Abstract
Although white matter hyperintensities (WMH), markers of cerebral small vessel disease (SVD), are believed to generally increase over time, some studies have shown sharp decreases after therapeutic intervention, suggesting that WMH progression may be more dynamic than previously thought. Our primary goal was to examine dynamic progression of WMH in a real-world sample of Alzheimer’s disease (AD) patients and normal elderly (NC), with varying degrees of SVD. WMH volumes from serial magnetic resonance imaging (MRI; mean = 1.8 years) were measured from NC (n = 44) and AD patients (n = 113) with high and low SVD burden. Dynamic progression for each individual was measured using spatial overlap images to assess shrinkage, growth, and stable WMH volumes. Significant group differences were found for shrinkage (p < 0.001), growth (p < 0.001) and stable (p < 0.001) WMH, where the AD high SVD group showed the largest changes relative to low SVD and NC. Our results suggest spatial progression measured at the individual patient level may be more sensitive to the dynamic nature of WMH.
Highlights
Recent advances in neuroimaging techniques have allowed for the volumetric quantification of white matter hyperintensities (WMH) of presumed vascular origin, a radiological biomarker of cerebral small vessel disease (SVD; Wardlaw et al, 2013) commonly visualized on T2-weighted (T2), proton density (PD), and fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI; Pantoni, 2010)
In light of the commonly accepted view that the pathogenesis and clinical characteristics of ‘‘WMH of presumed vascular origin’’ can be attributed to a set of heterogeneous and complex etiologies associated with cerebral SVD (Gouw et al, 2011), our findings provide further support for the dynamic nature of the underlying pathology that is reflected by these radiological entities
The findings from this study suggest that individual WMH volume changes are more dynamic than previously thought
Summary
Recent advances in neuroimaging techniques have allowed for the volumetric quantification of white matter hyperintensities (WMH) of presumed vascular origin, a radiological biomarker of cerebral small vessel disease (SVD; Wardlaw et al, 2013) commonly visualized on T2-weighted (T2), proton density (PD), and fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI; Pantoni, 2010). There is some recent evidence to suggest that in some cases, WMH burden may appear stable, with some studies even demonstrating regression or decreased WMH volume over time. There is some evidence to suggest that drug treatments may decrease or slow the progression of WMH (Mok et al, 2009), leading some clinical trials to implement WMH burden as a neuroimaging outcome measure (Dufouil et al, 2005; White et al, 2013)
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