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Wiseman SJ, Zhang JF, Gray C, Hamid C, Valdés Hernández MDC, Ballerini L, Thrippleton MJ, Manning C, Stringer M, Sleight E, Muñoz Maniega S, Morgan A, Cheng Y, Arteaga C, Jaime Garcia D, Clancy U, Doubal FN, Dhillon B, MacGillivray T, Wu YC, Wardlaw JM. Retinal capillary microvessel morphology changes are associated with vascular damage and dysfunction in cerebral small vessel disease. J Cereb Blood Flow Metab 2023; 43:231-240. [PMID: 36300327 PMCID: PMC9903216 DOI: 10.1177/0271678x221135658] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 01/24/2023]
Abstract
Cerebral small vessel disease (SVD) is a cause of stroke and dementia. Retinal capillary microvessels revealed by optical coherence tomography angiography (OCTA) are developmentally related to brain microvessels. We quantified retinal vessel density (VD) and branching complexity, investigating relationships with SVD lesions, white matter integrity on diffusion tensor imaging (DTI) and cerebrovascular reactivity (CVR) to CO2 in patients with minor stroke. We enrolled 123 patients (mean age 68.1 ± SD 9.9 years), 115 contributed retinal data. Right (R) and left (L) eyes are reported. After adjusting for age, eye disease, diabetes, blood pressure and image quality, lower VD remained associated with higher mean diffusivity (MD) (standardized β; R -0.16 [95%CI -0.32 to -0.01]) and lower CVR (L 0.17 [0.03 to 0.31] and R 0.19 [0.02 to 0.36]) in normal appearing white matter (NAWM). Sparser branching remained associated with sub-visible white matter damage shown by higher MD (R -0.24 [-0.08 to -0.40]), lower fractional anisotropy (FA) (L 0.17 [0.01 to 0.33]), and lower CVR (R 0.20 [0.02 to 0.38]) in NAWM. OCTA-derived metrics provide evidence of microvessel abnormalities that may underpin SVD lesions in the brain.
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Affiliation(s)
- Stewart J Wiseman
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Jun-Fang Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China
| | - Calum Gray
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Charlene Hamid
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Maria del C Valdés Hernández
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
| | - Lucia Ballerini
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Cameron Manning
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Michael Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
| | | | - Alasdair Morgan
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Yajun Cheng
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- Department of Neurology, West China Hospital, Sichuan
University, Chengdu, China
| | - Carmen Arteaga
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Dany Jaime Garcia
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Una Clancy
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- NHS Lothian Princess Alexandra Eye Pavilion, UK
| | - Tom MacGillivray
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
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Sun C, Chen T, Cong J, Wu X, Wang J, Yuan Y. Changes in retinal vascular bifurcation in eyes with myopia. BMC Ophthalmol 2022; 22:408. [PMID: 36271390 PMCID: PMC9585760 DOI: 10.1186/s12886-022-02629-y] [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: 07/17/2022] [Revised: 09/06/2022] [Accepted: 10/04/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the effect of myopia on retinal vascular bifurcation. Methods A cross-sectional study that retrospectively analyzed the fundus photographs and clinical data of 493 people who participated in routine physical examinations in Huadong Sanatorium. One eye of each subject was included in the analysis. Retinal vascular bifurcation measurements were extracted by using a validated computer program. One-way ANOVA and analysis of covariance were performed to compare the measurements across high myopia, low to moderate myopia, and non-myopia groups. Results The mean age was 41.83 ± 10.43 years and 63.49% were women. The mean spherical equivalent refraction (SER) was − 4.59 ± 3.07 D. Ninety-nine (20.08%) eyes met the definition of high myopia (SER ≤ -6.0 D), along with 234 (47.46%) low to moderate myopia (-6.0 D < SER <-0.5 D), and 160 (32.45%) non-myopia (SER ≥ -0.5 D). The differences in the arteriolar branching angle, venular branching coefficient, venular asymmetry ratio, venular angular asymmetry, and venular junctional exponent among the three groups remained significant (p < 0.05) after multivariate adjustment. Pairwise comparisons showed arteriolar branching angle and venular angular asymmetry in high myopia were significantly lower than low to moderate myopia (p < 0.001, p = 0.014 respectively) and non-myopia (p = 0.007, p = 0.048 respectively). Venular asymmetry ratio and venular branching coefficient in high myopia were significantly higher than low to moderate myopia (p = 0.029, p = 0.001 respectively) and non-myopia (p = 0.041, p = 0.043 respectively). There was a significant difference in venular junctional exponent between high myopia and low to moderate myopia (p = 0.031). Conclusion The vascular bifurcation differs in dependence on the myopic refractive error and a significant increase in the difference can be observed in high myopic eyes.
