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Auriel E, Westover MB, Bianchi MT, Reijmer Y, Martinez-Ramirez S, Ni J, Van Etten E, Frosch MP, Fotiadis P, Schwab K, Vashkevich A, Boulouis G, Younger AP, Johnson KA, Sperling RA, Hedden T, Gurol ME, Viswanathan A, Greenberg SM. Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging. Stroke 2015; 46:2129-35. [PMID: 26159796 DOI: 10.1161/strokeaha.115.009208] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral microinfarcts (CMI) are important contributors to vascular cognitive impairment. Magnetic resonance imaging diffusion-weighted imaging (DWI) hyperintensities have been suggested to represent acute CMI. We aim to describe a mathematical method for estimating total number of CMI based on the presence of incidental DWI lesions. METHODS We reviewed magnetic resonance imaging scans of subjects with cognitive decline, cognitively normal subjects and previously reported subjects with past intracerebral hemorrhage (ICH). Based on temporal and spatial characteristics of DWI lesions, we estimated the annual rate of CMI needed to explain the observed rate of DWI lesion detection in each group. To confirm our estimates, we performed extensive sampling for CMI in the brain of a deceased subject with past lobar ICH who found to have a DWI lesion during life. RESULTS Clinically silent DWI lesions were present in 13 of 343 (3.8%) cognitively impaired and 10 of 199 (5%) cognitively intact normal non-ICH patients, both lower than the incidence in the past ICH patients (23 of 178; 12.9%; P<0.0006). The predicted annual incidence of CMI ranges from 16 to 1566 for non-ICH and 50 to 5041 for ICH individuals. Histological sampling revealed a total of 60 lesions in 32 sections. Based on previously reported methods, this density of CMI yields an estimated total brain burden maximum likelihood estimate of 9321 CMIs (95% confidence interval, 7255-11 990). CONCLUSIONS Detecting even a single DWI lesion suggests an annual incidence of hundreds of new CMI. The cumulative effects of these lesions may directly contribute to small-vessel-related vascular cognitive impairment.
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Affiliation(s)
- Eitan Auriel
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - M Brandon Westover
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Matt T Bianchi
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Yael Reijmer
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Sergi Martinez-Ramirez
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Jun Ni
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Ellis Van Etten
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Matthew P Frosch
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Panagiotis Fotiadis
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Kris Schwab
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Anastasia Vashkevich
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Grégoire Boulouis
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Alayna P Younger
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Keith A Johnson
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Reisa A Sperling
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Trey Hedden
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - M Edip Gurol
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Anand Viswanathan
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Steven M Greenberg
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.).
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Reijmer YD, Fotiadis P, Martinez-Ramirez S, Salat DH, Schultz A, Shoamanesh A, Ayres AM, Vashkevich A, Rosas D, Schwab K, Leemans A, Biessels GJ, Rosand J, Johnson KA, Viswanathan A, Gurol ME, Greenberg SM. Structural network alterations and neurological dysfunction in cerebral amyloid angiopathy. Brain 2014; 138:179-88. [PMID: 25367025 DOI: 10.1093/brain/awu316] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Cerebral amyloid angiopathy is a common form of small-vessel disease and an important risk factor for cognitive impairment. The mechanisms linking small-vessel disease to cognitive impairment are not well understood. We hypothesized that in patients with cerebral amyloid angiopathy, multiple small spatially distributed lesions affect cognition through disruption of brain connectivity. We therefore compared the structural brain network in patients with cerebral amyloid angiopathy to healthy control subjects and examined the relationship between markers of cerebral amyloid angiopathy-related brain injury, network efficiency, and potential clinical consequences. Structural brain networks were reconstructed from diffusion-weighted magnetic resonance imaging in 38 non-demented patients with probable cerebral amyloid angiopathy (69 ± 10 years) and 29 similar aged control participants. The efficiency of the brain network was characterized using graph theory and brain amyloid deposition was quantified by Pittsburgh compound B retention on positron emission tomography imaging. Global efficiency of the brain network was reduced in patients compared to controls (0.187 ± 0.018 and 0.201 ± 0.015, respectively, P < 0.001). Network disturbances were most pronounced in the occipital, parietal, and posterior temporal lobes. Among patients, lower global network efficiency was related to higher cortical amyloid load (r = -0.52; P = 0.004), and to magnetic resonance imaging markers of small-vessel disease including increased white matter hyperintensity volume (P < 0.001), lower total brain volume (P = 0.02), and number of microbleeds (trend P = 0.06). Lower global network efficiency was also related to worse performance on tests of processing speed (r = 0.58, P < 0.001), executive functioning (r = 0.54, P = 0.001), gait velocity (r = 0.41, P = 0.02), but not memory. Correlations with cognition were independent of age, sex, education level, and other magnetic resonance imaging markers of small-vessel disease. These findings suggest that reduced structural brain network efficiency might mediate the relationship between advanced cerebral amyloid angiopathy and neurologic dysfunction and that such large-scale brain network measures may represent useful outcome markers for tracking disease progression.
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Affiliation(s)
- Yael D Reijmer
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Panagiotis Fotiadis
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sergi Martinez-Ramirez
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David H Salat
- 2 Athinoula A. Martinos Centre for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Aaron Schultz
- 2 Athinoula A. Martinos Centre for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Ashkan Shoamanesh
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alison M Ayres
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anastasia Vashkevich
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Diana Rosas
- 3 Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin Schwab
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander Leemans
- 4 Image Sciences Institute, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Biessels
- 5 Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jonathan Rosand
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- 3 Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA 6 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- 1 Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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