid Angiopathy.
机构信息
From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.).
Centre Hospitalier Sainte-Anne, Université Paris Descartes, France (G.B.).
出版信息
Stroke. 2018 Oct;49(10):2330-2336. doi: 10.1161/STROKEAHA.118.022280.
Background and Purpose- We aimed to explore the association between presence of cerebral cortical microinfarcts (CMIs) on magnetic resonance imaging and other small-vessel disease neuroimaging biomarkers in cerebral amyloid angiopathy (CAA) and to analyze the role of CMIs on individual cognitive domains and dementia conversion. Methods- Participants were recruited from an ongoing longitudinal research cohort of eligible CAA patients between March 2006 and October 2016. A total of 102 cases were included in the analysis that assessed the relationship of cortical CMIs to CAA neuroimaging markers. Ninety-five subjects had neuropsychological tests conducted within 1 month of magnetic resonance imaging scanning. Seventy-five nondemented CAA patients had cognitive evaluation data available during follow-up. Results- Among 102 patients enrolled, 40 patients had CMIs (39%) on magnetic resonance imaging. CMIs were uniformly distributed throughout the cortex without regional predilection ( P=0.971). The presence of CMIs was associated with lower total brain volume (odds ratio, 0.85; 95% CI, 0.74-0.98; P=0.025) and presence of cortical superficial siderosis (odds ratio, 2.66; 95% CI, 1.10-6.39; P=0.029). In 95 subjects with neuropsychological tests, presence of CMIs was associated with impaired executive function (β, -0.23; 95% CI, -0.44 to -0.02; P=0.036) and processing speed (β, -0.24; 95% CI, -0.45 to -0.04; P=0.020). Patients with CMIs had a higher cumulative dementia incidence compared with patients without CMIs ( P=0.043), whereas only baseline total brain volume (hazard ratio, 0.76; 95% CI, 0.62-0.92; P=0.006) independently predicted dementia conversion. Conclusions- Magnetic resonance imaging-detected CMIs in CAA correlated with greater overall disease burden. The presence of CMIs was associated with worse cognitive performance, whereas only total brain atrophy independently predicted dementia conversion.
背景与目的-我们旨在探讨磁共振成像上存在皮质微梗死（CMIs）与脑淀粉样血管病（CAA）中其他小血管疾病神经影像学标志物之间的关系，并分析 CMIs 在个体认知域和痴呆转化中的作用。方法-参与者是从 2006 年 3 月至 2016 年 10 月期间进行的一项正在进行的纵向研究队列中符合条件的 CAA 患者中招募的。共纳入 102 例分析，评估皮质 CMIs 与 CAA 神经影像学标志物的关系。95 例受试者在磁共振成像扫描后 1 个月内进行了神经心理学测试。75 例非痴呆性 CAA 患者在随访期间有认知评估数据。结果-在纳入的 102 例患者中，40 例（39%）患者在磁共振成像上存在 CMIs。CMIs 均匀分布于整个皮质，无区域偏好（P=0.971）。存在 CMIs 与总脑容量较低相关（比值比，0.85；95%置信区间，0.74-0.98；P=0.025）和皮质表浅铁质沉着症的存在相关（比值比，2.66；95%置信区间，1.10-6.39；P=0.029）。在 95 例进行神经心理学测试的受试者中，存在 CMIs 与执行功能受损相关（β，-0.23；95%置信区间，-0.44 至-0.02；P=0.036）和处理速度受损相关（β，-0.24；95%置信区间，-0.45 至-0.04；P=0.020）。与无 CMIs 的患者相比，存在 CMIs 的患者累积痴呆发生率更高（P=0.043），而只有基线总脑容量（危险比，0.76；95%置信区间，0.62-0.92；P=0.006）独立预测痴呆转化。结论-在 CAA 中，磁共振成像检测到的 CMIs 与更大的整体疾病负担相关。CMIs 的存在与认知功能下降相关，而只有总脑萎缩独立预测痴呆转化。
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