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Affiliation(s)
- Caixia Sun
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
| | - Tingli Chen
- Department of Ophthalmology, Huadong Sanatorium, Wuxi, Jiangsu Province, China
| | - Jing Cong
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
| | - Xinyuan Wu
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
| | - Jing Wang
- Department of Ophthalmology, Huadong Sanatorium, Wuxi, Jiangsu Province, China
| | - Yuanzhi Yuan
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China. .,Department of Ophthalmology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian Province, China. .,Center for Evidence-based Medicine, Fudan University, Shanghai, China.
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Retinal microvascular function is associated with the cerebral microcirculation as determined by intravoxel incoherent motion MRI. J Neurol Sci 2022; 440:120359. [DOI: 10.1016/j.jns.2022.120359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
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Tao W, Kwapong WR, Xie J, Wang Z, Guo X, Liu J, Ye C, Wu B, Zhao Y, Liu M. Retinal microvasculature and imaging markers of brain frailty in normal aging adults. Front Aging Neurosci 2022; 14:945964. [PMID: 36072485 PMCID: PMC9441884 DOI: 10.3389/fnagi.2022.945964] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe retina and brain share a similar embryologic origin, blood barriers, and microvasculature features. Thus, retinal imaging has been of interest in the aging population to help in the early detection of brain disorders. Imaging evaluation of brain frailty, including brain atrophy and markers of cerebral small vessel disease (CSVD), could reflect brain health in normal aging, but is costly and time-consuming. In this study, we aimed to evaluate the retinal microvasculature and its association with radiological indicators of brain frailty in normal aging adults.MethodsSwept-source optical coherence tomography angiography (SS-OCTA) and 3T-MRI brain scanning were performed on normal aging adults (aged ≥ 50 years). Using a deep learning algorithm, microvascular tortuosity (VT) and fractal dimension parameter (Dbox) were used to evaluate the superficial vascular complex (SVC) and deep vascular complex (DVC) of the retina. MRI markers of brain frailty include brain volumetric measures and CSVD markers that were assessed.ResultsOf the 139 normal aging individuals included, the mean age was 59.43 ± 7.31 years, and 64.0% (n = 89) of the participants were females. After adjustment of age, sex, and vascular risk factors, Dbox in the DVC showed a significant association with the presence of lacunes (β = 0.58, p = 0.007), while VT in the SVC significantly correlated with the score of cerebral deep white matter hyperintensity (β = 0.31, p = 0.027). No correlations were found between brain volumes and retinal microvasculature changes (P > 0.05).ConclusionOur report suggests that imaging of the retinal microvasculature may give clues to brain frailty in the aging population.
