Cerebral Blood Flow by Using Pulsed Arterial Spin-Labeling in Elderly Subjects with White Matter Hyperintensities

A.J Bastos-Leite,E Sanz-Arigita,S.A.R.B Rombouts,F Barkhof,P Scheltens,J.P.A Kuijer,A.A Gouw,W.M Van Der Flier,E.C Van Straaten

doi:10.3174/ajnr.a1091

A.J Bastos-Leite, E Sanz-Arigita + Show 7 more

Open Access

https://doi.org/10.3174/ajnr.a1091

Copy DOI

Abstract

On MR imaging, white matter hyperintensities (WMH) on T2-weighted images are generally considered as a surrogate marker of ischemic small vessel disease in elderly subjects. Pulsed arterial spin-labeling (PASL) is a noninvasive MR perfusion-weighted technique. We hypothesized that elderly subjects with diffuse confluent WMH should have lower cerebral blood flow (CBF) measurements than subjects with punctiform or beginning confluent WMH. MR images of 21 subjects (13 women; mean age, 76 years; SD, 5), stratified for the degree of WMH, from a single center within the multinational Leukoaraiosis and Disability (LADIS) study, were investigated. CBF images were obtained by means of quantitative imaging of perfusion by using a single-subtraction second version, with thin-section TI periodic saturation PASL. Values of cortical gray matter, subcortical (including white matter and deep gray matter), and global CBF were calculated. CBF measurements of subjects with diffuse confluent WMH (n = 7) were compared with those of subjects with punctiform or beginning confluent WMH (n = 14). Subjects with diffuse confluent WMH were found to have approximately 20% lower mean global CBF (43.5 mL/100 mL/min; SD, 6.3) than subjects with punctiform or beginning confluent WMH (57.9 mL/100 mL/min; SD, 8.6; P < .01), as well as approximately 20% lower mean subcortical (P < .01) and cortical gray matter CBF (P < .05). PASL revealed a significant reduction of CBF measurements in elderly subjects with diffuse confluent WMH.

Highlights

AND PURPOSE: On MR imaging, white matter hyperintensities (WMH) on T2-weighted images are generally considered as a surrogate marker of ischemic small vessel disease in elderly subjects
Pulsed arterial spin-labeling (PASL) revealed a significant reduction of cerebral blood flow (CBF) measurements in elderly subjects with diffuse confluent WMH
On MR imaging, white matter hyperintensities (WMH) on T2-weighted images, fluid-attenuated inversion recovery (FLAIR) images, and proton density–weighted images are generally considered as a surrogate marker of ischemic small vessel disease in elderly subjects,[1] but their significance is still under debate

Summary

Methods

MR images of 21 subjects (13 women; mean age, 76 years; SD, 5), stratified for the degree of WMH, from a single center within the multinational Leukoaraiosis and Disability (LADIS) study, were investigated. Subjects We included 21 subjects (8 men, 13 women) from a single center within the Leukoaraiosis and Disability (LADIS) study.[8] The current study was approved by both the local and the LADIS study institutional review boards, as well as by the LADIS study steering committee. BRAIN years, WMH on MR imaging of any degree according to the Fazekas scale,[9] absence of disability, presence of a regularly contactable informant, and agreement to sign an informed consent. Exclusion criteria were the following: presence of severe illnesses, severe unrelated neurologic diseases, leukoencephalopathy of nonvascular origin, severe psychiatric diseases, inability to give an informed consent, and inability or refusal to undergo cerebral MR imaging

Results

Discussion

Conclusion