Frey Benedikt M, Petersen Marvin, Mayer Carola, Schulz Maximilian, Cheng Bastian, Thomalla Götz
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Front Neurol. 2019 Mar 26;10:238. doi: 10.3389/fneur.2019.00238. eCollection 2019.
White matter hyperintensities of presumed vascular origin (WMH) are a common finding in elderly people and a growing social malady in the aging western societies. As a manifestation of cerebral small vessel disease, WMH are considered to be a vascular contributor to various sequelae such as cognitive decline, dementia, depression, stroke as well as gait and balance problems. While pathophysiology and therapeutical options remain unclear, large-scale studies have improved the understanding of WMH, particularly by quantitative assessment of WMH. In this review, we aimed to provide an overview of the characteristics, research subjects and segmentation techniques of these studies. We performed a systematic review according to the PRISMA statement. One thousand one hundred and ninety-six potentially relevant articles were identified via PubMed search. Six further articles classified as relevant were added manually. After applying a catalog of exclusion criteria, remaining articles were read full-text and the following information was extracted into a standardized form: year of publication, sample size, mean age of subjects in the study, the cohort included, and segmentation details like the definition of WMH, the segmentation method, reference to methods papers as well as validation measurements. Our search resulted in the inclusion and full-text review of 137 articles. One hundred and thirty-four of them belonged to 37 prospective cohort studies. Median sample size was 1,030 with no increase over the covered years. Eighty studies investigated in the association of WMH and risk factors. Most of them focussed on arterial hypertension, diabetes mellitus type II and Apo E genotype and inflammatory markers. Sixty-three studies analyzed the association of WMH and secondary conditions like cognitive decline, mood disorder and brain atrophy. Studies applied various methods based on manual (3), semi-automated (57), and automated segmentation techniques (75). Only 18% of the articles referred to an explicit definition of WMH. The review yielded a large number of studies engaged in WMH research. A remarkable variety of segmentation techniques was applied, and only a minority referred to a clear definition of WMH. Most addressed topics were risk factors and secondary clinical conditions. In conclusion, WMH research is a vivid field with a need for further standardization regarding definitions and used methods.
假定血管源性白质高信号（WMH）在老年人中很常见，并且在老龄化的西方社会中是一种日益严重的社会问题。作为脑小血管疾病的一种表现，WMH被认为是导致各种后遗症的血管因素，如认知衰退、痴呆、抑郁、中风以及步态和平衡问题。虽然病理生理学和治疗选择仍不明确，但大规模研究增进了我们对WMH的理解，特别是通过对WMH的定量评估。在本综述中，我们旨在概述这些研究的特征、研究对象和分割技术。我们根据PRISMA声明进行了系统综述。通过PubMed搜索识别出1196篇可能相关的文章。另外手动添加了6篇分类为相关的文章。应用一系列排除标准后，对剩余文章进行全文阅读，并将以下信息提取到标准化表格中：发表年份、样本量、研究中受试者的平均年龄、纳入的队列，以及WMH的定义、分割方法、方法论文参考文献以及验证测量等分割细节。我们的搜索结果是纳入并全文审查了137篇文章。其中134篇属于37项前瞻性队列研究。样本量中位数为1030，在涵盖的年份中没有增加。80项研究调查了WMH与风险因素的关联。其中大多数集中在动脉高血压、II型糖尿病、载脂蛋白E基因型和炎症标志物上。63项研究分析了WMH与认知衰退、情绪障碍和脑萎缩等继发疾病的关联。研究应用了基于手动（3项）、半自动（57项）和自动分割技术（75项）的各种方法。只有18%的文章提到了WMH的明确定义。该综述产生了大量从事WMH研究的文章。应用了各种各样的分割技术，只有少数文章提到了WMH的明确定义。大多数涉及的主题是风险因素和继发临床情况。总之，WMH研究是一个活跃的领域，在定义和使用方法方面需要进一步标准化。
