Relationship Between Venules and Perivascular Spaces in Sporadic Small Vessel Diseases.

Angela C.C Jochems,Tom Macgillivray,Stewart Wiseman,Francesca M Chappell,Kirstie Hetherington,Michael J Thrippleton,Alasdair G Morgan,Ian Marshall,Daniela Jaime Garcia,Gordon W Blair,Maria C Valdés-Hernández,Rosalind Brown,Michael S Stringer,Joanna M Wardlaw,Fergus N Doubal,Olivia K.L Hamilton,Una Clancy

doi:10.1161/strokeaha.120.029163

Angela C.C Jochems, Tom Macgillivray + Show 15 more

Open Access

https://doi.org/10.1161/strokeaha.120.029163

Copy DOI

Journal: Stroke	Publication Date: Apr 8, 2020
Citations: 22	License type: cc-by

Affiliation: UK Dementia Research Institute, University of Edinburgh

Abstract

Background and Purpose- Perivascular spaces (PVS) around venules may help drain interstitial fluid from the brain. We examined relationships between suspected venules and PVS visible on brain magnetic resonance imaging. Methods- We developed a visual venular quantification method to examine the spatial relationship between venules and PVS. We recruited patients with lacunar stroke or minor nondisabling ischemic stroke and performed brain magnetic resonance imaging and retinal imaging. We quantified venules on gradient echo or susceptibility-weighted imaging and PVS on T2-weighted magnetic resonance imaging in the centrum semiovale and then determined overlap between venules and PVS. We assessed associations between venular count and patient demographic characteristics, vascular risk factors, small vessel disease features, retinal vessels, and venous sinus pulsatility. Results- Among 67 patients (69% men, 69.0±9.8 years), only 4.6% (range, 0%-18%) of venules overlapped with PVS. Total venular count increased with total centrum semiovale PVS count in 55 patients after accounting for venule-PVS overlap (β=0.468 [95% CI, 0.187-0.750]) and transverse sinus pulsatility (β=0.547 [95% CI, 0.309-0.786]) and adjusting for age, sex, and systolic blood pressure. Conclusions- Despite increases in both visible PVS and suspected venules, we found minimal spatial overlap between them in patients with sporadic small vessel disease, suggesting that most magnetic resonance imaging-visible centrum semiovale PVS are periarteriolar rather than perivenular.

Highlights

Background and PurposePerivascular spaces (PVS) around venules may help drain interstitial fluid from the brain
Even when PVS overlapped with venules, PVS shapes often differed from the venule (Figures IV and V in the Data Supplement)
Venular count increased with centrum semiovale (CSO) PVS score (β=0.331 [95% CI, 0.058–0.604]), total CSO PVS count (β=0.605 [95% CI, 0.376–0.835]), and venule-PVS overlap (β=0.500 [95% CI, 0.256–0.744])

Summary

Methods

We developed a visual venular quantification method to examine the spatial relationship between venules and PVS. We recruited patients with lacunar stroke or minor nondisabling ischemic stroke and performed brain magnetic resonance imaging and retinal imaging. We assessed associations between venular count and patient demographic characteristics, vascular risk factors, small vessel disease features, retinal vessels, and venous sinus pulsatility. We used data from 2 prospective studies of sporadic SVDs: iSVD study (Inflammation in SVD)[4] and the MSS-3 (Mild Stroke Study 3). Both studies recruited patients with lacunar or minor nondisabling ischemic stroke (modified Rankin Scale score,

Results

Discussion

Conclusion