Hyperintensity In Patients Research Articles

Correlation between White Matter Hyperintensities Related Gray Matter Volume and Cognition in Cerebral Small Vessel Disease

Background and AimThe relationship between severity of cerebral small vessel disease, as defined by white matter hyperintensities classification, and gray matter volume of different brain regions has not been well defined. This study aimed to investigate brain regions with significant differences in gray matter volume associated with different degrees of white matter hyperintensities in patients with cerebral small vessel disease. Meanwhile, we examined whether correlations existed between gray matter volume in different brain regions and cognitive ability. Methods110 cerebral small vessel disease patients underwent 3.0T Magnetic resonance imaging scans and neuropsychological cognitive assessments. White matter hyperintensities of each subject was graded according to Fazekas grade scale and was divided into two groups: (A) White matter hyperintensities score of 1–2 points (n = 64), (B) White matter hyperintensities score of 3–6 points (n = 46). Gray matter volume was analyzed using voxel-based morphometry implemented in Statistical Parametric Mapping 12 software. ResultsBrain regions with significant differences in gray matter volume between groups were diffused throughout the brain. Patients with high white matter hyperintensities scores exhibited decreased gray matter volume in some subregions of the frontal lobes, the temporal lobes, the parahippocampal gyrus, hippocampus and thalamus (p < 0.05). Among them, gray matter volume in the ventrolateral area of right inferior temporal gyrus, together with the right posterior parietal and occipital thalamus were positively correlated with Montreal Cognitive Assessment scores (p < 0.05). Gray matter volume in the extreme ventrolateral area of right inferior temporal gyrus along with the entorhinal cortex of left parahippocampal gyrus were positively correlated with both Montreal Cognitive Assessment and Mini-Mental Status Examination scores (p < 0.05). ConclusionsCerebral small vessel disease is considered as a whole brain disease and local white matter lesions can influence the gray matter in remote areas. Reducing the severity and progression of white matter hyperintensities may help to prevent secondary brain atrophy and cognitive impairment.

Effect of vitamin D on cognitive function and white matter hyperintensity in patients with mild Alzheimer's disease.

To examine the effect of vitamin D level on cognitive function and white matter hyperintensity (WMH) in patients with mild Alzheimer's disease (AD). We recruited patients with mild AD, and carried out clinical interviews, neuropsychological assessments, laboratory tests and brain magnetic resonance imaging. In total, 146 patients with mild AD (68 men, 78 women; mean age 79.1 ± 7.0 years; mean education 10.2 ± 4.3 years) were enlisted. The mean Mini-Mental State Examination (MMSE) score was 21.0 ± 3.8. The 25-hydroxy vitamin D (25[OH]D) level was correlated negatively with the WMH volume (β = -0.219, P = 0.004) after adjusting for age, sex, years of education, apolipoprotein ε4 allele status, seasons of blood sampling, hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease and total brain volume. The 25(OH)D level was correlated positively with the MMSE score (β = 0.309, P < 0.001) after adjusting for the same covariates. Multivariate regression analysis with the MMSE score serving as the dependent variable and adjustment for covariates showed that the 25(OH)D level was an independent predictor of the MMSE score (β = 0.322, P < 0.001), but the WMH volume was not (β = 0.056, P = 0.587). These findings suggest that WMH has no mediation effect between the 25(OH)D level and the MMSE score. Reduced plasma 25(OH)D levels were associated with low MMSE scores in patients with mild AD, but the underlying mechanism is not attributable to WMH. Thus, it suggested that the presence of another pathomechanism exists. Geriatr Gerontol Int 2020; 20: 52-58.

