Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan.
Jpn J Radiol. 2024 Oct;42(10):1110-1121. doi: 10.1007/s11604-024-01595-3. Epub 2024 Jun 19.
We examined whether time-course augmentation of perivascular space enlargement in the basal ganglia (BG-PVS) reflected cerebral small vessel disease (CSVD) severity by considering white matter hyperintensity lesion (WMHL) as an indicator for CSVD.
This study population included 416 older participants from a community-based cohort. They participated in magnetic resonance imaging (MRI) studies more than once during the study period. The grades for BG-PVS and WMHL were evaluated by visual rating scales; BG-PVS time-course augmentation in 4-9 years was also evaluated. At baseline, the participants were asked about their smoking and drinking history, and medical history. They also underwent a blood examination and their office blood pressure (BP) examination. In addition, 24-h ambulatory BP monitoring was also performed within the study period.
Of the 416 participants, 48 participants (11.5%) had BG-PVS time-course augmentation. The participants with BG-PVS augmentation had significantly lower LDL levels, hyper-nighttime BP, and lower nighttime BP fall in univariate analysis (p = 0.03, p = 0.03, p = 0.003, respectively). In multivariate analysis, lower nighttime BP fall and male sex showed significance (p = 0.02, 0.03, respectively). Additionally, BG-PVS time-course augmentation was significantly associated with subsequent WMHL severity in univariate analysis (p < 0.001), which remained significant in multivariate analysis adjusted by imaging and demographic factors (p = 0.03). In multivariate analysis, additionally adjusted by the clinical factors, the significance disappeared (p = 0.07).
This study revealed that the lower nighttime BP fall in ambulatory blood pressure monitoring was a factor significantly associated with BG-PVS augmentation. Moreover, the BG-PVS time-course augmentation would be a notable finding that was associated with the subsequent WMHL.
通过将脑白质高信号病变（WMHL）作为脑小血管病（CSVD）的指标，我们研究了基底节区血管周围间隙扩大（BG-PVS）的时间进程增强是否反映了 CSVD 的严重程度。
本研究人群包括来自社区为基础的队列的 416 名老年参与者。他们在研究期间多次参加了磁共振成像（MRI）研究。通过视觉评分量表评估 BG-PVS 和 WMHL 的分级；还评估了 4-9 年内 BG-PVS 的时间进程增强。在基线时，参与者被询问了他们的吸烟和饮酒史以及病史。他们还进行了血液检查和诊室血压（BP）检查。此外，在研究期间还进行了 24 小时动态血压监测。
在 416 名参与者中，有 48 名（11.5%）有 BG-PVS 时间进程增强。在单变量分析中，BG-PVS 增强的参与者的 LDL 水平明显较低，夜间血压升高，夜间血压下降幅度较低（p=0.03，p=0.03，p=0.003，分别）。在多变量分析中，夜间血压下降幅度和男性性别具有显著意义（p=0.02，0.03）。此外，BG-PVS 时间进程增强在单变量分析中与随后的 WMHL 严重程度显著相关（p<0.001），在调整了影像学和人口统计学因素后，这一相关性仍然显著（p=0.03）。在多变量分析中，在进一步调整了临床因素后，这种相关性消失（p=0.07）。
本研究表明，动态血压监测中的夜间血压下降幅度较低是与 BG-PVS 增强显著相关的因素。此外，BG-PVS 的时间进程增强是与随后的 WMHL 相关的显著发现。
