Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China.
Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Eur Radiol. 2023 Nov;33(11):8057-8066. doi: 10.1007/s00330-023-09744-4. Epub 2023 Jun 7.
Venous pathology could contribute to the development of parenchymal lesions in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We aim to identify presumed periventricular venous infarction (PPVI) in CADASIL and analyze the associations between PPVI, white matter edema, and microstructural integrity within white matter hyperintensities (WMHs) regions.
We included forty-nine patients with CADASIL from a prospectively enrolled cohort. PPVI was identified according to previously established MRI criteria. White matter edema was evaluated using the free water (FW) index derived from diffusion tensor imaging (DTI), and microstructural integrity was evaluated using FW-corrected DTI parameters. We compared the mean FW values and regional volumes with different levels of FW (ranging from 0.3 to 0.8) in WMHs regions between the PPVI and non-PPVI groups. We used intracranial volume to normalize each volume. We also analyzed the association between FW and microstructural integrity in fiber tracts connected with PPVI.
We found 16 PPVIs in 10 of 49 CADASIL patients (20.4%). The PPVI group had larger WMHs volume (0.068 versus 0.046, p = 0.036) and higher FW in WMHs (0.55 versus 0.52, p = 0.032) than the non-PPVI group. Larger areas with high FW content were also found in the PPVI group (threshold: 0.7, 0.47 versus 0.37, p = 0.015; threshold: 0.8, 0.33 versus 0.25, p = 0.003). Furthermore, higher FW correlated with decreased microstructural integrity (p = 0.009) in fiber tracts connected with PPVI.
PPVI was associated with increased FW content and white matter degeneration in CADASIL patients.
PPVI is an important factor related with WMHs, and therefore, preventing the occurrence of PPVI would be beneficial for patients with CADASIL.
•Presumed periventricular venous infarction is important and occurs in about 20% of patients with CADASIL. •Presumed periventricular venous infarction was associated with increased free water content in the regions of white matter hyperintensities. •Free water correlated with microstructural degenerations in white matter tracts connected with the presumed periventricular venous infarction.
静脉病变可能导致伴有皮质下梗死和白质脑病的脑常染色体显性遗传性动脉病（CADASIL）的实质病变。我们旨在确定 CADASIL 中的假定脑室周围静脉梗死（PPVI），并分析 PPVI 与脑白质水肿（FW）和脑白质高信号（WMH）区域内的微观结构完整性之间的相关性。
我们纳入了前瞻性队列研究中的 49 名 CADASIL 患者。根据先前建立的 MRI 标准确定 PPVI。使用源自弥散张量成像（DTI）的自由水（FW）指数评估脑白质水肿，并用 FW 校正的 DTI 参数评估微观结构完整性。我们比较了有和无 PPVI 的两组患者在 WMH 区域内不同 FW 水平（0.3 至 0.8）的平均 FW 值和区域体积。我们使用颅内体积对每个体积进行归一化。我们还分析了与 PPVI 相关的纤维束中 FW 与微观结构完整性之间的相关性。
我们在 49 名 CADASIL 患者中的 10 名（20.4%）患者中发现了 16 例 PPVI。与无 PPVI 组相比，PPVI 组的 WMH 体积更大（0.068 比 0.046，p=0.036），WMH 中的 FW 更高（0.55 比 0.52，p=0.032）。在 PPVI 组中，也发现了更高 FW 含量的更大区域（阈值：0.7，0.47 比 0.37，p=0.015；阈值：0.8，0.33 比 0.25，p=0.003）。此外，更高的 FW 与与 PPVI 相关的纤维束中微观结构完整性的降低相关（p=0.009）。
PPVI 与 CADASIL 患者的 FW 含量增加和白质变性有关。
PPVI 是与 WMH 相关的重要因素，因此，预防 PPVI 的发生将有利于 CADASIL 患者。
假定脑室周围静脉梗死是 CADASIL 患者中的重要病变，发生率约为 20%。
假定脑室周围静脉梗死与脑白质高信号区域的自由水含量增加有关。
自由水与与假定脑室周围静脉梗死相关的白质束中的微观结构退变相关。
