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Gao Y, Zong C, Yao Y, Zhao H, Song Y, Zhang K, Yang H, Liu H, Wang Y, Li Y, Yang J, Song B, Xu Y. Elevated Fibrinogen-to-Albumin Ratio Correlates with Incident Stroke in Cerebral Small Vessel Disease. J Inflamm Res 2024; 17:4331-4343. [PMID: 38979435 PMCID: PMC11230119 DOI: 10.2147/jir.s466879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/15/2024] [Indexed: 07/10/2024] Open
Abstract
Purpose We aimed to explore the association between fibrinogen-to-albumin ratio (FAR) and the risk of incident stroke (IS) in a cohort of cerebral small vessel disease (CSVD) patients. Patients and Methods Participants were screened from a prospective CSVD database. Clinical data, hematologic measures and imaging findings were collected. The primary outcome was IS during follow-up, with a secondary outcome of composite vascular events (CVE) including IS, myocardial infarction (MI), and vascular deaths. Univariate and multivariate COX proportional risk models, along with competing risk models, were employed to identify factors associated with outcomes. Restricted cubic spline (RCS) and subgroup analyses were conducted to assess the association between FAR and the risk of IS and CVE in CSVD patients. Results In the final analysis of 682 CSVD patients over a median observation period of 34.0 [24.0-53.0] months, there were 33 cases of IS (4.84%, 1.55/100 person-years), 4 incidents of MI (0.59%, 0.19/100 person-years), 15 non-vascular deaths (2.20%, 0.70/100 person-years), and 37 occurrences of CVE (5.43%, 1.74/100 person-years). Multivariate Cox regression analysis revealed a significant positive correlation between elevated FAR and both IS (HR 1.146; 95% CI 1.043-1.259; P=0.004) and CVE (HR 1.156; 95% CI 1.063-1.257; P=0.001) in CSVD patients. Multivariate competing risk model showed the similar results (IS: HR 1.16; 95% CI 1.06-1.27; P=0.001, CVE: HR 1.15; 95% CI 1.05-1.26; P=0.003). RCS analysis indicated a linear relationship between FAR and the risks of both IS (P for non-linearity =0.7016) and CVE (P for non-linearity =0.6475), with an optimal cutoff value of 8.69, particularly in individuals over 60 years of age. Conclusion Elevated FAR demonstrated an independent and linear association with IS and the development of CVE in CSVD patients.
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Affiliation(s)
- Yuan Gao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
| | - Ce Zong
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ying Yao
- School of Health and Nursing, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Haixu Zhao
- School of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yuan Song
- School of Health and Nursing, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ke Zhang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hongxun Yang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hongbing Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yunchao Wang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yusheng Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
| | - Jing Yang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
| | - Bo Song
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
| | - Yuming Xu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
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Han Y, Chen H, Cao X, Yin X, Zhang J. A novel perspective for exploring the relationship between cerebral small vessel disease and deep medullary veins with automatic segmentation. Clin Radiol 2024; 79:e933-e940. [PMID: 38670919 DOI: 10.1016/j.crad.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND This study aimed to establish an intelligent segmentation algorithm to count the number of deep medullary veins (DMVs) and analyze the relationship between DMVs and imaging markers of cerebral small vessel disease (CSVD). METHODS DMVs on magnetic resonance imaging (MRI) of patients with CSVD were counted by intelligent segmentation and manual counting. The dice coefficient and intraclass correlation coefficient (ICC) were used to evaluate their consistency and correlation. Structural MR images were used to assess imaging markers and total burden of CSVD. A multivariate linear regression model was used to evaluate the correlation between the number of DMVs counted by intelligent segmentation and imaging markers of CSVD, including white matter hyperintensities of the presumed vascular origin, lacune, perivascular spaces, cerebral microbleeds, and total CSVD burden. RESULTS A total of 305 patients with CSVD were enrolled. An intelligent segmentation algorithm was established to calculate the number of DMVs, and it was validated and tested. The number of DMVs counted intelligently significantly correlated with the manual counting method (r = 0.761, P< 0.001). The number of smart-counted DMVs negatively correlated with the imaging markers and total burden of CSVD (P< 0.001), and the correlation remained after adjusting for age and hypertension (P< 0.05). CONCLUSIONS The proposed intelligent segmentation algorithm, which was established to count DMVs, can provide objective and quantitative imaging information for the follow-up of patients with CSVD. DMVs are involved in CSVD pathogenesis and a likely new imaging marker for CSVD.
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Affiliation(s)
- Y Han
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - H Chen
- Academy for Engineering and Technology, Fudan University, Shanghai 200040, China
| | - X Cao
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China; National Center for Neurological Disorders, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - X Yin
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - J Zhang
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China; National Center for Neurological Disorders, 12 Wulumuqi Middle Road, Shanghai 200040, China.
