Luo Wei, Dai Zhiqiang, Wu Wenjing, Li Haitao, Zhang Yang
Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
7T Magnetic Resonance Imaging Translational Medical Center, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
PeerJ. 2025 Jun 16;13:e19460. doi: 10.7717/peerj.19460. eCollection 2025.
White matter hyperintensities (WMHs) are hyperintense lesions observed on magnetic resonance imaging (MRI) and are unique imaging indicators of cerebral small vessel diseases. WMH-related white matter alterations have been correlated with cognitive impairment and cerebrovascular pathology. Some studies suggest that vascular hemodynamic changes contribute to WMH development, ultimately leading to vascular dementia (VaD). However, the association between WMH burden and VaD remains inconclusive. This meta-analysis aimed to quantify the relationship between WMH volume and VaD severity and to clarify the role of WMHs in VaD pathogenesis.
A systematic literature search was performed using the MEDLINE, EMBASE, and Cochrane Library databases. A total of 15 studies with 4,061 patients were selected. The meta-analysis was performed using the RevMan software (version 5.4) and Stata software (version 14.0). All the patients underwent brain MRI to assess WMH volumes or levels, and compared the differences in WMH levels among the VaD group, the non-cognitively impaired (NCI) group, the cognitively impaired no dementia (CIND) group, and the Alzheimer's disease (AD) group.
The meta-analysis showed that all patients in the VaD group had high white matter signals on brain MRI. They also had higher WMH volumes compared to patients in the NCI, CIND, and AD groups. WMH correlated with cerebrovascular pathology, with irregular and periventricular WMHs being more specific to VaD. Sensitivity analyses were performed to identify sources of heterogeneity, while funnel plot and Egger's test suggested potential publication bias.
Patients with VaD exhibit significantly greater WMH than those with AD, NCI, and CIND, reinforcing the role of cerebrovascular pathology in VaD. These findings emphasize the need for standardized imaging assessments, multi-modal biomarkers, and the development of predictive models to enhance early diagnosis, personalized risk assessment, and targeted therapeutic strategies for VaD.
脑白质高信号（WMHs）是在磁共振成像（MRI）上观察到的高信号病变，是脑小血管疾病独特的影像学指标。与WMH相关的脑白质改变与认知障碍和脑血管病变有关。一些研究表明，血管血流动力学变化促成了WMH的发展，最终导致血管性痴呆（VaD）。然而，WMH负担与VaD之间的关联仍无定论。这项荟萃分析旨在量化WMH体积与VaD严重程度之间的关系，并阐明WMH在VaD发病机制中的作用。
使用MEDLINE、EMBASE和Cochrane图书馆数据库进行系统的文献检索。共纳入15项研究，涉及4061例患者。使用RevMan软件（5.4版）和Stata软件（14.0版）进行荟萃分析。所有患者均接受脑部MRI检查以评估WMH体积或水平，并比较VaD组、非认知障碍（NCI）组、认知障碍无痴呆（CIND）组和阿尔茨海默病（AD）组之间WMH水平的差异。
荟萃分析显示，VaD组所有患者脑部MRI上均有高白质信号。与NCI组、CIND组和AD组患者相比，他们的WMH体积也更大。WMH与脑血管病变相关，不规则和脑室周围的WMH对VaD更具特异性。进行敏感性分析以确定异质性来源，同时漏斗图和Egger检验提示存在潜在的发表偏倚。
VaD患者的WMH明显高于AD、NCI和CIND患者，这进一步证实了脑血管病变在VaD中的作用。这些发现强调了标准化影像学评估、多模态生物标志物以及开发预测模型以加强VaD的早期诊断、个性化风险评估和靶向治疗策略的必要性。