Analysis of heterogeneity of peritumoral T2 hyperintensity in patients with pretreatment glioblastoma: Prognostic value of MRI-based radiomics

PurposeOn MR imaging, peritumoral T2 hyperintensity surrounding glioblastoma is known to contain tumor cell infiltrates, thus contributing to poor prognosis. This study aimed to determine the incremental prognostic value of radiomics on peritumoral T2 hyperintensity in pretreatment glioblastoma. MethodsOne hundred fourteen pathologically confirmed glioblastoma patients were retrospectively selected from March 2008 to May 2018 (our institution, n = 61; the Cancer Imaging Archive, n = 53). All patients were randomly divided into either training (n = 80) or test set (n = 34). Manually segmented peritumoral T2 hyperintensity yielded 106 radiomic features per patient. A random forest variable selection was used to select the most relevant radiomic features. Four Cox proportional hazards models were fitted with clinical features, clinical features with tumor/peritumoral volumes, radiomics, and all of them combined. Kaplan-Meier survival curves of the models were plotted with log-rank tests. All models were validated on a test set using prediction error curves over survival times. ResultsA random forest variable selection yielded five relevant features among the 106 radiomic features (two shape, two gray-level and one first order features). These radiomic features increased survival prediction accuracy when they were added onto clinical and tumor/peritumoral volumetric features (combined model, P = 0.011). On test set, the combined model showed lower mean survival prediction error rate (0.14) than clinical (0.191) or radiomic (0.178) model. ConclusionsThe clinical model with radiomic features demonstrated improved survival predictive performance than the model without radiomic features, thus suggesting incremental prognostic value of peritumoral radiomics as MR imaging biomarker in pretreatment glioblastoma.

White Matter Hyperintensities in Patients with Sporadic Hemiplegic Migraine.

To identify the differences in overall occurrence, location, and disease burden of white matter hyperintensities (WMH) in patients with sporadic hemiplegic migraine (SHM) and patients with migraine headaches. We included patients who met diagnostic criteria proposed by the third International Classification of Headache Disorders (ICHD-3) for SHM and migraine headache. WMHs were identified using T2 fluid-attenuated inversion recovery axial sequence and classified based upon the location. The disease burden was assessed using Scheltens visual rating scale. Fifty patients met the diagnostic criteria for SHM and 100 patients for migraine headache. Patients in the study group were similar to the control group in terms of age (47.7 ± 12.2 years vs. 48.17 ± 9.7 years; P = .814) and gender (M: F; 14:36 vs. M: F 25:75; P = .693). WMH were found in 28 (56%) patients with SHM and 44 (44%) in patients with migraine headache. The proportion of patients with WMH was not different between the two groups (P = .166). On univariate analysis, the proportion of patients with WMH in parietal, occipital, and infratentorial regions was higher in patients with SHM. White matter burden determined by visual rating scale and proportion of patients with lesions ≥5 mm in diameter was also significantly higher in patients with SHM. On multivariate analysis, the WMH occurrence in the parietal lobe (P = .043) was found to be significantly higher in SHM. The WMH occurrence in patients with SHM is significantly more in the parietal lobe when compared to those with migraine headaches. WMH burden was also higher in patients with SHM, and larger white matter lesions occurred more frequently in these patients with SHM (compared to ordinary migraineurs).

Spectrally fat-suppressed coronal 2D TSE sequences may be more sensitive than 2D STIR for the detection of hyperintense optic nerve lesions.

The aim of the study is to compare coronal spectrally fat-suppressed 2D turbo spin-echo (TSE) with 2D short-tau inversion-recovery (STIR) sequences for the detection of optic nerve hyperintensities in patients with acute optic nerve neuritis (ON). A retrospective review of patients with suspected unilateral ON and pathological visual evoked potentials, who received coronal TSE and STIR sequences with similar fast and clinically feasible acquisition times in addition to our standard imaging protocol. All images were evaluated and compared concerning the presence of optic nerve lesions, lesion lengths, and signal intensities in different anatomical parts of the optic nerves and CNR measures. A summary confidence score (CS) was calculated based on each reader's subjective confidence regarding the scoring items. Interobserver agreements regarding the detection of optic nerve lesions were excellent for both sequences (TSE, κ = 0.89 and STIR, κ = 0.80). Greater extensions (17.4 ± 6.3mm vs. 14.1 ± 5.8mm), as well as higher numbers of optic nerve lesions in symptomatic nerves, were detected on TSE (49/52) compared with STIR (45/52) sequences (both p < 0.001). Overall CS were significantly (p < 0.001) higher for TSE (2.8) compared with STIR (2.1) sequences regarding the presence or absence of optic nerve lesions. CNR ratios of lesions' mean signal intensities vs. ipsilateral surrounding orbital fat and vs. signal intensity measurements from contralateral optic nerves were significantly higher on TSE compared with STIR (p < 0.001 for both comparisons). Spectrally fat-suppressed coronal 2D TSE sequences appear to be more sensitive for the detection of hyperintense optic lesions compared with 2D STIR sequences. • Spectrally fat-suppressed TSE sequences showed higher detection rates of hyperintense optic nerve lesions, as well as a higher reader confidence scores compared with STIR. • Optic nerve signal abnormalities on TSE sequences were brighter and showed a greater expansion along the optic nerve course. • CNR measures were significantly higher on TSE compared with STIR, when comparing the ratios of mean signal intensities of optic nerve lesions to ipsilateral orbital fat and to contralateral healthy optic nerves of both sequences.