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Liu ZY, Wang P, Zhai FF, Ao DH, Han F, Li ML, Zhou LX, Ni J, Yao M, Zhang SY, Cui LY, Jin ZY, Zhu YC. Dynamic Mechanism of Cerebral Venous Disruption: Longitudinal Evidence From a Community-Based Cohort. J Am Heart Assoc 2024; 13:e034145. [PMID: 38761086 PMCID: PMC11179834 DOI: 10.1161/jaha.123.034145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/15/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND This study aims to investigate the temporal and spatial patterns of structural brain injury related to deep medullary veins (DMVs) damage. METHODS AND RESULTS This is a longitudinal analysis of the population-based Shunyi cohort study. Baseline DMVs numbers were identified on susceptibility-weighted imaging. We assessed vertex-wise cortex maps and diffusion maps at both baseline and follow-up using FSL software and the longitudinal FreeSurfer analysis suite. We performed statistical analysis of global measurements and voxel/vertex-wise analysis to explore the relationship between DMVs number and brain structural measurements. A total of 977 participants were included in the baseline, of whom 544 completed the follow-up magnetic resonance imaging (age 54.97±7.83 years, 32% men, mean interval 5.56±0.47 years). A lower number of DMVs was associated with a faster disruption of white matter microstructural integrity, presented by increased mean diffusivity and radial diffusion (β=0.0001 and SE=0.0001 for both, P=0.04 and 0.03, respectively), in extensive deep white matter (threshold-free cluster enhancement P<0.05, adjusted for age and sex). Of particular interest, we found a bidirectional trend association between DMVs number and change in brain volumes. Specifically, participants with mild DMVs disruption showed greater cortical enlargement, whereas those with severe disruption exhibited more significant brain atrophy, primarily involving clusters in the frontal and parietal lobes (multiple comparison corrected P<0.05, adjusted for age, sex, and total intracranial volume). CONCLUSIONS Our findings posed the dynamic pattern of brain parenchymal lesions related to DMVs injury, shedding light on the interactions and chronological roles of various pathological mechanisms.
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Affiliation(s)
- Zi-Yue Liu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Pei Wang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Fei-Fei Zhai
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Dong-Hui Ao
- Department of Neurology Wu Han Tong Ji Hospital Wuhan China
| | - Fei Han
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Ming-Li Li
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Li-Xin Zhou
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jun Ni
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Ming Yao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shu-Yang Zhang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Li-Ying Cui
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Zheng-Yu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yi-Cheng Zhu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Hu Z, Li Z, Shi Y, Liu S, Shen Y, Hu F, Li Q, Liu X, Gou X, Chen Z, Yang D. Advancements in investigating the role of cerebral small vein loss in Alzheimer's disease-related pathological changes. Neurol Sci 2024; 45:1875-1883. [PMID: 38133856 DOI: 10.1007/s10072-023-07208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
Alzheimer's disease (AD) is the prevailing type of dementia in the elderly, yet a comprehensive comprehension of its precise underlying mechanisms remains elusive. The investigation of the involvement of cerebral small veins in the advancement of AD has yet to be sufficiently explored in previous studies, primarily due to constraints associated with pathological staining techniques. However, recent research has provided valuable insights into multiple pathophysiological occurrences concerning cerebral small veins in AD, which may manifest sequentially, concurrently, or in a self-perpetuating manner. These events are presumed to be among the initial processes in the disease's progression. The impact of cerebral small vein loss on amyloid beta (Aβ) clearance through the glial lymphatic system is noteworthy. There exists a potential interdependence between collagen deposition and Aβ deposition in cerebral small veins. The compromised functionality of cerebral small veins can result in decreased cerebral perfusion pressure, potentially leading to cerebral tissue ischemia and edema. Additionally, the reduction of cerebral small veins may facilitate the infiltration of inflammatory factors into the brain parenchyma, thereby eliciting neuroinflammatory responses. Susceptibility-weighted imaging (SWI) is a valuable modality for the efficient assessment of cerebral small veins, precisely the deep medullary vein (DMV), and holds promise for the identification of precise and reliable imaging biomarkers for AD. This review presents a comprehensive overview of the current advancements and obstacles to the impairment of cerebral small veins in AD. Additionally, we emphasize future research avenues and the importance of conducting further investigations in this domain.
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Affiliation(s)
- Zhenzhu Hu
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Zhaoying Li
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Yu Shi
- Department of Neurology, Xuzhou Cancer Hospital, Xuzhou, 221000, Jiangsu, China
| | - Shanyu Liu
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Yuling Shen
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Fangfang Hu
- Department of Neurology, Xuzhou Cancer Hospital, Xuzhou, 221000, Jiangsu, China
| | - Qingqing Li
- Department of Neurology, Xuzhou Cancer Hospital, Xuzhou, 221000, Jiangsu, China
| | - Xu Liu
- Department of Neurology, Xuzhou Cancer Hospital, Xuzhou, 221000, Jiangsu, China
| | - Xinyu Gou
- Department of Neurology, Guang'an People's Hospital, Guang'an, 638001, China
| | - Zhenwei Chen
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Dongdong Yang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China.
