Association between Perivascular Spaces and Progression of White Matter Hyperintensities in Lacunar Stroke Patients.

Caroline M J Loos,Robert J Van Oostenbrugge,Julie Staals,Pim Klarenbeek,Jeroen Hendrikse

doi:10.1371/journal.pone.0137323

Caroline M J Loos, Robert J Van Oostenbrugge + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0137323

Copy DOI

Abstract

ObjectivesPerivascular spaces are associated with MRI markers of cerebral small vessel disease, including white matter hyperintensities. Although perivascular spaces are considered to be an early MRI marker of cerebral small vessel disease, it is unknown whether they are associated with further progression of MRI markers, especially white matter hyperintensities. We determined the association between perivascular spaces and progression of white matter hyperintensities after 2-year follow-up in lacunar stroke patients.MethodsIn 118 lacunar stroke patients we obtained brain MRI and 24-hour ambulatory blood pressure measurements at baseline, and a follow-up brain MRI 2 years later. We visually graded perivascular spaces and white matter hyperintensities at baseline. Progression of white matter hyperintensities was assessed using a visual white matter hyperintensity change scale. Associations with white matter hyperintensity progression were tested with binary logistic regression analysis.ResultsExtensive basal ganglia perivascular spaces were associated with progression of white matter hyperintensities (OR 4.29; 95% CI: 1.28–14.32; p<0.05), after adjustment for age, gender, 24-hour blood pressure and vascular risk factors. This association lost significance after additional adjustment for baseline white matter hyperintensities. Centrum semiovale perivascular spaces were not associated with progression of white matter hyperintensities.ConclusionsOur study shows that extensive basal ganglia perivascular spaces are associated with progression of white matter hyperintensities in cerebral small vessel disease. However, this association was not independent of baseline white matter hyperintensities. Therefore, presence of white matter hyperintensities at baseline remains an important determinant of further progression of white matter hyperintensities in cerebral small vessel disease.

Highlights

Perivascular spaces (PVS) are cerebrospinal fluid-filled spaces surrounding the small penetrating cerebral vessels in the basal ganglia and centrum semiovale [1]
Extensive basal ganglia perivascular spaces were associated with progression of white matter hyperintensities, after adjustment for age, gender, 24-hour blood pressure and vascular risk factors
Our study shows that extensive basal ganglia perivascular spaces are associated with progression of white matter hyperintensities in cerebral small vessel disease

Summary

Introduction

Perivascular spaces (PVS) are cerebrospinal fluid-filled spaces surrounding the small penetrating cerebral vessels in the basal ganglia and centrum semiovale [1]. Magnetic resonance imaging (MRI) visible PVS are associated with risk factors for cerebral small vessel disease (cSVD), such as age and hypertension [2,3]. The location of PVS may indicate different types of underlying cSVD: basal ganglia PVS are more strongly associated with blood pressure-related arteriopathy, whereas centrum semiovale PVS are associated with cerebral amyloid angiopathy [5]. Perivascular spaces in these two regions are anatomically different: two leptomeningeal layers surround the basal ganglia small vessels, and superficial perforating small vessels in the centrum semiovale are only surrounded by one layer [2]

Objectives

Methods

Conclusion