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Affiliation(s)
- Wendan Tao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Jianyang Xie
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Zetao Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaonan Guo
- School of Information Science and Engineering, Yanshan University, Qinhuangdao, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Zhao
- The Affiliated People’s Hospital of Ningbo University, Ningbo, China
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- Yitian Zhao,
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ming Liu,
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Quick S, Procter TV, Moss J, Seeker L, Walton M, Lawson A, Baker S, Beletski A, Garcia DJ, Mohammad M, Mungall W, Onishi A, Tobola Z, Stringer M, Jansen MA, Vallatos A, Giarratano Y, Bernabeu MO, Wardlaw JM, Williams A. Loss of the heterogeneous expression of flippase ATP11B leads to cerebral small vessel disease in a normotensive rat model. Acta Neuropathol 2022; 144:283-303. [PMID: 35635573 PMCID: PMC9288385 DOI: 10.1007/s00401-022-02441-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 01/20/2023]
Abstract
Cerebral small vessel disease (SVD) is the leading cause of vascular dementia, causes a quarter of strokes, and worsens stroke outcomes. The disease is characterised by patchy cerebral small vessel and white matter pathology, but the underlying mechanisms are poorly understood. This microvascular and tissue damage has been classically considered secondary to extrinsic factors, such as hypertension, but this fails to explain the patchy nature of the disease, the link to endothelial cell (EC) dysfunction even when hypertension is absent, and the increasing evidence of high heritability to SVD-related brain damage. We have previously shown the link between deletion of the phospholipase flippase Atp11b and EC dysfunction in an inbred hypertensive rat model with SVD-like pathology and a single nucleotide polymorphism (SNP) in ATP11B associated with human sporadic SVD. Here, we generated a novel normotensive transgenic rat model, where Atp11b is deleted, and show pathological, imaging and behavioural changes typical of those in human SVD, but that occur without hypertension. Atp11bKO rat brain and retinal small vessels show ECs with molecular and morphological changes of dysfunction, with myelin disruption in a patchy pattern around some but not all brain small vessels, similar to the human brain. We show that ATP11B/ATP11B is heterogeneously expressed in ECs in normal rat and human brain even in the same transverse section of the same blood vessel, suggesting variable effects of the loss of ATP11B on each vessel and an explanation for the patchy nature of the disease. This work highlights a link between inherent EC dysfunction and vulnerability to SVD white matter damage with a marked heterogeneity of ECs in vivo which modulates this response, occurring even in the absence of hypertension. These findings refocus our strategies for therapeutics away from antihypertensive (and vascular risk factor) control alone and towards ECs in the effort to provide alternative targets to prevent a major cause of stroke and dementia.
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Affiliation(s)
- Sophie Quick
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Tessa V Procter
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Jonathan Moss
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, EH16 4UU, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Luise Seeker
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Marc Walton
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Angus Lawson
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Serena Baker
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Anna Beletski
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Daniela Jaime Garcia
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Mehreen Mohammad
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - William Mungall
- Bioresearch and Veterinary Services, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Ami Onishi
- Bioresearch and Veterinary Services, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Zuzanna Tobola
- Centre for Clinical Brain Sciences, Edinburgh Imaging, Row Fogo Centre for Research into Ageing and the Brain, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Michael Stringer
- Centre for Clinical Brain Sciences, Edinburgh Imaging, Row Fogo Centre for Research into Ageing and the Brain, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Maurits A Jansen
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Antoine Vallatos
- Centre for Clinical Brain Sciences, Edinburgh Imaging, Row Fogo Centre for Research into Ageing and the Brain, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Ylenia Giarratano
- College of Medicine and Veterinary Medicine, College of Science and Engineering, Bayes Centre, Usher Institute, University of Edinburgh, Edinburgh, EH16 4UX, UK
| | - Miguel O Bernabeu
- College of Medicine and Veterinary Medicine, College of Science and Engineering, Bayes Centre, Usher Institute, University of Edinburgh, Edinburgh, EH16 4UX, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, Edinburgh Imaging, Row Fogo Centre for Research into Ageing and the Brain, University of Edinburgh, Edinburgh, EH16 4SB, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Anna Williams
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, EH16 4UU, UK.
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, EH16 4SB, UK.
