Moreton Fiona C, Düring Marco, Phan Thanh, Srikanth Velandai, Beare Richard, Huang Xuya, Jouvent Eric, Chabriat Hugues, Dichgans Martin, Muir Keith W
Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, Scotland.
Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany.
Eur Stroke J. 2017 Sep;2(3):264-271. doi: 10.1177/2396987317718450. Epub 2017 Jul 7.
Lacunes are defined morphologically by size and location, but radiological characteristics alone may be unable to distinguish small vessel disease aetiology from alternative mechanisms. We investigated the branching order of arterial vessels associated with basal ganglia lacunes in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), in order to improve the understanding of their pathogenesis in pure cerebral small vessel disease.
Adults with a confirmed diagnosis of CADASIL were included. A pilot study was conducted in a Scottish CADASIL cohort. The Paris-Munich CADASIL cohort was used for independent validation. Lacunes identified on T1-weighted magnetic resonance imaging scans were registered to a standard brain template. A microangiographic template of the basal ganglia vasculature was automatically overlaid onto coronal slices, and raters estimated the vessel branching order related to each lacune.
Of 179 lacunes, 150 (84%) were associated with third-order vessels. In 14 incident lacunes, 11 (79%) were associated with third-order vessels. In the pilot study, lacune volume was significantly lower in lacunes associated with third-order vessels (0.04 ml ± 0.04 ml) compared to second-order vessels (0.48 ± 0.16 ml; < 0.001).
In this study of CADASIL patients, most lacunes were small and associated with third-order vessel disease. This suggests that these are the vessels primarily affected in cerebral small vessel disease. Microangiographic template techniques could be used to further investigate in a general stroke population whether finding large lacunes originating from higher order vessels indicates an alternative cause of stroke.
Lacunes in pure small vessel disease are associated with the smallest vessels in the basal ganglia.
腔隙灶是根据大小和位置进行形态学定义的，但仅靠放射学特征可能无法区分小血管病病因与其他机制。我们研究了伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病（CADASIL）中与基底节腔隙灶相关的动脉分支顺序，以增进对其在单纯性脑小血管病发病机制中的理解。
纳入确诊为CADASIL的成年患者。在一个苏格兰CADASIL队列中进行了一项初步研究。巴黎 - 慕尼黑CADASIL队列用于独立验证。在T1加权磁共振成像扫描上识别出的腔隙灶被配准到标准脑模板。基底节脉管系统的微血管造影模板自动覆盖在冠状切片上，评估者估计与每个腔隙灶相关的血管分支顺序。
在179个腔隙灶中，150个（84%）与三级血管相关。在14个新发腔隙灶中，11个（79%）与三级血管相关。在初步研究中，与二级血管相关的腔隙灶（0.48±0.16 ml）相比，与三级血管相关的腔隙灶体积显著更小（0.04 ml±0.04 ml；P<0.001）。
在这项对CADASIL患者的研究中，大多数腔隙灶较小且与三级血管病变相关。这表明这些是脑小血管病中主要受影响的血管。微血管造影模板技术可用于在一般卒中人群中进一步研究，发现源自高阶血管的大腔隙灶是否提示卒中的另一种病因。
单纯性小血管病中的腔隙灶与基底节中最小的血管相关。