Completeness of circle of Willis and white matter hyperintensities in patients with severe internal carotid artery stenosis.

We investigated whether completeness of the circle of Willis (CoW) protected patients with severe internal carotid artery (ICA) stenosis against white matter hyperintensities (WMHs). We included 115 patients with unilateral ICA stenosis ≥ 70%. The completeness of CoW was assessed and WMHs were rated on a visual scale. The score of deep and periventricular WMHs was compared between patients with complete and incomplete CoW and between the two hemispheres, ipsilateral and contralateral to stenosed ICA. We included 115 patients with severe ICA stenosis, 60 patients had a complete CoW (52.17%) and 55 had an incomplete CoW (47.83%). The patients with incomplete CoW had higher score of deep WMHs (OR = 1.82, 95% CI 1.08-3.06, P= 0.023) and periventricular WMHs (OR = 4.53, 95% CI 2.09-9.81, P = 0.000) than those with complete CoW. In the patients with incomplete CoW, the score of deep WMHs (OR = 4.14, 95% CI 1.33-12.93, P = 0.014) and periventricular WMHs (OR = 5.46, 95% CI 1.16-25.62, P = 0.032) was higher in the hemisphere ipsilateral to stenosed ICA than that in the contralateral hemisphere. In the patients with complete CoW, there was no significant difference in the score of deep WMHs (OR = 2.10, 95% CI 0.37-11.91, P= 0.401) and periventricular WMHs (OR = 2.83, 95% CI 0.99-8.05, P = 0.051) between the ipsilateral and contralateral hemispheres to stenosed ICA. The completeness of CoW protected patients with severe ICA stenosis against WMHs.

Editors' note: Increased resting cerebral blood flow in adult Fabry disease: MRI arterial spin labeling study

In “Increased resting cerebral blood flow in adult Fabry disease: MRI arterial spin labeling study,” Phyu et al. reported that patients with Fabry disease (FD) have significantly higher cerebral blood flow (CBF) in the white matter than normal controls, and that this difference is most notable in the splenium of the corpus callosum (SCC). Based on these findings, they proposed that white matter hyperintensities (WMH) in patients with FD are the result of hyperperfusion. In their experience, Cocozza and Quarantelli note that the SCC is infrequently hyperintense in patients with FD and suggest that a mechanism other than hyperperfusion is responsible for WMH in FD. In response, Werring et al. acknowledge that (1) the correlation between hyperperfusion in the SCC and WMH in the SCC is not indicative of causation and (2) there is a low prevalence of SCC hyperintensities in patients with FD compared with patients with multiple sclerosis, though they note that prior studies also demonstrate increased CBF in the SCC of patients with FD. Further multimodal studies are needed to assess the relationship between CBF and WMH in patients with FD. In “Increased resting cerebral blood flow in adult Fabry disease: MRI arterial spin labeling study,” Phyu et al. reported that patients with Fabry disease (FD) have significantly higher cerebral blood flow (CBF) in the white matter than normal controls, and that this difference is most notable in the splenium of the corpus callosum (SCC). Based on these findings, they proposed that white matter hyperintensities (WMH) in patients with FD are the result of hyperperfusion.