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Cho BJ, Lee M, Han J, Kwon S, Oh MS, Yu KH, Lee BC, Kim JH, Kim C. Prediction of White Matter Hyperintensity in Brain MRI Using Fundus Photographs via Deep Learning. J Clin Med 2022; 11:jcm11123309. [PMID: 35743380 PMCID: PMC9224833 DOI: 10.3390/jcm11123309] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose: We investigated whether a deep learning algorithm applied to retinal fundoscopic images could predict cerebral white matter hyperintensity (WMH), as represented by a modified Fazekas scale (FS), on brain magnetic resonance imaging (MRI). Methods: Participants who had undergone brain MRI and health-screening fundus photography at Hallym University Sacred Heart Hospital between 2010 and 2020 were consecutively included. The subjects were divided based on the presence of WMH, then classified into three groups according to the FS grade (0 vs. 1 vs. 2+) using age matching. Two pre-trained convolutional neural networks were fine-tuned and evaluated for prediction performance using 10-fold cross-validation. Results: A total of 3726 fundus photographs from 1892 subjects were included, of which 905 fundus photographs from 462 subjects were included in the age-matched balanced dataset. In predicting the presence of WMH, the mean area under the receiver operating characteristic curve was 0.736 ± 0.030 for DenseNet-201 and 0.724 ± 0.026 for EfficientNet-B7. For the prediction of FS grade, the mean accuracies reached 41.4 ± 5.7% with DenseNet-201 and 39.6 ± 5.6% with EfficientNet-B7. The deep learning models focused on the macula and retinal vasculature to detect an FS of 2+. Conclusions: Cerebral WMH might be partially predicted by non-invasive fundus photography via deep learning, which may suggest an eye–brain association.
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Affiliation(s)
- Bum-Joo Cho
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (B.-J.C.); (S.K.)
- Medical Artificial Intelligence Center, Hallym University Medical Center, Anyang 14068, Korea;
- Division of Biomedical Informatics, Seoul National University Biomedical Informatics (SNUBI), Seoul National University College of Medicine, Seoul 03080, Korea
| | - Minwoo Lee
- Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (M.L.); (M.S.O.); (K.-H.Y.); (B.-C.L.)
| | - Jiyong Han
- Medical Artificial Intelligence Center, Hallym University Medical Center, Anyang 14068, Korea;
| | - Soonil Kwon
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (B.-J.C.); (S.K.)
| | - Mi Sun Oh
- Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (M.L.); (M.S.O.); (K.-H.Y.); (B.-C.L.)
| | - Kyung-Ho Yu
- Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (M.L.); (M.S.O.); (K.-H.Y.); (B.-C.L.)
| | - Byung-Chul Lee
- Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (M.L.); (M.S.O.); (K.-H.Y.); (B.-C.L.)
| | - Ju Han Kim
- Division of Biomedical Informatics, Seoul National University Biomedical Informatics (SNUBI), Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: (J.H.K.); (C.K.); Tel.: +82-2-740-8320 (J.H.K.); +82-33-240-5255 (C.K.); Fax: +82-2-3673-2167 (J.H.K.); +82-33-255-6244 (C.K.)
| | - Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Korea
- Correspondence: (J.H.K.); (C.K.); Tel.: +82-2-740-8320 (J.H.K.); +82-33-240-5255 (C.K.); Fax: +82-2-3673-2167 (J.H.K.); +82-33-255-6244 (C.K.)
