Visual and previsual MRI-criteria for early diagnosis of cerebral small vessels disease in middle-aged patients: clinical and neuroimaging correlations

Abstract

Background. The urgency of cerebral small vessel disease (cSVD) in modern neurology is considered mainly in terms of the development of vascular dementia and early diagnosis of Alzheimer’s disease. Minimal changes in MRI images and indistinct cognitive disorders in SNAMA-type cSVD (sporadic non-amyloid microangiopathy) last for a long time until they manifest as acute cerebrovascular disorders and/or significant mental deficits. However, clinical and neuroimaging criteria for early diagnosis of the disease have not been established yet, and the nature of the correlations between the indicators of neuropsychological and multiparametric MRI studies has not been clarified. Purpose – to develop criteria for early diagnosis of SNAMA cerebrovascular disease in middle-aged patients using neuropsychological studies and high-field multiparametric MRI. Materials and methods. The study enrolled 34 middle-aged patients (52.5 ± 10.8) with hypertension of stage 1–2, stage I–II and cSVD (women – 11 (32.4%), men – 23 (67.6%)). The control group (19 healthy individuals) was identical in age, gender and total duration of education. MRI (3T) was performed in the following modes: T1-2WI, DWI, 3D Brain FLAIR SHC, 3D tra, VEN BOLD, DTI medium iso SENSE. Neuropsychological studies were performed using the MoSA questionnaire evaluating the EIS, VIS, AIS, LIS, MIS, OIS domains. Results and discussion. We developed and introduced a modified scoring system for determining the severity of the burden of cerebral small vessels disease (BcSVDearly) in clinical practice. Among the early visual MRI markers, the expansion of the perivascular spaces was dominated in 27 (79.4%) of participants. A minor increase in Σ BcSVDearly to 6–7 points was found in 10 (29.4%) patients. The age norm (0–4 points) corresponded to the indicators of Σ BcSVDearly 23 out of 34 (67.6%) in the main group. Additional evidence of the disease was obtained by DTI MRI. The most significant decrease in FA was recorded in belt fibers (Δ: up to – 31.4%) and semioval centers (Δ: up to – 33.6%), the largest increase in MD was recorded in hooked bundles (Δ: up to 24.4%); right prefrontal, orbitofrontal and parietal areas (Δ up to 28.0%). According to the MoSA scale, moderate cognitive impairment was detected in 29 of 34 (85.3%) patients with a significant decrease in scores in the domains of EIS, VIS, LIS and AIS (p <0.001). The severity of early clinical manifestations of cSVD (non-amnestic polydomain moderate disorders of attention, speech, visual-spatial and executive cognitive functions) has been found to be moderately / markedly correlated with THMS, MD (positive) and FA (negative).Conclusions. We determined early visual signs of cSVD associated with arterial hypertension: dilated perivascular spaces, hyperintensity of the periventricular deep white matter of the brain, decrease by 9–33.6% of FA coefficient and increase by 20.8% – 28.0% MD. Moderate correlations between neuropsychological and neuroimaging studies have been demonstrated.