Postoperative Resolution of Magnetic Resonance Imaging Signal Intensity Changes and the Associated Impact on Outcomes in Degenerative Cervical Myelopathy: Analysis of a Global Cohort of Patients.

Subanalysis of the prospective AOSpine CSM North America and International studies. To describe the postoperative changes in magnetic resonance imaging (MRI) spinal cord signal intensity in degenerative cervical myelopathy (DCM) patients and to investigate the impact of its postoperative resolution on clinical outcomes. When examining the spinal cord, hyperintensity found in MRI T2-weighted images and hypointensity in T1-weighted images are known to correlate with preoperative severity of DCM and to predict postoperative neurological recovery. However, the clinical importance of these signal intensity changes in postoperative images has not been established. Among 757 surgical DCM patients enrolled in two prospective multicenter studies, postoperative MRI images obtained between 6 and 24 months after the operation were examined with a focus on T2 hyper- and T1 hypointensity in the spinal cord. The 2-year postoperative Nurick grade, modified Japanese Orthopaedic Association score and modified Japanese Orthopaedic Association recovery rate (RR) were analyzed between patients with or without resolution of signal intensity changes. A total of 167 patients with preoperative T2 hyperintensity were included with complete postoperative MRI images. Of these patients, 11% showed resolution of signal intensity changes, 70% retained T2 hyperintensity only, and 19% showed both T2 hyper- and T1 hypointensity postoperatively. There was a stepwise trend toward worse postoperative outcomes, with the no signal intensity change group showing the best outcome and the T1 hypointensity group showing the worst (mean RR: 72% vs. 51% vs. 36%, P = 0.02). Patients who exhibited resolution of T2 hyperintensity showed better outcomes than those who retained it (RR: 72% vs. 47%, P = 0.04), but the resolution of T1 hypointensity was not associated with improved outcomes (RR: 38% vs. 26%, P = 0.36). Postoperative resolution of T2 hyperintensity in patients with DCM was associated with the best clinical outcomes, whereas those with T1 hypointensity showed the worst. 3.

Dynamic Changes in White Matter Hyperintensities in Reversible Cerebral Vasoconstriction Syndrome

White matter hyperintense lesions (WMHs) are highly prevalent in patients with reversible cerebral vasoconstriction syndrome (RCVS); however, their characteristics and underlying pathophysiology are unclear. To investigate the spatiotemporal distribution and pathomechanisms of WMHs in patients with RCVS. We prospectively recruited patients with RCVS over a 3-year period from January 2010 through December 2012 from the headache center or emergency department of Taipei Veterans General Hospital, Taipei, Taiwan, a 2947-bed national medical center. In total, 85 patients with RCVS were approached, of whom 4 declined to participate, 5 declined follow-up scans, 6 were lost to follow-up, and 5 had suboptimal images. Patients received serial isotropic 3-dimension fluid-attenuated inversion recovery sequence imaging (1-mm slice thickness) with a 3-T magnetic resonance imaging machine as well as transcranial and extracranial color-coded sonography on registration and during follow-ups (at 1 and 2 months, with variations adapting to clinical condition). Data were analyzed from January 2015 to May 2017. The fluid-attenuated inversion recovery lesion segmentation toolbox was used to segment WMHs automatically. The WMHs were classified as periventricular or deep and were segmented into 13 anatomical locations. The neuroimaging scientists who executed the program were blinded to clinical information. Vascular parameters, including the Lindegaard index (vasoconstriction severity), pulsatility index, and resistance index of the internal carotid artery, were independently collected for comparison. Sixty-five patients with RCVS completed the study and underwent a total of 162 magnetic resonance imaging examinations. Of the 65 included patients, 58 (89%) were women, and the mean (SD) age was 50.1 (8.9) years. The total mean (SD) WMH load peaked at 3.2 (4.4) cm3 in the third week postonset and fell to 0.8 (0.6) cm3 in the fourth week. White matter hyperintensities were predominantly frontal and periventricular. White matter hyperintensity load correlated strongly with Lindegaard index during the second week of the disease course (r = 0.908; P < .001) and also correlated with the pulsatility index and resistance index of the internal carotid artery. White matter hyperintensities in patients with RCVS have a dynamic temporal evolution that parallels disease severity. The finding of partially reversible WMHs deserves attention and should be known by clinicians taking care of patients with RCVS. White matter hyperintensities in RCVS may be attributed, at least partially, to regional hypoperfusion and impaired dampening capacity to central pulsatile flow.