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Liao M, Wang M, Li H, Li J, Yi M, Lan L, Ouyang F, Shi L, Fan Y. Discontinuity of deep medullary veins in SWI is associated with deep white matter hyperintensity volume and cognitive impairment in cerebral small vessel disease. J Affect Disord 2024; 350:600-607. [PMID: 38253134 DOI: 10.1016/j.jad.2024.01.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/30/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Discontinuation of the deep medullary veins (DMVs) may be an early imaging marker for identifying cognitive impairment caused by cerebral small vessel disease (CSVD). However, this method lacks mechanistic exploration. We aimed to investigate whether the DMV score is related to CSVD imaging markers and cognitive impairment in patients with CSVD. METHODS This retrospective study included patients with CSVD who completed DMV score and cognition (e.g., MMSE, MoCA) assessments, and underwent MRI scanning (T2-FLAIR for white matter hyperintensities (WMH) volume, T1-weighted MRI for brain parenchymal fractions (BPF) analysis, and SWI for assessment of DMV score). The CSVD imaging markers were quantitatively assessed using the AccuBrain® system. We assessed the diagnostic value of neuroimaging biomarkers for detecting CSVD-related cognitive impairment. In addition, we explored the relationship between the DMV score, CSVD imaging markers, and cognition using mediation analysis. RESULTS Ninety-four patients with CSVD were divided into a cognitive impairment group (n = 39) and a non-cognitive impairment group (n = 55). Higher DMV scores, larger WMH volumes, and smaller BPF were observed in the cognitive impairment group than those in the non-cognitive impairment group. Receiver operating characteristics (ROC) analysis revealed that the discovery value of the integration of patient age, BPF, whole WMH volume, and DMV score for cognitive impairment was 0.742, with a sensitivity and specificity of 79.5 % and 61.5 %, respectively. Mediation analysis showed mediation by WMH and BPF in the relationship between DMV score and cognitive impairment (all P < 0.05). LIMITATIONS This study did not evaluate the DMV score in subregions according to DMV anatomy. CONCLUSIONS The DMV score is significantly associated with cognitive impairment in patients with CSVD, and this association is mediated through WMH and BPF.
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Affiliation(s)
- Mengshi Liao
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meng Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinbiao Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Yi
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Linfang Lan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fubing Ouyang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuhua Fan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Gao Y, Zong C, Liu H, Zhang K, Yang H, Wang Y, Li Y, Song B, Xu Y. Clinical features and associated factors of coexisting intracerebral hemorrhage in patients with cerebral small vessel disease: a cross-sectional study. Sci Rep 2024; 14:5596. [PMID: 38454101 PMCID: PMC10920749 DOI: 10.1038/s41598-024-55968-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/29/2024] [Indexed: 03/09/2024] Open
Abstract
Intracerebral hemorrhage (ICH) is generally considered to be closely related to cerebral small vessel disease (CSVD), leading to a poor prognosis. However, the coexistence of ICH in general CSVD patients and related factors remain underreported. In our cross-sectional study, we screened 414 CSVD patients from a database at the Department of Neurology, First Affiliated Hospital of Zhengzhou University (September 2018 to April 2022). Imaging biomarkers of CSVD and coexisting ICH lesion were assessed. Factors associated with coexisting ICH in CSVD were determined using multivariate logistic regression analysis. ICH was observed in 59 patients (14.3%). Multivariate logistic regression showed that previous history of ischemic stroke or transient ischemic attack (OR 5.189, 95%CI 2.572-10.467, P < 0.001), high-grade perivascular space in the basal ganglia (n > 10) (OR 2.051, 95%CI 1.044-4.027, P = 0.037) and low adjusted calcium-phosphorus product (OR 0.728 per 1 [mmol/L]2 increase, 95%CI 0.531-0.998, P = 0.049) were associated with coexisting ICH in CSVD patients. The considerable proportion of coexisting ICH and revelation of associated factors in general CSVD patients alert physicians of the potential risk of the reoccurrence of ICH, and might have a significant impact on therapeutic strategies.
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Affiliation(s)
- Yuan Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China
| | - Ce Zong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China
| | - Hongbing Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China
| | - Ke Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China
| | - Hongxun Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China
| | - Yunchao Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China
| | - Yusheng Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China.
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Wang D, Xiang Y, Peng Y, Zeng P, Zeng B, Chai Y, Li Y. Deep Medullary Vein and MRI Markers Were Related to Cerebral Hemorrhage Subtypes. Brain Sci 2023; 13:1315. [PMID: 37759916 PMCID: PMC10526710 DOI: 10.3390/brainsci13091315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/02/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND To explore the performance of deep medullary vein (DMV) and magnetic resonance imaging (MRI) markers in different intracerebral hemorrhage (ICH) subtypes in patients with cerebral small vessel disease (CSVD). METHODS In total, 232 cases of CSVD with ICH were included in this study. The clinical and image data were retrospectively analyzed. Patients were divided into hypertensive arteriopathy (HTNA)-related ICH, cerebral amyloid angiopathy (CAA)-related ICH, and mixed ICH groups. The DMV score was determined in the cerebral hemisphere contralateral to the ICH. RESULTS The DMV score was different between the HTNA-related and mixed ICH groups (p < 0.01). The MRI markers and CSVD burden score were significant among the ICH groups (p < 0.05). Compared to mixed ICH, HTNA-related ICH diagnosis was associated with higher deep white matter hyperintensity (DWMH) (OR: 0.452, 95% CI: 0.253-0.809, p < 0.05) and high-degree perivascular space (PVS) (OR: 0.633, 95% CI: 0.416-0.963, p < 0.05), and CAA-related ICH diagnosis was associated with increased age (OR: 1.074; 95% CI: 1.028-1.122, p = 0.001). The DMV score correlated with cerebral microbleed (CMB), PVS, DWMH, periventricular white matter hyperintensity (PWMH), and CSVD burden score (p < 0.05) but not with lacuna (p > 0.05). Age was an independent risk factor for the severity of DMV score (OR: 1.052; 95% CI: 0.026-0.076, p < 0.001). CONCLUSION DMV scores, CSVD markers, and CSVD burden scores were associated with different subtypes of ICH. In addition, DMV scores were associated with the severity of CSVD and CSVD markers.