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Qu Y, Lee JJW, Zhuo Y, Liu S, Thomas RL, Owens DR, Zee BCY. Risk Assessment of CHD Using Retinal Images with Machine Learning Approaches for People with Cardiometabolic Disorders. J Clin Med 2022; 11:jcm11102687. [PMID: 35628812 PMCID: PMC9143834 DOI: 10.3390/jcm11102687] [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: 04/15/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Coronary heart disease (CHD) is the leading cause of death worldwide, constituting a growing health and social burden. People with cardiometabolic disorders are more likely to develop CHD. Retinal image analysis is a novel and noninvasive method to assess microvascular function. We aim to investigate whether retinal images can be used for CHD risk estimation for people with cardiometabolic disorders. Methods: We have conducted a case–control study at Shenzhen Traditional Chinese Medicine Hospital, where 188 CHD patients and 128 controls with cardiometabolic disorders were recruited. Retinal images were captured within two weeks of admission. The retinal characteristics were estimated by the automatic retinal imaging analysis (ARIA) algorithm. Risk estimation models were established for CHD patients using machine learning approaches. We divided CHD patients into a diabetes group and a non-diabetes group for sensitivity analysis. A ten-fold cross-validation method was used to validate the results. Results: The sensitivity and specificity were 81.3% and 88.3%, respectively, with an accuracy of 85.4% for CHD risk estimation. The risk estimation model for CHD with diabetes performed better than the model for CHD without diabetes. Conclusions: The ARIA algorithm can be used as a risk assessment tool for CHD for people with cardiometabolic disorders.
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Affiliation(s)
- Yimin Qu
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Y.Q.); (J.J.-W.L.)
| | - Jack Jock-Wai Lee
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Y.Q.); (J.J.-W.L.)
| | - Yuanyuan Zhuo
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518005, China;
| | - Shukai Liu
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518005, China;
| | - Rebecca L. Thomas
- Diabetes Research Group, Swansea University, Swansea SA2 8PP, UK; (R.L.T.); (D.R.O.)
| | - David R. Owens
- Diabetes Research Group, Swansea University, Swansea SA2 8PP, UK; (R.L.T.); (D.R.O.)
| | - Benny Chung-Ying Zee
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Y.Q.); (J.J.-W.L.)
- Clinical Trials and Biostatistics Lab, CUHK Shenzhen Research Institute, Shenzhen 518057, China
- Correspondence:
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8
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van Dinther M, Schram MT, Jansen JFA, Backes WH, Houben AJHM, Berendschot TTJM, Schalkwijk CG, Stehouwer CDA, van Oostenbrugge RJ, Staals J. Extracerebral microvascular dysfunction is related to brain MRI markers of cerebral small vessel disease: The Maastricht Study. GeroScience 2021; 44:147-157. [PMID: 34816376 PMCID: PMC8811003 DOI: 10.1007/s11357-021-00493-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cerebral small vessel disease (cSVD) is a late consequence of cerebral microvascular dysfunction (MVD). MVD is hard to measure in the brain due to its limited accessibility. Extracerebral MVD (eMVD) measures can give insights in the etiology of cerebral MVD, as MVD may be a systemic process. We aim to investigate whether a compound score consisting of several eMVD measures is associated with structural cSVD MRI markers. METHODS Cross-sectional data of the population-based Maastricht Study was used (n = 1872, mean age 59 ± 8 years, 49% women). Measures of eMVD included flicker light-induced retinal arteriolar and venular dilation response (retina), albuminuria and glomerular filtration rate (kidney), heat-induced skin hyperemia (skin), and plasma biomarkers of endothelial dysfunction (sICAM-1, sVCAM-1, sE-selectin, and von Willebrand factor). These measures were standardized into z scores and summarized into a compound score. Linear and logistic regression analyses were used to investigate the associations between the compound score and white matter hyperintensity (WMH) volume, and the presence of lacunes and microbleeds, as measured by brain MRI. RESULTS The eMVD compound score was associated with WMH volume independent of age, sex, and cardiovascular risk factors (St β 0.057 [95% CI 0.010-0.081], p value 0.01), but not with the presence of lacunes (OR 1.011 [95% CI 0.803-1.273], p value 0.92) or microbleeds (OR 1.055 [95% CI 0.896-1.242], p value 0.52). CONCLUSION A compound score of eMVD is associated with WMH volume. Further research is needed to expand the knowledge about the role of systemic MVD in the pathophysiology of cSVD.