Characterizing Deep White Matter Hyperintensities in Patients with Symptomatic Isolated Cortical Superficial Siderosis

In patient with cerebral amyloid angiopathy (CAA) presenting with lobar hemorrhage (LH), magnetic resonance imaging (MRI) white matter hyperintensities (WMH) tend to be predominant in posterior regions with the "multiple subcortical spots" WMH pattern as the most frequent topographical WMH pattern. Our aim was to analyze WMH severity and topographical distribution in patients with cortical superficial siderosis (CSS). We retrospectively analyzed MRIs from consecutive symptomatic isolated (i.e., without LH) CSS and LH-CAA (with or without associated CSS) patients. We analyzed baseline clinical characteristics including age, history of hypertension, diabetes, hypercholesterolemia, and pre-existing cognitive deficit. The presence of lobar microbleeds (MB) was scored on T2*. FLAIR (fluid-attenuated inversion recovery) WMH severity (using the Fazekas scale) and topographical distribution (using [slightly modified] earlier described WMH patterns) were analyzed and compared between both groups. Twenty CSS and 63 LH-CAA patients were analyzed. Baseline clinical characteristics were similar between both groups, except for hypercholesterolemia less frequently present in the CSS group (P = .026). Lobar MB were significantly less frequently present in the CSS group (P < .01), and CSS was more frequently focal in the CSS group compared with LH-CAA patients with associated CSS (P = .03). Mean Fazekas scale was significantly lower in CSS patients (P = .011). WMH patterns did not differ between both groups, with the multiple subcortical spots pattern as the most frequently observed pattern. Relative severe WMH scores and similar topographical distribution in CSS patients argue for WMH as a CAA-related feature in these patients with isolated CSS, adding level of evidence that isolated CSS could correspond to early manifestations of CAA.

Serum IL-8 is a marker of white-matter hyperintensities in patients with Alzheimer's disease

IntroductionNeuroinflammation and cerebrovascular disease (CeVD) have been implicated in cognitive impairment and Alzheimer's disease (AD). The present study aimed to examine serum inflammatory markers in preclinical stages of dementia and in AD, as well as to investigate their associations with concomitant CeVD. MethodsWe performed a cross-sectional case–control study including 96 AD, 140 cognitively impaired no dementia (CIND), and 79 noncognitively impaired participants. All subjects underwent neuropsychological and neuroimaging assessments, as well as collection of blood samples for measurements of serum samples interleukin (IL)-6, IL-8, and tumor necrosis factor α levels. Subjects were classified as CIND or dementia based on clinical criteria. Significant CeVD, including white-matter hyperintensities (WMHs), lacunes, and cortical infarcts, was assessed by magnetic resonance imaging. ResultsAfter controlling for covariates, higher concentrations of IL-8, but not the other measured cytokines, were associated with both CIND and AD only in the presence of significant CeVD (CIND with CeVD: odds ratios [ORs] 4.53; 95% confidence interval [CI] 1.5–13.4 and AD with CeVD: OR 7.26; 95% CI 1.2–43.3). Subsequent multivariate analyses showed that among the types of CeVD assessed, only WMH was associated with higher IL-8 levels in CIND and AD (WMH: OR 2.81; 95% CI 1.4–5.6). DiscussionSerum IL-8 may have clinical utility as a biomarker for WMH in AD. Longitudinal follow-up studies would help validate these findings.

Kidney function is associated with severity of white matter hyperintensity in patients with acute ischemic stroke/TIA.

