Department of Neurology and Neurosurgery, University Medical Centre Utrecht, the Netherlands (D.K., G.J.B.).
Departments of Radiology and Nuclear Medicine (M.W.V., E.E.B., E.J.V.), Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.
Stroke. 2024 Dec;55(12):2863-2871. doi: 10.1161/STROKEAHA.124.046731. Epub 2024 Nov 25.
Cerebral small vessel disease (SVD) is manifested on magnetic resonance imaging (MRI) by white matter hyperintensities, lacunes, microbleeds, and atrophy. While these manifestations can be part of normal aging, a high burden has been associated with cognitive impairment and vascular events. Distinguishing between normal versus abnormal SVD lesion burden in clinical practice remains complex. Our objective is to establish age- and sex-specific normative data for MRI manifestations of SVD, to support clinical assessment in individual patients.
We used 11 465 MRI scans from 5402 participants of the Rotterdam Study, the Netherlands, an ongoing prospective population-based cohort since 1990, to develop percentile curves for white matter hyperintensities and brain parenchymal fraction and probability curves for the prevalence and count of lacunes and microbleeds, across ages 45 to 100 years, stratified by sex.
Participants were primarily White (≈97%), with a mean age at first scan of 64.7 (range, 45.7-97.9) years, and 55.7% being female participants. For all SVD MRI manifestations, the curves demonstrated nonlinear trends, with accelerating burden with advancing age (eg, doubling of white matter hyperintensity fraction every 10 years). Regarding brain parenchymal fraction, a decline was seen earlier in male participants (≈45 years) than female participants (≈60 years) and was more pronounced in male participants over time. Female participants had slightly higher white matter hyperintensity fractions compared with male participants across all ages. Lacunes and microbleeds were more frequently found in male participants than in female participants, and microbleeds were more prevalent than lacunes.
We provide comprehensive normative data for different MRI manifestations of SVD, presented as percentile and probability curves by age, stratified by sex. This can aid clinicians to actually quantify the SVD burden on an individual patient's MRI scans and detect patterns of abnormality.
脑小血管病（SVD）在磁共振成像（MRI）上表现为白质高信号、腔隙、微出血和萎缩。虽然这些表现可能是正常衰老的一部分，但高负担与认知障碍和血管事件有关。在临床实践中，区分正常与异常 SVD 病变负担仍然很复杂。我们的目标是为 SVD 的 MRI 表现建立年龄和性别特异性的正常数据，以支持对个体患者的临床评估。
我们使用了来自荷兰鹿特丹研究的 5402 名参与者的 11465 次 MRI 扫描，这是一项自 1990 年以来持续进行的前瞻性人群队列研究，以制定 45 至 100 岁年龄组的白质高信号和脑实质分数的百分位数曲线，以及腔隙和微出血的患病率和数量的概率曲线，按性别分层。
参与者主要为白人（约 97%），首次扫描时的平均年龄为 64.7 岁（范围为 45.7-97.9 岁），55.7%为女性参与者。所有 SVD MRI 表现的曲线均显示出非线性趋势，随着年龄的增长（例如，白质高信号分数每 10 年增加一倍），负担逐渐增加。关于脑实质分数，男性参与者（约 45 岁）比女性参与者（约 60 岁）更早出现下降，而且随着时间的推移，男性参与者的下降更为明显。在所有年龄段，女性参与者的白质高信号分数略高于男性参与者。腔隙和微出血在男性参与者中比在女性参与者中更常见，并且微出血比腔隙更常见。
我们提供了 SVD 不同 MRI 表现的综合正常数据，按年龄和性别分层，以百分位数和概率曲线表示。这可以帮助临床医生在个体患者的 MRI 扫描上实际量化 SVD 负担，并发现异常模式。
