Cerebral White Matter Hypoperfusion Increases with Small-Vessel Disease Burden. Data From the Third International Stroke Trial
Cerebral White Matter Hypoperfusion Increases with Small-Vessel Disease Burden. Data From the Third International Stroke Trial
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DOI：
10.1016/j.jstrokecerebrovasdis.2017.03.002
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发表时间：
2017-07-01
影响因子：
2.5
通讯作者：
Wardlaw, Joanna M.
中科院分区：
文献类型：
--
作者：
Arba, Francesco;Mair, Grant;Wardlaw, Joanna M.
背景：白质病变与脑灌注受损有关，但个体和联合小血管疾病（SVD）特征对白质灌注的影响尚不清楚。方法：我们研究了在第三次国际脑卒中试验中接受灌注成像的患者。我们评估了个体SVD特征（白质变、凹窝）和脑萎缩的基线计算机断层扫描或磁共振成像。另外，我们通过4个基于时间的灌注成像参数评估脑卒中对侧大脑半球侧脑室水平的白质，以寻找可见的低灌注区（存在或不存在）。我们检查了SVD特征（单独的和综合的）与低灌注存在之间的关系，使用调整了年龄、性别、基线美国国立卫生研究院卒中量表、高血压和糖尿病的逻辑回归。结果：115例患者有完整的灌注数据，中位（四分位间距）年龄为81（72-86）岁，其中78例（52%）为男性。低灌注在平均转运时间（MTT）上最常见（63例，55%），在达到最大流量的时间上最不常见（19例，17%）。SVD评分与低灌注（如MTT，比值比[OR] = 2.80； 95%可信区间[CI] = 1.56-5.03）的独立相关性强于单独的SVD标记（如白质低衰减评分，MTT, OR = 1.49, 95% CI = 1.09-2.04）。基线血压不因有无低灌注或SVD评分而有差异。随着SVD总评分的增加，白质灌注不足的出现也随之增加。结论：与单个SVD特征相比，SVD总评分与灌注不足的相关性更一致，为SVD评分概念提供了有效性。SVD负荷增加表明白质灌注恶化。
Background: Leukoaraiosis is associated with impaired cerebral perfusion, but the effect of individual and combined small-vessel disease (SVD) features on white matter perfusion is unclear. Methods: We studied patients recruited with perfusion imaging in the Third International Stroke Trial. We rated individual SVD features (leukoaraiosis, lacunes) and brain atrophy on baseline plain computed tomography or magnetic resonance imaging. Separately, we assessed white matter at the level of the lateral ventricles in the cerebral hemisphere contralateral to the stroke for visible areas of hypoperfusion (present or absent) on 4 time-based perfusion imaging parameters. We examined associations between SVD features (individually and summed) and presence of hypoperfusion using logistic regression adjusted for age, sex, baseline National Institutes of Health Stroke Scale, hypertension, and diabetes. Results: A total of 115 patients with median (interquartile range) age of 81 (72-86) years, 78 (52%) of which were male, had complete perfusion data. Hypoperfusion was most frequent on mean transit time (MTT; 63 patients, 55%) and least frequent on time to maximum flow (19 patients, 17%). The SVD score showed stronger independent associations with hypoperfusion (e.g., MTT, odds ratio [OR] = 2.80; 95% confidence interval [CI] = 1.56-5.03) than individual SVD markers (e.g., white matter hypoattenuation score, MTT, OR = 1.49, 95% CI = 1.09-2.04). Baseline blood pressure did not differ by presence or absence of hypoperfusion or across strata of SVD score. Presence of white matter hypoperfusion increased with SVD summed score. Conclusions: The SVD summed score was associated with hypoperfusion more consistently than individual SVD features, providing validity to the SVD score concept. Increasing SVD burden indicates worse perfusion in the white matter.