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Affiliation(s)
- Dan Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
- Department of Radiology, Mianyang Central Hospital, 12# Changjia Lane, Mianyang 621000, China
| | - Yayun Xiang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
| | - Yuling Peng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
| | - Peng Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
| | - Bang Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
| | - Ying Chai
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
- Department of Radiology, People’s Hospital of Shapingba District, 44# Xiaolongkan New Street, Chongqing 400010, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
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Ye S, Feng K, Li Y, Liu S, Wu Q, Feng J, Liao X, Jiang C, Liang B, Yuan L, Chen H, Huang J, Yang Z, Lu Z, Li H. High homocysteine is associated with idiopathic normal pressure hydrocephalus in deep perforating arteriopathy: a cross-sectional study. BMC Geriatr 2023; 23:382. [PMID: 37344765 PMCID: PMC10286484 DOI: 10.1186/s12877-023-03991-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 04/22/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The pathogenesis and pathophysiology of idiopathic normal pressure hydrocephalus (iNPH) remain unclear. Homocysteine may reduce the compliance of intracranial arteries and damage the endothelial function of the blood-brain barrier (BBB), which may be the underlying mechanism of iNPH. The overlap cases between deep perforating arteriopathy (DPA) and iNPH were not rare for the shared risk factors. We aimed to investigate the relationship between serum homocysteine and iNPH in DPA. METHODS A total of 41 DPA patients with iNPH and 49 DPA patients without iNPH were included. Demographic characteristics, vascular risk factors, laboratory results, and neuroimaging data were collected. Multivariable logistic regression analysis was performed to investigate the relationship between serum homocysteine and iNPH in DPA patients. RESULTS Patients with iNPH had significantly higher homocysteine levels than those without iNPH (median, 16.34 mmol/L versus 14.28 mmol/L; P = 0.002). There was no significant difference in CSVD burden scores between patients with iNPH and patients without iNPH. Univariate logistic regression analysis demonstrated that patients with homocysteine levels in the Tertile3 were more likely to have iNPH than those in the Tertile1 (OR, 4.929; 95% CI, 1.612-15.071; P = 0.005). The association remained significant after multivariable adjustment for potential confounders, including age, male, hypertension, diabetes mellitus, atherosclerotic cardiovascular disease (ASCVD) or hypercholesterolemia, and eGFR level. CONCLUSION Our study indicated that high serum homocysteine levels were independently associated with iNPH in DPA. However, further research is needed to determine the predictive value of homocysteine and to confirm the underlying mechanism between homocysteine and iNPH.
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Affiliation(s)
- Shisheng Ye
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Kaiyan Feng
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Yizhong Li
- Department of Radiology, Maoming People's Hospital, Maoming, China
| | - Sanxin Liu
- Department of Neurology, the third affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiaoling Wu
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Jinwen Feng
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Xiaorong Liao
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Chunmei Jiang
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Bo Liang
- Department of Radiology, Maoming People's Hospital, Maoming, China
| | - Li Yuan
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Hai Chen
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Jinbo Huang
- Department of Neurology, Maoming People's Hospital, Maoming, China
- Department of Neurology, Maoming maternal and child health Hospital, Maoming, China
| | - Zhi Yang
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Zhengqi Lu
- Department of Neurology, the third affiliated hospital of Sun Yat-sen University, Guangzhou, China.
| | - Hao Li
- Department of Neurology, Maoming People's Hospital, Maoming, China.
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9
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Tian Y, Li S, Yang Y, Cai X, Jing J, Wang S, Meng X, Mei L, Jin A, Yao D, Wei T, Wang Y, Pan Y, Wang Y. Associations of deep medullary veins with vascular risk factors, laboratory indicators, and cerebral small vessel disease: A population-based study. Brain Behav 2023; 13:e2974. [PMID: 37032510 PMCID: PMC10176017 DOI: 10.1002/brb3.2974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/08/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
OBJECTIVE Deep medullary veins (DMVs) were not considered a typical marker of cerebral small vessel disease (CSVD) due to limited understanding of their involvement in pathology of CSVD. This study aimsto investigate potential vascular risk factors for DMVs and their associations with CSVD. METHODS In total, 1909 community-dwelling participants were included in this analysis. Demographic, clinical, laboratory, and imaging data were collected. DMV scores (0-18) werecalculated as the sum of bilateral frontal, parietal, and occipital regional scores using a semiquantitative visual scale (0-3). The presence, total burden, and imaging markers of CSVD were assessed. Linear regression analyses were conducted to explore potential vascular factors for DMV scores. Binary and ordinal logistic regression analyses were performed to investigate the associations of DMV scores with CSVD and its markers. RESULTS Mean age was 61.8 (SD 6.5) years, and 1027 (53.8%) of participants were men. The median DMV scores were14 (IQR 12-16). DMV scores wererelated to age, male sex, body mass index, diastolic blood pressure, hypercholesterolaemia, atrial fibrillation, current drinking, total cholesterol, triglycerides, low-density lipoprotein, hemoglobin A1c, leukocytes, lymphocytes, hemoglobin, and platelets (p < .05). DMV scores wereassociated with the presence and total burden of CSVD (Rothwell's scale), modified white matter hyperintensity burden, and enlarged perivascular spaces in centrum semiovale (p < .05). However, these associations between DMV scores and CSVD disappeared after adjusting for potential confounders. CONCLUSION Several conventional vascular factors were associated with DMVs. The relationship between DMVs and CSVD was vulnerable, suggesting decreased visible and discontinuous DMVs may differ mechanistically from traditional markers of CSVD.
