Javierre-Petit Carles, Kontzialis Marinos, Leurgans Sue E, Bennett David A, Schneider Julie A, Arfanakis Konstantinos
Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL 60616, USA.
Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
Brain Commun. 2024 Jul 30;6(4):fcae252. doi: 10.1093/braincomms/fcae252. eCollection 2024.
Enlarged perivascular spaces (EPVS) are common in older adults, but their neuropathologic correlates are unclear mainly because most work to date has relied on visual rating scales and/or clinical cohorts. The present study first developed a deep-learning model for automatic segmentation, localization and quantification of EPVS in brain MRI, and then used this model to investigate the neuropathologic, clinical and cognitive correlates of EPVS in 817 community-based older adults that underwent autopsy. The new method exhibited high sensitivity in detecting EPVS as small as 3 mm, good segmentation accuracy and consistency. Most EPVS were located in the frontal lobe, but the highest density was observed in the basal ganglia. EPVS in the cerebrum and specifically in the frontal lobe were associated with infarcts independent of other neuropathologies, while temporal and occipital EPVS were associated with cerebral amyloid angiopathy. EPVS in most brain lobes were also associated with diabetes mellitus independently of neuropathologies, while basal ganglia EPVS were independently associated with hypertension, supporting the notion of independent pathways from diabetes and hypertension to EPVS. Finally, EPVS were associated with lower cognitive performance independently of neuropathologies and clinical variables, suggesting that EPVS represent additional abnormalities contributing to lower cognition.
血管周围间隙增宽（EPVS）在老年人中很常见，但其神经病理学相关性尚不清楚，主要是因为迄今为止大多数研究都依赖于视觉评分量表和/或临床队列。本研究首先开发了一种深度学习模型，用于在脑磁共振成像（MRI）中对EPVS进行自动分割、定位和定量，然后使用该模型研究817名接受尸检的社区老年人中EPVS的神经病理学、临床和认知相关性。新方法在检测小至3毫米的EPVS时表现出高灵敏度、良好的分割准确性和一致性。大多数EPVS位于额叶，但在基底节中观察到的密度最高。大脑中的EPVS，特别是额叶中的EPVS，与梗死相关，独立于其他神经病理学，而颞叶和枕叶的EPVS与脑淀粉样血管病相关。大多数脑叶中的EPVS也独立于神经病理学与糖尿病相关，而基底节EPVS与高血压独立相关，支持从糖尿病和高血压到EPVS存在独立途径的观点。最后，EPVS与较低的认知表现相关，独立于神经病理学和临床变量，这表明EPVS代表了导致认知降低的额外异常情况。
