Abstract
White matter lesions (WMLs) in normal elderly are related to chronic ischemia, and progression of WML occurs mostly in moderate to severe disease. However, the mechanism is uncertain. Thus, we enrolled fifty-six normal elderly patients without large artery disease. The severity of WML on MRI was graded as grade 0, I, II and III using the modified Fazekas scale. Cerebral blood flow (CBF) was measured by Xenon-CT. We found that CBF (mL/100 g/min) within periventricular lesions and in the right and left centrum semiovales were 20.33, 21.27 and 21.03, respectively, in group I; 16.33, 15.55 and 15.91, respectively, in group II; and 14.05, 14.46 and 14.23, respectively, in group III. CBF of normal-appearing white matter (NAWM) around periventricular areas and in the right and left centrum semiovales were 20.79, 22.26 and 22.15, respectively, in group 0; 21.12, 22.17 and 22.25, respectively, in group I; 18.02, 19.45 and 19.62, respectively, in group II; and 16.38, 18.18 and 16.74, respectively, in group III. Significant reductions in CBF were observed not only within lesions but also in NAWM surrounding the lesions. In addition, CBF was reduced significantly within lesions compared to NAWM of the same grade. Furthermore, CBF was reduced significantly in NAWM in grades II and III when compared to grades 0 and I. Our finding indicates that ischemia may play a role in the pathogenesis of WML. Additionally, our finding provides an alternative explanation for finding that the progression of WML occurred more commonly in patients with moderate to severe WML.
Highlights
White matter lesions (WMLs) are frequently observed on Flair and T2-weighted brain MRI scans in clinically normal elderly patients and are strongly associated with increasing age [1,2]
Using Flair and T2-weighted brain MRI, O’Sullivan et al [11] were the first to report a reduction in cerebral blood flow (CBF) in both periventricular WMLs and normal–appearing white matter (NAWM) around periventricular areas
The mean values of CBF within periventricular lesions and in the right and left centrum semiovales among different WML grades are shown in table 2
Summary
White matter lesions (WMLs) are frequently observed on Flair and T2-weighted brain MRI scans in clinically normal elderly patients and are strongly associated with increasing age [1,2]. Using Flair and T2-weighted brain MRI, O’Sullivan et al [11] were the first to report a reduction in CBF in both periventricular WMLs and normal–appearing white matter (NAWM) around periventricular areas. This finding further suggests that chronic ischemia may be the cause of WMLs. This finding further suggests that chronic ischemia may be the cause of WMLs If this is the case, areas with NAWM with decreased CBF may develop into WML in long-term follow-up studies. The relatively small sample size limited classification of participants by the severity of WML, and as a result, the relationship between the CBF in NAWM regions and WMLs and the severity of the WML is not clear
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