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Affiliation(s)
- Yu Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shan Li
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Yingying Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xueli Cai
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Suying Wang
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lerong Mei
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Dongxiao Yao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tiemin Wei
- Department of Cardiology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
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10
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He L, Guo ZN, Qu Y, Wang RT, Zhang P, Yang Y, Jin H. Effect of dynamic cerebral autoregulation on the association between deep medullary vein changes and cerebral small vessel disease. Front Physiol 2023; 14:1037871. [PMID: 37082245 PMCID: PMC10110974 DOI: 10.3389/fphys.2023.1037871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Abstract
Changes in the deep medullary vein (DMV) are reported to be associated with cerebral small vessel disease (CSVD). While the mechanisms of this association are unclear, dynamic cerebral autoregulation (dCA) has been speculated to participate in this association. Thus, we aimed to verify the association between DMV changes and total CSVD burden and further investigate the effect of dCA function on this correlation. In this prospective study, 95 Asian patients aged ≥18 years were included in the final assessment. DMV scores and total CSVD burden were determined using magnetic resonance imaging sequences. Transfer function analysis was performed to analyze dCA function. Generalized linear regressions were used to assess the relationship between DMV changes and total CSVD burden as well as between DMV changes and dCA function. An interaction model was utilized to assess the effect of dCA function on the association between DMV changes and total CSVD burden. Generalized linear models showed a significant positive association between DMV changes and total CSVD burden (p = 0.039) and a significant negative association between DMV changes and dCA function (p = 0.018). The interaction model demonstrated a significant positive interaction of dCA impairment on the association between DMV changes and the total CSVD burden (p = 0.02). Thus, we came to the conclusion that changes in DMV were correlated independently with both CSVD and dCA impairment and furthermore, impaired dCA function play an interaction effect on the association between DMV changes and the total CSVD burden. Our results can help improve the understanding of the complex pathogenesis and progression of CSVD, thereby facilitating early intervention and treatment development.
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Affiliation(s)
- Ling He
- Stroke Center and Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Zhen-Ni Guo
- Stroke Center and Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- China National Comprehensive Stroke Center, Changchun, China
- Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Yang Qu
- Stroke Center and Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- China National Comprehensive Stroke Center, Changchun, China
- Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Run-Ting Wang
- Stroke Center and Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Peng Zhang
- Stroke Center and Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- China National Comprehensive Stroke Center, Changchun, China
- Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Yi Yang
- Stroke Center and Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- China National Comprehensive Stroke Center, Changchun, China
- Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Hang Jin
- Stroke Center and Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- China National Comprehensive Stroke Center, Changchun, China
- Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
- *Correspondence: Hang Jin,
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11
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Lan H, Lei X, Xu Z, Chen S, Gong W, Cai Y. New insights in addressing cerebral small vessel disease: Associated with extracellular fluid in white matter. Front Neurosci 2022; 16:1042824. [PMID: 36340793 PMCID: PMC9631816 DOI: 10.3389/fnins.2022.1042824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the role of extracellular fluid, assessed by diffusion tensor imaging (DTI) metrics of free water (FW), in the white matter of patients with cerebral small vessel disease (CSVD). Materials and methods The baseline clinical and imaging data of 129 patients with CSVD were collected and reviewed. CSVD MR markers, including periventricular white matter hyperintensity (PWMH), deep white matter hyperintensity (DWMH), cerebral microbleed (CMB), enlarged perivascular space (PVS), and lacunar infarction (LI), were identified, and CSVD burden was calculated. According to total CSVD MR marker score, cases were classified as mild, moderate, or severe. The mean FW and fractional anisotropy (FA) values were calculated using DTI images. Results The mean white matter FW was associated with the CSVD MR markers, including PWMH, DWMH, LI and PVS (P < 0.05). Moreover, age, hypertension, diabetes mellitus, and FW value were associated with total CSVD MR marker score (P < 0.05). Ordinal logistic regression analysis revealed that FW and age were independently associated with CSVD burden (P < 0.05). Finally, FW in white matter was associated with FA (r = –0.334, P < 0.001). Conclusion Extracellular fluid changes, assessed by DTI metrics of FW in white matter, were associated with CSVD markers and burden. An increased extracellular fluid volume in the white matter was associated with lower FA.
