Ackah Joseph Amihere, Du Heng, Yang Wenjie, Zeng Huixing, Chan Jason Tsz Lok, Lo Michael Lung Cheung, Chen Xiangyan
Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, China.
Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Clin Transl Neurol. 2025 Jun;12(6):1187-1200. doi: 10.1002/acn3.70005. Epub 2025 Apr 17.
Exploring the prevalence and association between intracranial atherosclerosis (ICAS) and cerebral small vessel diseases (CSVD), this study delved beyond the current scope, utilising high-resolution vessel wall MRI (HRVW-MRI) to investigate how subtle changes in intracranial atherosclerotic features influence the various burdens of CSVD.
Stroke-free Chinese adult participants were recruited from our ongoing community-based MRI cohort. HRVW-MRI technique with a T1-weighted 3D SPACE sequence was used to assess atherosclerotic plaque features: plaque load, degree of stenosis, remodelling index, eccentricity. A multi-sequence MRI assessment elucidated CSVD markers, including white matter hyperintensities, lacune infarcts, microbleeds and enlarged perivascular spaces. Statistical analyses, including sensitivity and specificity tests, chi-square, correlation and regression models were fitted to explore the association between ICAS and CSVD.
Of the 225 participants (mean age 64.90 ± 6.87 years) included in the study, 101 (45%) were males. Thirty-nine participants (17.3%) presented with ICAS (8 progressive plaques and 31 were pre-atherosclerotic). One hundred and six (47.1%) participants recorded at least one clinically significant marker of CSVD. The subtle changes (increment or decrement) in atherosclerotic features such as positive remodelling, plaque load, eccentricity, degree of stenosis and the morphology (ICAS severity) may parallelly influence the distinct markers and overall CSVD burden.
This study demonstrates that the association between ICAS and CVSD extends beyond mere co-existence due to shared risk factors, suggesting the presence of a dose-effect relationship between ICAS and CVSD. HRVW-MRI could elucidate diagnostic metrics and characteristic features that reveal how ICAS impacts distinct CSVD burdens, thereby enhancing clinical decisions.
本研究旨在探讨颅内动脉粥样硬化（ICAS）与脑小血管病（CSVD）之间的患病率及关联，超越了当前的研究范畴，利用高分辨率血管壁磁共振成像（HRVW - MRI）来研究颅内动脉粥样硬化特征的细微变化如何影响CSVD的各种负担。
从我们正在进行的基于社区的磁共振成像队列中招募无中风的中国成年参与者。采用T1加权3D SPACE序列的HRVW - MRI技术评估动脉粥样硬化斑块特征：斑块负荷、狭窄程度、重塑指数、偏心度。多序列磁共振成像评估阐明了CSVD标志物，包括白质高信号、腔隙性梗死、微出血和血管周围间隙增宽。进行了包括敏感性和特异性测试、卡方检验、相关性和回归模型在内的统计分析，以探讨ICAS与CSVD之间的关联。
在纳入研究的225名参与者（平均年龄64.90±6.87岁）中，101名（45%）为男性。39名参与者（17.3%）出现ICAS（8个进展性斑块和31个动脉粥样硬化前期斑块）。106名（47.1%）参与者记录到至少一项具有临床意义的CSVD标志物。动脉粥样硬化特征的细微变化（增加或减少），如正向重塑、斑块负荷、偏心度、狭窄程度和形态（ICAS严重程度）可能会平行影响不同的标志物和整体CSVD负担。
本研究表明，ICAS与CVSD之间的关联不仅仅是由于共同的危险因素而并存，这表明ICAS与CVSD之间存在剂量 - 效应关系。HRVW - MRI可以阐明诊断指标和特征，揭示ICAS如何影响不同的CSVD负担，从而改善临床决策。
