De Reuck Jacques, Auger Florent, Durieux Nicolas, Cordonnier Charlotte, Deramecourt Vincent, Pasquier Florence, Maurage Claude-Alain, Leys Didier, Bordet Regis
Université Lille 2, INSERM U 1171, Lille, France.
Eur Stroke J. 2016 Jun;1(2):122-129. doi: 10.1177/2396987316650780. Epub 2016 May 18.
White matter changes and lacunar infarcts are regarded as linked to the same underlying small-vessel pathology. On magnetic resonance imaging, white matter changes are frequently observed, while the number of lacunar infarcts is probably underestimated. The present study post-mortem 7.0-tesla magnetic resonance imaging study compares the severity and the distribution of white matter changes and lacunar infarcts in different neurodegenerative and vascular dementia syndromes in order to determine their impact on the disease evolution.
Eighty-four post-mortem brains consisting of 15 patients with pure Alzheimer's disease and 12 with associated cerebral amyloid angiopathy, 14 patients with frontotemporal lobar degeneration, 7 with Lewy body dementia, 10 with progressive supranuclear palsy, 14 with vascular dementia and 12 control brains were examined. Six hemispheric coronal sections of each brain underwent 7.0-tesla magnetic resonance imaging. Location and severity of white matter changes and lacunar infarcts were evaluated semi-quantitatively in each section separately.
White matter changes predominated in the prefrontal and frontal sections of frontotemporal lobar degeneration and in the post-central section of associated cerebral amyloid angiopathy brains, while overall increased in vascular dementia cases. Lacunar infarcts were more frequent in the vascular dementia brains and mainly increased in the centrum semiovale.
White matter changes have a different topographic distribution in neurodegenerative diseases and are most severe and extended in vascular dementia. Lacunar infarcts predominate in the deep white matter of vascular dementia compared to the neurodegenerative diseases. Vascular cognitive impairment is mainly linked to white matter changes due to chronic ischaemia as well as to lacunar infarcts due to small-vessel occlusion.
白质改变和腔隙性脑梗死被认为与相同的潜在小血管病变有关。在磁共振成像中，白质改变经常被观察到，而腔隙性脑梗死的数量可能被低估。本项7.0特斯拉磁共振成像尸检研究比较了不同神经退行性疾病和血管性痴呆综合征中白质改变和腔隙性脑梗死的严重程度及分布，以确定它们对疾病进展的影响。
检查了84个尸检大脑，其中包括15例单纯阿尔茨海默病患者和12例伴有脑淀粉样血管病患者、14例额颞叶变性患者、7例路易体痴呆患者、10例进行性核上性麻痹患者、14例血管性痴呆患者以及对照大脑12例。对每个大脑的六个半球冠状切片进行7.0特斯拉磁共振成像检查。分别对每个切片中白质改变和腔隙性脑梗死的位置及严重程度进行半定量评估。
白质改变在前额颞叶变性的额叶前部和额叶以及伴有脑淀粉样血管病大脑的中央后回最为明显，而在血管性痴呆病例中总体上有所增加。腔隙性脑梗死在血管性痴呆大脑中更为常见，主要在半卵圆中心增加。
白质改变在神经退行性疾病中具有不同的地形分布，在血管性痴呆中最为严重且范围更广。与神经退行性疾病相比，腔隙性脑梗死在血管性痴呆的深部白质中占主导。血管性认知障碍主要与慢性缺血导致的白质改变以及小血管闭塞导致的腔隙性脑梗死有关。
