From the UCL Stroke Research Centre (J.G.B., D.W., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London; Department of Statistical Science (G.A.), University College London, United Kingdom; Stroke Research Centre (H.D.), Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China; Department of Neurology (K.-J.L.), Korea University Guro Hospital, Seoul; Department of Neurology (J.-S.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Neurology, Department of Medicine (K.C.T., G.K.K.L.) and Department of Diagnostic Radiology (H.M.), The University of Hong Kong; Department of Neurology (Y.D.K., J.-H.H.), Yonsei University College of Medicine, Seoul; Department of Neurology (T.-J.S.), Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea; Department of Neurology (D.S.D.), Sisli Hamidiye Etfal Teaching and Research Hospital, University of Health Sciences, Turkey; Department of Radiology (M.N.), Saga University Faculty of Medicine; Division of Neurology (M.Y., H.H.), Department of Internal Medicine, Saga University Faculty of Medicine, Japan; Stroke Center Klinik Hirslanden Zürich (M.K., N.P.); University of Basel (M.K.); Department of Neurology and Stroke Center University Hospital and University of Basel (A.Z.), Switzerland; Centre for Clinical Brain Sciences (R.A.-S.S., F.C., J.M.W.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science at University of Liverpool (G.Y.H.L.), Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom; Department of Neurology (L.P., M.B.G., S.J.), Inselspital, Bern University Hospital, Switzerland; Department of Imaging, School of Clinical Sciences at Monash Health (L.-A.S.), Peninsula Clinical School, Peninsula Health (C.C.K.), and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health (T.G.P.), Monash University, Melbourne, Australia; Department of Neurology (M.B., F.F.), University Hospital of Würzburg, Germany; Department of Imaging and Interventional Radiology (J.A., W.C.) and Division of Neurology, Department of Medicine and Therapeutics (C.C., T.W.L., Y.O.Y.S.), Prince of Wales Hospital, The Chinese University of Hong Kong; Institute of Applied Health Sciences (S.D.J.M.), University of Aberdeen, United Kingdom; Biomedical Imaging Group Rotterdam (F.D.), Department of Radiology and Nuclear Medicine (D.H.K.D.-N.), Erasmus University Medical Centre, Rotterdam, The Netherlands; Departments of Radiology and Nuclear Medicine (M.E.K.) and Neurology (J.S.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre; Department of Psychiatry and Neuropsychology (S.K.), School for Mental Health and Neuroscience, Maastricht University, The Netherlands; University of Lille (G.K., R.B.), Inserm, CHU de Lille, Lille Neuroscience & Cognition, France; National Centre for Healthy Ageing (V.K.S.), Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology (Y.Y.), Kansai Medical University, Osaka, Japan; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey; and Department of Neurology (H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Neurology. 2024 Jan 9;102(1):e207795. doi: 10.1212/WNL.0000000000207795. Epub 2023 Dec 13.
Visible perivascular spaces are an MRI marker of cerebral small vessel disease and might predict future stroke. However, results from existing studies vary. We aimed to clarify this through a large collaborative multicenter analysis.
We pooled individual patient data from a consortium of prospective cohort studies. Participants had recent ischemic stroke or transient ischemic attack (TIA), underwent baseline MRI, and were followed up for ischemic stroke and symptomatic intracranial hemorrhage (ICH). Perivascular spaces in the basal ganglia (BGPVS) and perivascular spaces in the centrum semiovale (CSOPVS) were rated locally using a validated visual scale. We investigated clinical and radiologic associations cross-sectionally using multinomial logistic regression and prospective associations with ischemic stroke and ICH using Cox regression.
We included 7,778 participants (mean age 70.6 years; 42.7% female) from 16 studies, followed up for a median of 1.44 years. Eighty ICH and 424 ischemic strokes occurred. BGPVS were associated with increasing age, hypertension, previous ischemic stroke, previous ICH, lacunes, cerebral microbleeds, and white matter hyperintensities. CSOPVS showed consistently weaker associations. Prospectively, after adjusting for potential confounders including cerebral microbleeds, increasing BGPVS burden was independently associated with future ischemic stroke (versus 0-10 BGPVS, 11-20 BGPVS: HR 1.19, 95% CI 0.93-1.53; 21+ BGPVS: HR 1.50, 95% CI 1.10-2.06; = 0.040). Higher BGPVS burden was associated with increased ICH risk in univariable analysis, but not in adjusted analyses. CSOPVS were not significantly associated with either outcome.
In patients with ischemic stroke or TIA, increasing BGPVS burden is associated with more severe cerebral small vessel disease and higher ischemic stroke risk. Neither BGPVS nor CSOPVS were independently associated with future ICH.
可见的血管周围间隙是脑小血管疾病的 MRI 标志物，可能预测未来的中风。然而，现有研究的结果存在差异。我们旨在通过一项大型协作多中心分析来阐明这一点。
我们汇集了来自前瞻性队列研究联盟的个体患者数据。参与者最近患有缺血性中风或短暂性脑缺血发作（TIA），接受了基线 MRI 检查，并进行了缺血性中风和症状性颅内出血（ICH）的随访。使用经过验证的视觉量表对基底节区血管周围间隙（BGPVS）和半卵圆中心血管周围间隙（CSOPVS）进行局部评分。我们使用多项逻辑回归进行横截面临床和影像学关联研究，使用 Cox 回归进行前瞻性缺血性中风和 ICH 关联研究。
我们纳入了来自 16 项研究的 7778 名参与者（平均年龄 70.6 岁，42.7%为女性），中位随访时间为 1.44 年。发生了 80 例 ICH 和 424 例缺血性中风。BGPVS 与年龄增长、高血压、既往缺血性中风、既往 ICH、腔隙性梗死、脑微出血和脑白质高信号有关。CSOPVS 则显示出较弱的一致性关联。前瞻性地，在调整包括脑微出血在内的潜在混杂因素后，BGPVS 负担的增加与未来缺血性中风独立相关（与 0-10BGPVS 相比，11-20BGPVS：HR 1.19，95%CI 0.93-1.53；21+BGPVS：HR 1.50，95%CI 1.10-2.06；P=0.040）。在单变量分析中，较高的 BGPVS 负担与 ICH 风险增加相关，但在调整分析中并非如此。CSOPVS 与两种结果均无显著相关性。
在缺血性中风或 TIA 患者中，BGPVS 负担的增加与更严重的脑小血管疾病和更高的缺血性中风风险相关。BGPVS 和 CSOPVS 均与未来 ICH 无关。