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Affiliation(s)
- Maud van Dinther
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands. .,CARIM - School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,MHeNs - School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jacobus F A Jansen
- MHeNs - School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Walter H Backes
- CARIM - School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,MHeNs - School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alfons J H M Houben
- CARIM - School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tos T J M Berendschot
- MHeNs - School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM - School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Casper G Schalkwijk
- CARIM - School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- CARIM - School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,CARIM - School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,MHeNs - School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,CARIM - School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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9
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Past, present and future role of retinal imaging in neurodegenerative disease. Prog Retin Eye Res 2021; 83:100938. [PMID: 33460813 PMCID: PMC8280255 DOI: 10.1016/j.preteyeres.2020.100938] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 02/08/2023]
Abstract
Retinal imaging technology is rapidly advancing and can provide ever-increasing amounts of information about the structure, function and molecular composition of retinal tissue in humans in vivo. Most importantly, this information can be obtained rapidly, non-invasively and in many cases using Food and Drug Administration-approved devices that are commercially available. Technologies such as optical coherence tomography have dramatically changed our understanding of retinal disease and in many cases have significantly improved their clinical management. Since the retina is an extension of the brain and shares a common embryological origin with the central nervous system, there has also been intense interest in leveraging the expanding armamentarium of retinal imaging technology to understand, diagnose and monitor neurological diseases. This is particularly appealing because of the high spatial resolution, relatively low-cost and wide availability of retinal imaging modalities such as fundus photography or OCT compared to brain imaging modalities such as magnetic resonance imaging or positron emission tomography. The purpose of this article is to review and synthesize current research about retinal imaging in neurodegenerative disease by providing examples from the literature and elaborating on limitations, challenges and future directions. We begin by providing a general background of the most relevant retinal imaging modalities to ensure that the reader has a foundation on which to understand the clinical studies that are subsequently discussed. We then review the application and results of retinal imaging methodologies to several prevalent neurodegenerative diseases where extensive work has been done including sporadic late onset Alzheimer's Disease, Parkinson's Disease and Huntington's Disease. We also discuss Autosomal Dominant Alzheimer's Disease and cerebrovascular small vessel disease, where the application of retinal imaging holds promise but data is currently scarce. Although cerebrovascular disease is not generally considered a neurodegenerative process, it is both a confounder and contributor to neurodegenerative disease processes that requires more attention. Finally, we discuss ongoing efforts to overcome the limitations in the field and unmet clinical and scientific needs.
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10
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Huang K, Zhang Z, Huang S, Jia Y, Zhang M, Yun W. The association between retinal vessel abnormalities and H-type hypertension. BMC Neurol 2021; 21:6. [PMID: 33407217 PMCID: PMC7786500 DOI: 10.1186/s12883-020-02029-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
Background This study aimed to investigate the relationship between H-type hypertension and retinal vessel abnormalities. Methods Hypertensive patients were retrospectively enrolled in this study. According to plasma homocysteine (HCY), patients were divided into isolated hypertension and H-type hypertension groups. The diameter of retinal vessels and retinopathy were evaluated by retinal fundus photography. The differences of retinal vessel abnormalities between H-type hypertension and isolated hypertension were investigated by univariate and multivariate regression. Results A total of 191 hypertensive patients were included, of which 86 were with isolated hypertension and 105 with H-type hypertension. The H-type hypertension group had a higher ratio of retinopathy(P = 0.004) and higher degree of retinal arteriosclerosis (P = 0.005) than the isolated hypertension group. CRAE (107.47 ± 13.99µ m vs. 113.49 ± 11.72µ m, P = 0.002) and AVR (0.55 ± 0.06 vs. 0.58 ± 0.06, P = 0.001) were smaller in H-type hypertension group than those in isolated hypertension group. Multivariate analysis showed that after adjusting for age, sex, course of hypertension and diabetes, H-type hypertension was an independent risk factor of retinopathy (OR, 2.259; 95%CI, 1.165—4.378; P = 0.016), CRAE (β=-5.669; 95%CI, -9.452—-1.886; P = 0.004), and AVR (β=-0.023; 95%CI, -0.039—-0.007; P = 0.005). Conclusions H-type hypertension is closely related to more retinal vessel abnormalities than isolated hypertension. Controlling H-type hypertension may reduce the risk of small vascular damage.