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Affiliation(s)
- Haiyuan Lan
- Department of Radiology, Lishui Hospital of Traditional Chinese Medicine affiliated Zhejiang Chinese Medical University, Lishui, China
| | - Xinjun Lei
- Department of Radiology, Lishui Hospital of Traditional Chinese Medicine affiliated Zhejiang Chinese Medical University, Lishui, China
| | - Zhihua Xu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
- *Correspondence: Zhihua Xu,
| | - Songkuan Chen
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Wanfeng Gong
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yunqi Cai
- Department of Radiology, Lishui Hospital of Traditional Chinese Medicine affiliated Zhejiang Chinese Medical University, Lishui, China
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12
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van Harten T, Heijmans A, van Rooden S, Wermer MJ, van Osch MJ, Kuijf HJ, van Veluw SJ, Greenberg SM, van Buchem MA, van der Grond J, van Walderveen MA. Brain Deep Medullary Veins on 7T MRI in Dutch-Type Hereditary Cerebral Amyloid Angiopathy. J Alzheimers Dis 2022; 90:381-388. [DOI: 10.3233/jad-220354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Deep medullary vein (DMV) changes occur in cerebral small vessel diseases (SVD) and in Alzheimer’s disease. Cerebral amyloid angiopathy (CAA) is a common SVD that has a high co-morbidity with Alzheimer’s disease. So far, DMVs have not been evaluated in CAA. Objective: To evaluate DMVs in Dutch-type hereditary CAA (D-CAA) mutation carriers and controls, in relation to MRI markers associated with D-CAA. Methods: Quantitative DMV parameters length, tortuosity, inhomogeneity, and density were quantified on 7 Tesla 3D susceptibility weighted MRI in pre-symptomatic D-CAA mutation carriers (n = 8), symptomatic D-CAA mutation carriers (n = 8), and controls (n = 25). Hemorrhagic MRI markers (cerebral microbleeds, intracerebral hemorrhages, cortical superficial siderosis, convexity subarachnoid hemorrhage), non-hemorrhagic MRI markers (white matter hyperintensities, enlarged perivascular spaces, lacunar infarcts, cortical microinfarcts), cortical grey matter perfusion, and diffusion tensor imaging parameters were assessed in D-CAA mutation carriers. Univariate general linear analysis was used to determine associations between DMV parameters and MRI markers. Results: Quantitative DMV parameters length, tortuosity, inhomogeneity, and density did not differ between pre-symptomatic D-CAA mutation carriers, symptomatic D-CAA mutation carriers, and controls. No associations were found between DMV parameters and MRI markers associated with D-CAA. Conclusion: This study indicates that vascular amyloid-β deposition does not affect DMV parameters. In patients with CAA, DMVs do not seem to play a role in the pathogenesis of MRI markers associated with CAA.
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Affiliation(s)
- Thijs van Harten
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne Heijmans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanneke van Rooden
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke J.H. Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Matthias J.P. van Osch
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hugo J. Kuijf
- Image Science Institute, University Medical Center Utrecht, The Netherlands
| | - Susanne J. van Veluw
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, J.P.K. Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Steven M. Greenberg
- Department of Neurology, J.P.K. Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Mark A. van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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13
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Huang K, Liu J, Yun W, Cao Y, Zhang M. The role of asymmetrical prominent veins sign in early neurological deterioration of acute ischemic stroke patients. Front Neurol 2022; 13:860824. [PMID: 36046632 PMCID: PMC9420992 DOI: 10.3389/fneur.2022.860824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background and purpose Asymmetrical prominent veins sign (APVS) often appears on susceptibility-weighted angiography (SWAN) images in patients with acute stroke. Early neurological deterioration (END) is highly correlated with survival prognosis in patients with ischemic stroke. This study sought to explore the relationship between APVS and END in patients with acute stroke. Methods The subjects retrospectively enrolled in this study were patients with acute ischemic stroke in the middle cerebral artery supply area. All patients underwent head MRI, including the SWAN sequence, within 7 days of stroke symptom onset. END was defined as clinical deterioration or recurrence within 72 h after ischemic stroke. The volume of infarction on diffusion-weighted imaging was measured. Univariate and multivariate analyses were used to analyze the relationship between APVS and END. Spearman correlation between APVS grades and infarct volume, white matter hyperintensity (WMH) volume, and offending vessel were also analyzed. Results A total of 157 patients with middle cerebral artery infarct between September 2018 and April 2020 were included in the study. APVS appeared on MRI in 84 of 157 patients, and 34 of 157 patients were diagnosed with END. In patients with END, the proportion of severe APVS was higher than in patients without END (P = 0.001, x2 = 14.659). Patients with END were older and had a larger volume of infarct and WMH than patients without END (all P < 0.05). After adjustments were made for related risk factors of END, the severity of APVS was still related to END (OR = 2.56, 95% CI, 1.38–4.75; P for trend = 0.003). Spearman correlation showed that APVS grades were positively related to infarct volume (r = 0.289, P < 0.001) and 3-month modified Rankin Scale score (r = 0.203, P = 0.011) and negatively related to offending vessels (r = −0.170, P = 0.034). Conclusion APVS may be an important predictor of END in patients with acute ischemic stroke.
