Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region of China.
Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China.
Atherosclerosis. 2023 Sep;381:117247. doi: 10.1016/j.atherosclerosis.2023.117247. Epub 2023 Aug 19.
Despite reported correlations between intracranial arterial calcification (IAC) and white matter hyperintensities (WMH), little is known about the relationship between IAC pattern and WMH. By differentiating intimal and medial IAC, we aimed to investigate the relationship between IAC pattern and WMH.
Consecutive acute stroke patients were included. IAC pattern was categorized as intimal or medial on plain brain CT. The number of cerebral arteries involved by IAC for each patient was recorded. IAC severity was defined as focal or diffuse. On brain MRI, the burden of WMH was visually graded and classified as absent mild, moderate and severe. Multiple logistic regression was performed to examine the relationship between IAC and WMH.
Among 265 patients, intimal IAC was detected in 54.7% patients and medial IAC in 48.5% patients. Diffuse IAC was present in 27.9% patients, all of which were medial. WMH was found in 75.5% patients, including 39.6% patients with mild WMH, 26.0% with moderate WMH, and 9.8% with severe WMH. The severity of medial IAC was correlated with WMH occurrence (p < 0.001). Chi-square linear trend suggested the number of arteries involved by medial IAC (p < 0.001) and the severity of medial IAC (p < 0.001) were correlated with WMH burden. Multiple ordinal logistic regression demonstrated a positive correlation of WMH burden with the number of arteries involved by medial IAC (p < 0.001) and the severity of medial IAC (p < 0.001).
Medial IAC was correlated with WMH. The dose-effect relationship between medial IAC and WMH suggests underlying shared mechanisms of intracranial large artery disease and small vessel disease.
尽管颅内动脉钙化（IAC）与脑白质高信号（WMH）之间存在相关性，但关于 IAC 模式与 WMH 之间的关系知之甚少。通过区分内膜性和中膜性 IAC，我们旨在研究 IAC 模式与 WMH 之间的关系。
连续纳入急性脑卒中患者。根据平扫脑 CT 将 IAC 模式分为内膜性或中膜性。记录每位患者 IAC 累及的脑动脉数量。IAC 严重程度定义为局灶性或弥漫性。在脑 MRI 上，通过视觉分级评估 WMH 负荷，并分为无、轻度、中度和重度。采用多因素逻辑回归分析 IAC 与 WMH 之间的关系。
在 265 例患者中，54.7%的患者存在内膜性 IAC，48.5%的患者存在中膜性 IAC。27.9%的患者存在弥漫性 IAC，均为中膜性。75.5%的患者存在 WMH，其中 39.6%的患者为轻度 WMH，26.0%的患者为中度 WMH，9.8%的患者为重度 WMH。中膜性 IAC 的严重程度与 WMH 的发生相关（p<0.001）。卡方线性趋势检验提示中膜性 IAC 累及的动脉数量（p<0.001）和中膜性 IAC 的严重程度（p<0.001）与 WMH 负荷相关。多序逻辑回归显示，WMH 负荷与中膜性 IAC 累及的动脉数量（p<0.001）和中膜性 IAC 的严重程度（p<0.001）呈正相关。
中膜性 IAC 与 WMH 相关。中膜性 IAC 与 WMH 之间的剂量-效应关系提示颅内大血管疾病和小血管疾病之间存在潜在的共同发病机制。
