Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
UK Dementia Research Institute at The University of Edinburgh, Edinburgh, UK.
Neuropathol Appl Neurobiol. 2021 Dec;47(7):910-930. doi: 10.1111/nan.12737. Epub 2021 Jun 15.
Sporadic human cerebral small vessel disease (SVD) commonly causes stroke and dementia but its pathogenesis is poorly understood. There are recognised neuroimaging and histopathological features. However, relatively few studies have examined the relationship between the radiological and pathological correlates of SVD; better correlation would promote greater insight into the underlying biological changes.
We performed a systematic review to collate and appraise the information derived from studies that correlated histological with neuroimaging-defined SVD lesions. We searched for studies describing post-mortem imaging and histological tissue examination in adults, extracted data from published studies, categorised the information and compiled this narrative.
We identified 38 relevant studies, including at least 1146 subjects, 342 of these with SVD: 29 studies focussed on neuroradiological white matter lesions (WML), six on microinfarcts and three on dilated perivascular spaces (PVS) and lacunes. The histopathology terminology was diverse with few robust definitions. Reporting and methodology varied widely between studies, precluding formal meta-analysis. PVS and 'oedema' were frequent findings in WML, being described in at least 94 and 18 radiological WML, respectively, in addition to myelin pallor. Histopathological changes extended beyond the radiological lesion margins in at least 33 radiological WML. At least 43 radiological lesions not seen pathologically and at least 178 histological lesions were not identified on imaging.
Histopathological assessment of human SVD is hindered by inconsistent methodological approaches and unstandardised definitions. The data from this systematic review will help to develop standardised definitions to promote consistency in human SVD research.
散发性人脑小血管病（SVD）常引起中风和痴呆，但发病机制尚不清楚。存在公认的神经影像学和组织病理学特征。然而，很少有研究检查 SVD 的放射学和病理学相关性之间的关系；更好的相关性将促进对潜在生物学变化的更深入了解。
我们进行了系统评价，以整理和评估从与 SVD 的神经影像学定义病变相关的研究中获得的信息。我们搜索了描述成人死后影像学和组织学检查的研究，从已发表的研究中提取数据，对信息进行分类，并编写了叙述性综述。
我们确定了 38 项相关研究，包括至少 1146 名受试者，其中 342 名患有 SVD：29 项研究侧重于神经放射学白质病变（WML），6 项研究侧重于微梗死，3 项研究侧重于扩张的血管周围空间（PVS）和腔隙。组织病理学术语多种多样，缺乏稳健的定义。研究之间的报告和方法差异很大，排除了正式的荟萃分析。PVS 和“水肿”是 WML 的常见发现，在至少 94 项和 18 项放射学 WML 中分别描述，除了髓磷脂苍白。组织病理学变化至少在 33 项放射学 WML 的放射学病变边缘之外扩展。至少有 43 项放射学病变未在病理学上发现，至少有 178 项组织学病变未在影像学上发现。
人类 SVD 的组织病理学评估受到不一致的方法学方法和非标准化定义的阻碍。本系统评价的数据将有助于制定标准化定义，以促进人类 SVD 研究的一致性。
