Relationship between white matter hyperintensities and hyperintense vessel sign on fluid-attenuated inversion recvery magnetic resonance imaging in older adults

Abstract

Objective To investigate the correlation between white matter hyperintensities(WMH)and hyperintense vessel sign(HVS)on fluid-attenuated inversion recovery(FLAIR)magnetic resonance imaging(MRI)in old adults and to explore the risk factors and pathogeneses of WMH. Methods We retrospectively collected imaging and clinical data of patients who had received both head and neck CTA and brain MRI within one month at our hospital from 2013 to 2016.The Fazekas visual scale was used to evaluate periventricular white matter hyperintensity(PWMH)and deep white matter hyperintensity(DWMH)in each brain hemisphere.According to the presence or absence of HVS in a cerebral hemisphere, patients were assigned into an HVS-positive group or an HVS-negative group.Clinical data, PWMH, and DWMH differences were compared between the two groups. Results A total of 271 patients(542 cerebral hemispheres)were included in this study.HVS-positive imaging occurred in 79(14.6%)cerebral hemispheres and negative imaging was observed in 463(85.4%)cerebral hemispheres.There was a significant difference between the HVS-positive and negative groups in the ipsilateral CIA stenosis(χ2=126.840, P<0.01). The incidence of ipsilateral severe carotid artery stenosis in the HVS-positive group was 62.0%(49/79), which was significantly higher than 9.9%(46/463)in the HVS-negative group.The incidence of moderate-severe DWMH was 65.8%(52/79)in the HVS-positive group, which was higher than 34.8%(161/463)in the negative group(χ2=34.962, P<0.01). Nevertheless, the incidences of moderate-severe PWMH in the two groups were 65.8%(52/79)and 55.5%(257/463), respectively, without a significant difference between them(χ2=6.944, P=0.074). After adjusting for age, gender, ipsilateral ICA stenosis, hypertension, diabetes, etc.multivariate analysis suggested that HVS-positive imaging was still an independent risk factor for DWMH(OR=2.653, 95%CI: 1.489-4.726, P=0.001). Conclusions HVS-positive imaging is an independent risk factor for DWMH in the elderly, but no clear correlation with PWMH is found.It suggests that hypoperfusion is a possible mechanism for the development of DWMH in the elderly. Key words: White matter hyperintensities; Hyperintense vessel sign; Internal carotid artery stenosis; Fluid-attenuated inversion recovery; Magnetic resonance imaging