BackgroundPrevious studies suggested the potential interactions between cerebrovascular diseases and impaired renal function. However, the relationship between renal function and white matter hyperintensity (WMH), marker of cerebral small vessel disease, in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) remains unknown.MethodsWe consecutively enrolled 1632 subjects with AIS or TIA who underwent brain MRI for this analysis. The severity of WMH in both of periventricular (PVH) and deep subcortical white matter (SDWMH) was evaluated using Fazekas scale. Estimated glomerular filtration rate (eGFR) was calculated by the equation of the Modification Diet for Renal Disease. Multinomial logistic regression was performed to evaluate the association between the severity of WMH and eGFR.ResultsAdvanced age and hypertension were independently associated with the severity of both PVH and SDWMH (all p < 0.001). There is a significantly inverse association between eGFR and PVH. Patients having each 30 ml/min/1.73 m2 increase in eGFR was associated with 75 % of risk of having degree 3 of WMH in periventricular areas compared with degree 0 (p = 0.04, OR = 0.75, 95 % CI 0.61–0.92). However this inverse association was not found between eGFR and SDWMH (P = 0.50, OR = 0.93, 95 % CI0.75–1.14).ConclusionOur study demonstrates that renal dysfunction (eGFR) is independently associated with the severity of PVH but not SDWMH in patients with acute ischemic stroke. This results highlighted different pathological mechanism and risk factors of PVH and SDWMH.

Integrity of normal-appearing white matter: Influence of age, visible lesion burden and hypertension in patients with small-vessel disease

White matter hyperintensities accumulate with age and occur in patients with stroke, but their pathogenesis is poorly understood. We measured multiple magnetic resonance imaging biomarkers of tissue integrity in normal-appearing white matter and white matter hyperintensities in patients with mild stroke, to improve understanding of white matter hyperintensities origins. We classified white matter into white matter hyperintensities and normal-appearing white matter and measured fractional anisotropy, mean diffusivity, water content (T1-relaxation time) and blood–brain barrier leakage (signal enhancement slope from dynamic contrast-enhanced magnetic resonance imaging). We studied the effects of age, white matter hyperintensities burden (Fazekas score) and vascular risk factors on each biomarker, in normal-appearing white matter and white matter hyperintensities, and performed receiver-operator characteristic curve analysis. Amongst 204 patients (34.3–90.9 years), all biomarkers differed between normal-appearing white matter and white matter hyperintensities (P < 0.001). In normal-appearing white matter and white matter hyperintensities, mean diffusivity and T1 increased with age (P < 0.001), all biomarkers varied with white matter hyperintensities burden (P < 0.001; P = 0.02 signal enhancement slope), but only signal enhancement slope increased with hypertension (P = 0.028). Fractional anisotropy showed complex age-white matter hyperintensities-tissue interactions; enhancement slope showed white matter hyperintensities-tissue interactions. Mean diffusivity distinguished white matter hyperintensities from normal-appearing white matter best at all ages. Blood–brain barrier leakage increases with hypertension and white matter hyperintensities burden at all ages in normal-appearing white matter and white matter hyperintensities, whereas water mobility and content increase as tissue damage accrues, suggesting that blood–brain barrier leakage mediates small vessel disease-related brain damage.

Association of serum vascular endothelial growth factor levels and cerebral microbleeds in patients with Alzheimer's disease.

The association between the presence of cerebral microbleeds (CMBs) and serum vascular endothelial growth factor (VEGF) levels in patients with Alzheimer's disease (AD) was investigated. Consecutive AD patients who underwent magnetic resonance examination with susceptibility-weighted imaging (SWI) were prospectively examined. The presence of CMBs on SWI was independently interpreted. The number and location of microbleeds were assessed. Demographics including age, sex and risk factors were obtained. Serum VEGF levels were measured with an enzyme-linked immunosorbent assay. Of the 146 AD patients included, 47 (32.2%) patients had CMBs on SWI. The CMBs were most commonly located in strictly lobar locations (29/47, 61.7%). The mean VEGF levels were higher in the patients with CMBs than in those without (336.72 ± 15.18 vs. 192.37 ± 11.34 pg/ml). Multivariate logistic regression analyses showed that, for each 10 pg/ml increase of VEGF levels, there was a significant increase in the presence of CMBs after adjusting for age and sex, and after additional adjustment for cardiovascular risk factors, silent lacunar infarction and white matter hyperintensity in patients with AD (odds ratio 2.37; 95% confidence interval 1.53-4.02, P = 0.004). Serum VEGF levels are associated with the presence of CMBs in patients with AD.

