Correlation between Cerebral Microbleeds and White Matter Changes on MRI using Microbleed Anatomical Rating and Fazekas Scales: A Cross-sectional Study

Abstract

Introduction: Cerebral Microbleeds (CMBs) are small perivascular haemosiderin deposits in the brain that indicate bleeding events. The location of CMBs can provide insights into their underlying causes. CMBs found in peripheral lobar locations are often associated with cerebral amyloid angiopathy, while those occurring in deeper brain regions are more likely linked to hypertensive arteriopathy. White matter changes, known as Leukoaraiosis, have been linked to adverse cognitive functions, share risk factors with hypertension and microbleeds, and are associated with the severity of CMBs. Aim: To determine the correlation between CMBs and white matter changes on Magnetic Resonance Imagning (MRI) using the Microbleed Anatomical Rating Scale (MARS) and Fazekas scales. Materials and Methods: An analytical cross-sectional study was conducted in the Department of Radiodiagnosis, MS Ramaiah Hospitals, Bengaluru, Karnataka, India between November 2019 and June 2021, involving 65 subjects who underwent MRI brain scans at a tertiary care institute and were found to have microbleeds. Brain MRIs were performed using a 1.5 Tesla MRI Scanning Unit. Microbleeds were graded using the MARS, while white matter changes were graded using the Fazekas scale. The Chi-square test was employed to assess the significance of categorical data, and Spearman’s correlation was used to determine the correlation between MARS and Fazekas scale variables. Results: The subjects had a mean age range of 61 to 70 years, with a male-to-female ratio of 2:1. There was a significant correlation between MARS grade and Fazekas scale (p<0.001) with a correlation coefficient (r-value) of 1. The most commonly associated stroke subtype was lacunar infarct. Conclusion: There is a significant correlation between Leukoaraiosis (LA) and CMBs, indicating the end results of small vessel ischaemia and bleeding.