Incident lacunes preferentially localize to the edge of white matter hyperintensities: insights into the pathophysiology of cerebral small vessel disease
Incident lacunes preferentially localize to the edge of white matter hyperintensities: insights into the pathophysiology of cerebral small vessel disease
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DOI：
10.1093/brain/awt184
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发表时间：
2013-09-01
期刊：
影响因子：
14.5
通讯作者：
Dichgans, Martin
中科院分区：
文献类型：
--
作者：
Duering, Marco;Csanadi, Endy;Dichgans, Martin
白色物质高信号和腔隙是脑磁共振成像最常见的异常之一。它们通常与脑小血管疾病有关，并与中风和痴呆有关。我们检查了偶发腔隙和白色高信号之间的空间关系，并将这些发现与血管解剖学信息相关联，以研究两种病变类型之间可能的机制联系。276例常染色体显性遗传性脑动脉病伴皮质下梗死和白质脑病（CADASIL）患者（一种遗传学定义的小血管疾病，伴有NOTCH 3基因突变）通过磁共振成像随访，共随访633例患者年。使用差异图像和雅可比映射从注册的图像，我们确定了104个事件的空隙。大多数（n = 95; 91.3%）陷窝发生在白色高信号的边缘，而很少有陷窝在白色高信号内（n = 6; 5.8%）或外（n = 3; 2.9%）完全发育。增加血管解剖结构的信息显示，大多数偶发腔隙发生在白色高信号沿着供应相应脑区的穿支血管的近端。我们进一步研究了365例CADASIL患者和588例来自奥地利卒中预防研究的老年受试者中普遍存在的腔隙和白色高信号之间的空间关系。该结果与事故缺陷的结果一致。不同疾病阶段的病变患病率图显示两个队列中病变向皮质下区域扩散。我们的研究结果表明，腔隙和白色高信号的机制是密切相关的，并确定白色高信号的边缘作为腔隙的好发部位。我们的观测进一步支持和完善了白色物质高强度半影的概念。
White matter hyperintensities and lacunes are among the most frequent abnormalities on brain magnetic resonance imaging. They are commonly related to cerebral small vessel disease and associated with both stroke and dementia. We examined the spatial relationships between incident lacunes and white matter hyperintensities and related these findings to information on vascular anatomy to study possible mechanistic links between the two lesion types. Two hundred and seventy-six patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a genetically defined small vessel disease with mutations in the NOTCH3 gene were followed with magnetic resonance imaging over a total of 633 patient years. Using difference images and Jacobian maps from registered images we identified 104 incident lacunes. The majority (n = 95; 91.3%) of lacunes developed at the edge of a white matter hyperintensity whereas few lacunes were found to develop fully within (n = 6; 5.8%) or outside (n = 3; 2.9%) white matter hyperintensities. Adding information on vascular anatomy revealed that the majority of incident lacunes developed proximal to a white matter hyperintensity along the course of perforating vessels supplying the respective brain region. We further studied the spatial relationship between prevalent lacunes and white matter hyperintensities both in 365 patients with CADASIL and in 588 elderly subjects from the Austrian Stroke Prevention Study. The results were consistent with the results for incident lacunes. Lesion prevalence maps in different disease stages showed a spread of lesions towards subcortical regions in both cohorts. Our findings suggest that the mechanisms of lacunes and white matter hyperintensities are intimately connected and identify the edge of white matter hyperintensities as a predilection site for lacunes. Our observations further support and refine the concept of the white matter hyperintensity penumbra.