White Matter Hyperintensity in Patients with Mild Traumatic Brain Injury Correlates with Higher Coated-Platelet Levels (P3.323)

White Matter Hyperintensity in Patients with Mild Traumatic Brain Injury Correlates with Higher Coated-Platelet Levels (P3.323)

Loss of substantia nigra hyperintensity on 7 Tesla MRI of Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy

BackgroundSeven Tesla (7T) MRI can visualize anatomical alterations occurring in a hyperintense structure of the substantia nigra in Parkinson's disease (PD). ObjectiveWe investigated whether 7T MRI can detect the loss of substantia nigra hyperintensity in patients with PD, multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). MethodsUsing 7T MRI, we evaluated 26 healthy subjects, 30 patients with PD, 7 patients with MSA, and 3 patients with PSP. Two blinded readers independently assessed the images. We carried out a comparative analysis of five patients with hemiparkinsonism via 123I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane (123I-FP-CIT) SPECT. Results7T MRI revealed a definitive shape of nigral hyperintensity in healthy subjects, nearly identical to neuropathological characterization of nigrosome 1, and enabled instantaneous determination of its presence or absence in all subjects. Nigral hyperintensity was lost in all patients with PD, MSA with predominant parkinsonism, and PSP. One of five patients with MSA with predominant cerebellar ataxia showed an intact nigral hyperintensity. The side effects were mild and tolerable, and imaging was successful in patients with dyskinesia. Motion artifact incidence was higher in elderly subjects. In hemiparkinsonism cases, we observed partial loss of nigral hyperintensity on the side of less reduced 123I-FP-CIT binding, suggesting an ongoing iron deposition on the unaffected side in hemiparkinsonism. ConclusionsThe present findings suggest that 7T MRI represents an excellent tool for evaluating nigral hyperintensity in PD, MSA, and PSP, with tolerable side effects and limited motion artifacts. Thus, imaging of parkinsonism may benefit from using 7T MRI.

Abstract WP183: Renal function is Associated With Severity of White Matter Hyperintensity in Patients With Acute Ischemic Stroke/TIA

Introduction: Renal function impairment is characterized by glomerular endothelial dysfunction and lipohyalinosis, both of which are typical features of cerebral small vessel diseases(CSVD). We thus presume that renal function might be associated with silent CSVD-related MRI changes including white matter hyperintensity (WMH), lacune and microbleeds, which was supported by previous findings observed from the individuals without stroke. However, the relationship between renal function and WMH in patients with acute ischemic stroke or transcient ischemic stroke (AIS/TIA) remains unclear. Thus we aim to explore the potential risk factors of WMH in patients with AIS/TIA, especially the association between renal function and WMH located in both periventricular and deep area. Methods: A total of 1632 patients having an MRI examination were enrolled from SMART cohort for this analysis.The severity of WMH in both periventricular(PVH) and deep subcortical area(SDWMH) was evaluated using Fazekas scale. Estimated glomerular filtration rate(eGFR) was calculated by the equation of the Modification Diet for Renal Disease modified by the Chinese coefficient: eGFR(ml/min/1.73m 2 )=186хserum creatinine(exp[-1.154])хage(exp[-0.203])х1.233х0.742(if female).Multinomial logistic regression, adjusting for age, gender and vascular risk factors was performed to evaluate the association between the severity of WMH and eGFR. Results: Advanced age and hypertension were independently associated with the severity of PVH and SDWMH (all p&lt;0.001). Adjusting for age, gender and hypertension, the severity of PVH was found to be inversely related to eGFR. Each 30 ml/min/1.73m 2 increase in eGFR was related to a lower risk of having degree 3 of WMH in periventricular areas, (p=0.04, OR=0.75, 95%CI 0.61-0.92). However this inverse association was not found between eGFR and SDWMH(P=0.50). Conclusion: Our study demonstrates that renal dysfunction is independently associated with the severity of PVH but not SDWMH in patients with acute ischemic stroke. This result highlights different risk factors and mechanisms involved in the pathogenesis of PVH and SDWMH.

