Abstract
Background: Cerebral small vessel disease (SVD) is associated with cognitive decline, depression, increased mortality, and disability in stroke patients. MRI-visible perivascular spaces (PVS) are a sensitive neuroimaging marker of SVD. We aimed to explore the risk factors and associations with other SVD markers of PVS in two topographical regions (in the basal ganglia [BG] and centrum semiovale [CS]) in a cohort of spontaneous intracerebral hemorrhage (ICH) patients.Method: We included 306 consecutive patients from a prospective spontaneous ICH cohort. We rated PVS, white matter hyperintensities (WMH), cerebral microbleeds (CMB), and lacunes with validated visual rating scale. We collected clinical information using standardized forms. We predefined severe PVS as score > 2 and examined associations between PVS in both BG and CS regions and clinical and imaging markers of SVD by logistic regression.Results: In the multivariable logistic regression, increasing age (OR = 1.075; 95% CI = 1.038–1.113, p < 0.001), high CS PVS degrees (OR = 6.906; 95% CI = 3.024–15.774, p < 0.001), extensive periventricular WMH (OR = 2.878; 95% CI = 1.298–6.379, p = 0.009), and the presence of CMB (OR = 4.073, 95% CI = 1.869–8.877, p < 0.001) were independently associated with BG PVS severity. Alcohol-drinking habit (OR = 2.805; 95% CI = 1.451–5.422, p = 0.002), hyperlipidemia history (OR = 3.782; 95% CI = 1.582–8.783, p = 0.003), high BG PVS degrees (OR = 6.293; 95% CI = 2.755–14.371, p < 0.001) and the presence of strictly lobar CMB (OR = 2.556, 95% CI = 1.285–5.085, p = 0.008) were independent predictors of increased CS PVS severity.Conclusion: MRI-visible PVS in BG and CS regions are inter-related and have different risk factors in spontaneous ICH patients. Further studies are needed to explore the mechanism and clinical importance of PVS, with possible implications for cerebrovascular disease prevention and effective treatments.
Highlights
Spontaneous intracerebral hemorrhage (ICH) is a devastating neurological disorder resulting from ruptured blood vessels in the brain [1]
Increasing visibility of Perivascular spaces (PVS) on MRI are associated with increasing age, hypertension [9], stroke, other small vessel disease (SVD) features such as lacunar stroke and white matter hyperintensities (WMH) [10], systemic inflammation [11], multiple sclerosis [4], cognitive impairment, and dementia [12,13,14]
PVS were defined as ≤3 mm round or linear cerebrospinal fluid (CSF) isointensity lesions and were rated on axial T2W imaging with a validated visual rating scale [10, 21]: rated from 0, 1 [1,2,3,4,5,6,7,8,9,10], 2 [11,12,13,14,15,16,17,18,19,20], 3 [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40], and 4 (>40) in both the basal ganglia (BG) and centrum semiovale (CS) regions
Summary
Spontaneous (non-traumatic) intracerebral hemorrhage (ICH) is a devastating neurological disorder resulting from ruptured blood vessels in the brain [1]. PVS are round or linear delineated structures seen on MRI with intensities close to cerebrospinal fluid (CSF) and
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