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Affiliation(s)
| | - Jianfang Liu
- Department of Neurology, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Wenwei Yun
- Department of Neurology, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Yin Cao
- Department of Neurology, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
- Yin Cao
| | - Min Zhang
- Department of Neurology, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
- *Correspondence: Min Zhang
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14
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Rudilosso S, Chui E, Stringer MS, Thrippleton M, Chappell F, Blair GW, Garcia DJ, Doubal F, Hamilton I, Kopczak A, Ingrisch M, Kerkhofs D, Backes WH, Staals J, van Oostenbrugge R, Duering M, Dichgans M, Wardlaw JM. Prevalence and Significance of the Vessel-Cluster Sign on Susceptibility-Weighted Imaging in Patients With Severe Small Vessel Disease. Neurology 2022; 99:e440-e452. [PMID: 35606147 PMCID: PMC9421604 DOI: 10.1212/wnl.0000000000200614] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Magnetic resonance susceptibility-weighted imaging (SWI) can identify small brain blood vessels that contain deoxygenated blood due to its induced magnetic field disturbance. We observed focal clusters of possible dilated small vessels on SWI in white matter in severe small vessel disease (SVD). We assessed their prevalence, associations with SVD lesions, and vascular reactivity in patients with sporadic SVD and in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). METHODS Secondary cross-sectional analysis of a prospective multicenter observational study of patients with either sporadic SVD or CADASIL (INVESTIGATE-SVD) studied with 3 Tesla MRI including blood-oxygen-level-dependent MRI cerebrovascular reactivity (CVR). Two independent raters evaluated SWI sequences to identify "vessel-clusters" in white matter as focal low-signal dots/lines with small vessel appearance (interrater agreement, kappa statistic = 0.66). We assessed per-patient and per-cluster associations with SVD lesion type and severity on structural MRI sequences. We also assessed CVR within and at 2-voxel concentric intervals around the vessel-clusters using contralateral volumes as a reference. RESULTS Among the 77 patients enrolled, 76 had usable SWI sequences, 45 with sporadic SVD (mean age 64 years [SD 11], 26 men [58%]) and 31 with CADASIL (53 years [11], 15 men [48%]). We identified 94 vessel-clusters in 36 of the 76 patients (15/45 sporadic SVD, 21/31 CADASIL). In covariate-adjusted analysis, patients with vessel-clusters had more lacunes (OR, 95% CI) (1.30, 1.05-1.62), higher white matter hyperintensity (WMH) volume (per-log10 increase, 1.92, 1.04-3.56), and lower CVR in normal appearing white matter (per %/mm Hg, 0.77, 0.60-0.99), compared with patients without vessel-clusters. Fifty-seven of the 94 vessel-clusters (61%) corresponded to noncavitated or partially cavitated WMH on fluid-attenuated inversion recovery, and 37 of 94 (39%) to complete cavities. CVR magnitude was lower than in the corresponding contralateral volumes (mean difference [SD], t, p) within vessel-cluster volumes (-0.00046 [0.00088], -3.021, 0.005) and in the surrounding volume expansion shells up to 4 voxels (-0.00011 [0.00031], -2.140, 0.039; -0.00010 [0.00027], -2.295, 0.028) in vessel-clusters with complete cavities, but not in vessel-clusters without complete cavitation. DISCUSSION Vessel-clusters might correspond to maximally dilated vessels in white matter that are approaching complete tissue injury and cavitation. The pathophysiologic significance of this new feature warrants further longitudinal investigation.
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Affiliation(s)
- Salvatore Rudilosso
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Ernest Chui
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Michael S Stringer
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Michael Thrippleton
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Francesca Chappell
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Gordon W Blair
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Daniela Jaime Garcia
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Fergus Doubal
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Iona Hamilton
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Anna Kopczak
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Michael Ingrisch
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Danielle Kerkhofs
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Walter H Backes
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Julie Staals
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Robert van Oostenbrugge
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Marco Duering
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Martin Dichgans
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Joanna M Wardlaw
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany.
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15
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Liu ZY, Zhai FF, Ao DH, Han F, Li ML, Zhou L, Ni J, Yao M, Zhang SY, Cui LY, Jin ZY, Zhu YC. Deep medullary veins are associated with widespread brain structural abnormalities. J Cereb Blood Flow Metab 2022; 42:997-1006. [PMID: 34855528 PMCID: PMC9125483 DOI: 10.1177/0271678x211065210] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
Our aim is to investigate the association of cerebral deep medullary veins (DMVs) with white matter microstructural integrity and regional brain atrophy in MRI. In a community-based cohort of 979 participants (mean age 55.4 years), DMVs were identified on susceptibility-weighted imaging. Brain structural measurements including gray matter and hippocampus volumes, as well as diffusion tensor metrics, were evaluated. The mean (SD)number of DMVs was 19.0 (1.7). A fewer number of DMVs was related to lower fractional anisotropy and higher mean diffusivity in multiple voxels on the white matter skeleton (threshold-free cluster enhancement corrected p < 0.05, adjusted for age and sex). Also, fewer DMVs were significantly related to a lower gray matter fraction and a hippocampal fraction (0.10 and 0.11 per DMV, respectively; SE, 0.03 for both; p < 0.001 for both). A significant correlation between DMVs' reduction and cortical atrophy was observed in the bilateral occipital lobes, temporal lobes, hippocampus, and frontal lobes (p < 0.001, adjusted for age, sex, and total intracranial volume). Our results provided evidence that cerebral small venules disease play a role in brain parenchymal lesions and neurodegenerative processes.
