Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
Department of Neurology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
Eur Radiol. 2022 Mar;32(3):1951-1958. doi: 10.1007/s00330-021-08288-9. Epub 2021 Oct 26.
Radiological diagnosis of subtypes of cerebral small vessel diseases remains challenging. This study aimed to explore the spatial distribution of cerebral microbleeds (CMBs) in cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) in contrast to cerebral amyloid angiopathy (CAA) in the lobar regions.
Thirty-two patients with CADASIL and 33 patients with probable CAA were prospectively and consecutively included. On 3-Tesla susceptibility-weighted magnetic resonance images, CMBs were analyzed for incidence and volume within atlas-based regions of interest, followed by voxel-wise analysis using risk mapping. The distribution of CMBs was correlated with the status of hypertension. Correlation and group differences with a p-value less than 0.05 were considered to be significant.
As compared with the CAA group, the CADASIL group presents a larger CMB volume in hippocampus/amygdala and white matter (nonparametric analysis of covariance, p = 0.014 and 0.037, respectively), a smaller CMB volume in parietal lobe (p = 0.038), and a higher incidence in hippocampus/amygdala, white matter, and insula (logistic regression, p = 0.019, 0.024, and 0.30, respectively). As part of the exclusion criteria of probable CAA, thalamus, basal ganglia, and pons exhibit greater CMB volume/incidence in the CADASIL group. In CADASIL patients, hot spots of CMBs are identified in the putamen and posteromedial thalamus; hypertension is associated with larger CMB volumes in insula, basal ganglia, and pons.
The spatial distribution of CMBs is differentiable between CADASIL and CAA in lobar regions. In CADASIL patients, hypertension has a region-dependent mediating effect on the CMB volume.
• The topological distribution of lobar CMBs is differentiable between CADASIL and CAA. • In CADASIL patients, hypertension mediates CMB volume and the mediation is region dependent. • CMB risk mapping allows for voxel-wise exploration of CMB distribution and reveals hot spots in the putamen and posteromedial thalamus in CADASIL.
脑小血管疾病亚型的放射学诊断仍然具有挑战性。本研究旨在探讨脑常染色体显性动脉病伴皮质下梗死和白质脑病（CADASIL）与脑淀粉样血管病（CAA）在脑叶区域的脑微出血（CMB）的空间分布。
前瞻性连续纳入 32 例 CADASIL 患者和 33 例可能的 CAA 患者。在 3T 磁共振磁敏感加权成像上，基于图谱的感兴趣区分析 CMB 的发生率和体积，然后使用风险映射进行体素分析。CMB 的分布与高血压的状态相关。具有小于 0.05 的 p 值的相关性和组间差异被认为是显著的。
与 CAA 组相比，CADASIL 组在海马/杏仁核和白质中的 CMB 体积更大（非参数协方差分析，p = 0.014 和 0.037），在顶叶中的 CMB 体积更小（p = 0.038），在海马/杏仁核、白质和脑岛中的发生率更高（逻辑回归，p = 0.019、0.024 和 0.30）。作为可能的 CAA 的排除标准的一部分，丘脑、基底节和脑桥在 CADASIL 组中显示出更大的 CMB 体积/发生率。在 CADASIL 患者中，壳核和丘脑后内侧是 CMB 的热点；高血压与脑岛、基底节和脑桥中的 CMB 体积增大有关。
脑叶区域 CADASIL 和 CAA 之间的 CMB 空间分布是可区分的。在 CADASIL 患者中，高血压对 CMB 体积有区域依赖性的介导作用。
CADASIL 和 CAA 之间的脑叶 CMB 的拓扑分布是可区分的。
在 CADASIL 患者中，高血压介导 CMB 体积，且介导作用具有区域依赖性。
CMB 风险映射允许对 CMB 分布进行体素级探索，并在 CADASIL 中揭示壳核和丘脑后内侧的热点。
