Small vessel disease is associated with altered cerebrovascular pulsatility but not resting cerebral blood flow
Small vessel disease is associated with altered cerebrovascular pulsatility but not resting cerebral blood flow
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DOI：
10.1177/0271678x18803956
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发表时间：
2020-01-01
影响因子：
6.3
通讯作者：
Wardlaw, Joanna M.
中科院分区：
文献类型：
--
作者：
Shi, Yulu;Thrippleton, Michael J.;Wardlaw, Joanna M.
脑血管疾病（SVD）导致25%的缺血性中风和45%的痴呆。我们的目的是探讨脑血流（CBF）和颅内脉搏在SVD中的作用。我们扫描了60例轻度缺血性卒中患者，表现出一系列白质高强度（WMH）。我们使用半定量量表评估WMH和血管周围空间(PVS)，并测量WMH体积。我们使用相衬MRI测量了主要脑血管和脑脊液（CSF）的流量和脉搏。我们研究了血流、脉搏和SVD特征之间的关系。数据完整的56/60例患者（40例男性，67.8±8.3岁）中，WMH体积中位数为10.7 mL（范围1.4 ~ 75.0 mL），占颅内体积中位数0.77%（0.11 ~ 5.17%）。静脉窦搏动指数（PI）越大，WMH体积越大（如上矢状窦，β = 1.29, P < 0.01），基底神经节PVS越大（比值比= 1.38,95%可信区间1.06,1.79，上矢状窦PI每增加0.1），与年龄、性别和血压无关。脑脊液脉搏和脑血流与SVD特征无关。我们的研究结果支持SVD特征与颅内搏动增加密切相关，而不是与低整体CBF密切相关，并为SVD的机制研究、治疗和预防提供了潜在的靶点。
Cerebral small vessel disease (SVD) contributes to 25% of ischemic strokes and 45% of dementias. We aimed to investigate the role of cerebral blood flow (CBF) and intracranial pulsatility in SVD. We scanned 60 patients with minor ischemic stroke, representing a range of white matter hyperintensities (WMH). We rated WMH and perivascular spaces (PVS) using semi-quantitative scales and measured WMH volume. We measured flow and pulsatility in the main cerebral vessels and cerebrospinal fluid (CSF) using phase-contrast MRI. We investigated the association between flow, pulsatility and SVD features. In 56/60 patients (40 male, 67.8 +/- 8.3 years) with complete data, median WMH volume was 10.7 mL (range 1.4-75.0 mL), representing median 0.77% (0.11-5.17%) of intracranial volume. Greater pulsatility index (PI) in venous sinuses was associated with larger WMH volume (e.g. superior sagittal sinus, beta = 1.29, P < 0.01) and more basal ganglia PVS (e.g. odds ratio = 1.38, 95% confidence interval 1.06, 1.79, per 0.1 increase in superior sagittal sinus PI) independently of age, sex and blood pressure. CSF pulsatility and CBF were not associated with SVD features. Our results support a close association of SVD features with increased intracranial pulsatility rather than with low global CBF, and provide potential targets for mechanistic research, treatment and prevention of SVD.