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Affiliation(s)
- Zi-Yue Liu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei-Fei Zhai
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong-Hui Ao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Neurology, Wu Han Tong Ji Hospital, Wuhan, China
| | - Fei Han
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming-Li Li
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lixin Zhou
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Yao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Yang Zhang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Ying Cui
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng-Yu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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16
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Xu Z, Li F, Xing D, Song H, Chen J, Duan Y, Yang B. A Novel Imaging Biomarker for Cerebral Small Vessel Disease Associated With Cognitive Impairment: The Deep-Medullary-Veins Score. Front Aging Neurosci 2021; 13:720481. [PMID: 34759812 PMCID: PMC8572877 DOI: 10.3389/fnagi.2021.720481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To explore the biomarkers of cerebral small vessel disease (CSVD) associated with cognitive impairment. Methods: A total of 69 patients with CSVD were enrolled in the study, and baseline clinical and imaging data were reviewed retrospectively. The following neuroimaging biomarkers of CSVD were identified: high-grade white matter hyperintensity (HWMH), cerebral microbleeds (CMB), enlarged perivascular space (PVS), and lacunar infarct (LI). A total score for CSVD was calculated. The deep medullary veins (DMVs) were divided into six segments according to the regional anatomy. The total DMV score (0–18) was derived from the sum of the scores of the six individual segments, the scores of which ranged from 0 to 3, for a semiquantitative assessment of the DMV that was based on segmental continuity and visibility. Results: The DMV score, patient age, and total CSVD score were independently associated with the presence or absence of cognitive impairment in patients with CSVD (P < 0.05). By integrating patient age and the total CSVD and DMV scores, the area under the curve of the receiver operating characteristic curve (AUROC) for predicting CSVD associated with cognitive impairment was 0.885, and the sensitivity and specificity were 64.71 and 94.23%, respectively. Conclusions: The DMV score may be a novel imaging biomarker for CSVD associated with cognitive impairment. The integration of the DMV score with age and total CSVD score should increase the predictive value of the DMV score for CSVD associated with cognitive impairment.
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Affiliation(s)
- Zhihua Xu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China.,Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Fangfei Li
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China.,General Hospital of Northern Theater Command Training Base for Graduate, Dalian Medical University, Shenyang, China
| | - Dengxiang Xing
- Center for Medical Data, General Hospital of Northern Theater Command, Shenyang, China
| | - Hongyan Song
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jingshu Chen
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yang Duan
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China.,General Hospital of Northern Theater Command Training Base for Graduate, Dalian Medical University, Shenyang, China.,General Hospital of Northern Theater Command Training Base for Graduate, Jinzhou Medical University, Shenyang, China.,General Hospital of Northern Theater Command Training Base for Graduate, China Medical University, Shenyang, China
| | - Benqiang Yang
- General Hospital of Northern Theater Command Training Base for Graduate, China Medical University, Shenyang, China.,Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
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17
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Xu Z, Li F, Wang B, Xing D, Pei Y, Yang B, Duan Y. New Insights in Addressing Cerebral Small Vessel Disease: Association With the Deep Medullary Veins. Front Aging Neurosci 2020; 12:597799. [PMID: 33335483 PMCID: PMC7736107 DOI: 10.3389/fnagi.2020.597799] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To assess the suitability of deep medullary vein visibility in susceptibility weighted imaging-magnetic resonance imaging studies as a method for the diagnosis and evaluation of cerebral small vessel disease progression. Methods A total of 92 patients with CSVD were enrolled and baseline clinical and imaging data were reviewed retrospectively. Neuroimaging biomarkers of CSVD including high-grade white matter hyperintensity (HWMH), cerebral microbleed (CMB), enlarged perivascular space (PVS), and lacunar infarct (LI) were identified and CSVD burden was calculated. Cases were grouped accordingly as mild, moderate, or severe. The DMV was divided into six segments according to the regional anatomy. The total DMV score (0-18) was calculated as the sum of the six individual segmental scores, which ranged from 0 to 3, for a semi-quantitative assessment of the DMV based on segmental continuity and visibility. Results The DMV score was independently associated with the presence of HWMH, PVS, and LI (P < 0.05), but not with presence and absence of CMB (P > 0.05). Correlation between the DMV score and the CSVD burden was significant (P < 0.05) [OR 95% C.I., 1.227 (1.096-1.388)]. Conclusion The DMV score was associated with the presence and severity of CSVD.
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Affiliation(s)
- Zhihua Xu
- Department of Radiology, TongDe Hospital of Zhejiang Province, Hangzhou, China.,Department of Radiology, Center for Neuroimaging, General Hospital of Northern Theater Command, Shenyang, China
| | - Fangfei Li
- Department of Radiology, Center for Neuroimaging, General Hospital of Northern Theater Command, Shenyang, China.,General Hospital of Northern Theater Command Training Base for Graduate, Dalian Medical University, Shenyang, China
| | - Bing Wang
- Department of Scientific Research, General Hospital of Northern Theater Command, Shenyang, China
| | - Dengxiang Xing
- Center for Medical Data, General Hospital of Northern Theater Command, Shenyang, China
| | - Yusong Pei
- General Hospital of Northern Theater Command Training Base for Graduate, Jinzhou Medical University, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Yang Duan
- Department of Radiology, Center for Neuroimaging, General Hospital of Northern Theater Command, Shenyang, China.,General Hospital of Northern Theater Command Training Base for Graduate, Dalian Medical University, Shenyang, China.,General Hospital of Northern Theater Command Training Base for Graduate, Jinzhou Medical University, Shenyang, China.,General Hospital of Northern Theater Command Training Base for Graduate, China Medical University, Shenyang, China
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