Spotlight on the January 12 Issue

#### Notable in Neurology This issue features an article determining which distinct thalamic regions are associated with gravity perception and another identifying genetic associations with white matter hyperintensities in patients with stroke. Another featured article focuses on resting-state functional connectivity in the salience, sensorimotor, and default mode networks during migraine attacks induced by pituitary adenylate cyclase-activating polypeptide-38. ### Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes In this study of 121 patients with primary intracerebral hemorrhage (ICH), Spearman rank correlation coefficients for modified Rankin scores …

Genome-wide meta-analysis of cerebral white matter hyperintensities in patients with stroke.

Objective:For 3,670 stroke patients from the United Kingdom, United States, Australia, Belgium, and Italy, we performed a genome-wide meta-analysis of white matter hyperintensity volumes (WMHV) on data imputed to the 1000 Genomes reference dataset to provide insights into disease mechanisms.Methods:We first sought to identify genetic associations with white matter hyperintensities in a stroke population, and then examined whether genetic loci previously linked to WMHV in community populations are also associated in stroke patients. Having established that genetic associations are shared between the 2 populations, we performed a meta-analysis testing which associations with WMHV in stroke-free populations are associated overall when combined with stroke populations.Results:There were no associations at genome-wide significance with WMHV in stroke patients. All previously reported genome-wide significant associations with WMHV in community populations shared direction of effect in stroke patients. In a meta-analysis of the genome-wide significant and suggestive loci (p < 5 × 10−6) from community populations (15 single nucleotide polymorphisms in total) and from stroke patients, 6 independent loci were associated with WMHV in both populations. Four of these are novel associations at the genome-wide level (rs72934505 [NBEAL1], p = 2.2 × 10−8; rs941898 [EVL], p = 4.0 × 10−8; rs962888 [C1QL1], p = 1.1 × 10−8; rs9515201 [COL4A2], p = 6.9 × 10−9).Conclusions:Genetic associations with WMHV are shared in otherwise healthy individuals and patients with stroke, indicating common genetic susceptibility in cerebral small vessel disease.

Nocturnal Hypoxemia Is Associated with White Matter Hyperintensities in Patients with a Minor Stroke or Transient Ischemic Attack.

Obstructive sleep apnea (OSA) is a risk factor for stroke, which is modulated by accompanying nocturnal hypoxemia. White matter hyperintensities (WMH) share many of the same risk factors as stroke. The purpose of this study was to investigate whether OSA and nocturnal hypoxemia are associated with white matter disease in patients with minor stroke and transient ischemic attack. Patients with minor stroke or TIA were recruited. Level 3 diagnostic sleep testing was used to diagnose OSA and quantify nocturnal hypoxemia. Significant OSA was defined as respiratory disturbance index ≥ 15, and nocturnal hypoxemia was defined as oxyhemoglobin saturation < 90% for ≥ 12% of total monitoring time. WMH were assessed and quantified on FLAIR MRI. The volume of WMH was compared between those with and without significant OSA and between those with and without nocturnal hypoxemia. One hundred nine patients were included. Thirty-four (31%) had OSA and 37 (34%) had nocturnal hypoxemia. Total WMH volume was significantly greater in the OSA than in the non-OSA groups (p = 0.04). WMH volume was also significantly higher in the hypoxic than the non-hypoxic groups (p = 0.001). Mutivariable analysis with adjustment for age, hypertension, and diabetes showed that nocturnal hypoxemia was independently associated with WMH volume (p = 0.03) but OSA was not (p = 0.29). We conclude that nocturnal hypoxemia, predominantly related to OSA, is independently associated with WMH in patients who present with minor ischemic stroke and TIA and may contribute to its pathogenesis.