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Affiliation(s)
- Kuankuan Huang
- Department of Neurology, Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, No.29, Xinglong Lane, Tianning District, Changzhou, 213004, Jiangsu, China
| | - Zhixiang Zhang
- Department of Neurology, Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, No.29, Xinglong Lane, Tianning District, Changzhou, 213004, Jiangsu, China
| | - Shan Huang
- Department of Neurology, Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, No.29, Xinglong Lane, Tianning District, Changzhou, 213004, Jiangsu, China
| | - Yanwen Jia
- Ophthalmology Department of Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, No.29, Xinglong Lane, Tianning District, 213004, Changzhou, Jiangsu, China
| | - Min Zhang
- Department of Neurology, Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, No.29, Xinglong Lane, Tianning District, Changzhou, 213004, Jiangsu, China.
| | - Wenwei Yun
- Department of Neurology, Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, No.29, Xinglong Lane, Tianning District, Changzhou, 213004, Jiangsu, China.
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11
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Ballerini L, McGrory S, Valdés Hernández MDC, Lovreglio R, Pellegrini E, MacGillivray T, Muñoz Maniega S, Henderson R, Taylor A, Bastin ME, Doubal F, Trucco E, Deary IJ, Wardlaw J. Quantitative measurements of enlarged perivascular spaces in the brain are associated with retinal microvascular parameters in older community-dwelling subjects. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2020; 1:100002. [PMID: 33458712 PMCID: PMC7792660 DOI: 10.1016/j.cccb.2020.100002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/05/2020] [Accepted: 08/18/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Perivascular Spaces (PVS) become increasingly visible with advancing age on brain MRI, yet their relationship to morphological changes in the underlying microvessels remains poorly understood. Retinal and cerebral microvessels share morphological and physiological properties. We compared computationally-derived PVS morphologies with retinal vessel morphologies in older people. METHODS We analysed data from community-dwelling individuals who underwent multimodal brain MRI and retinal fundus camera imaging at mean age 72.55 years (SD=0.71). We assessed centrum semiovale PVS computationally to determine PVS total volume and count, and mean per-subject individual PVS length, width and size. We analysed retinal images using the VAMPIRE software suite, obtaining the Central Retinal Artery and Vein Equivalents (CRVE and CRAE), Arteriole-to-Venule ratio (AVR), and fractal dimension (FD) of both eyes. We investigated associations using general linear models, adjusted for age, gender, and major vascular risk factors. RESULTS In 381 subjects with all measures, increasing total PVS volume and count were associated with decreased CRAE in the left eye (volume β=-0.170, count β=-0.184, p<0.001). No associations of PVS with CRVE were found. The PVS total volume, individual width and size increased with decreasing FD of the arterioles (a) and venules (v) of the left eye (total volume: FDa β=-0.137, FDv β=-0.139, p<0.01; width: FDa β=-0.144, FDv β=-0.158, p<0.01; size: FDa β=-0.157, FDv β=-0.162, p<0.01). CONCLUSIONS Increase in PVS number and size visible on MRI reflect arteriolar narrowing and lower retinal arteriole and venule branching complexity, both markers of impaired microvascular health. Computationally-derived PVS metrics may be an early indicator of failing vascular health and should be tested in longitudinal studies.
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Affiliation(s)
- Lucia Ballerini
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Sarah McGrory
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Maria del C. Valdés Hernández
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | | | - Enrico Pellegrini
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Tom MacGillivray
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Susana Muñoz Maniega
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Ross Henderson
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Adele Taylor
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Mark E. Bastin
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Fergus Doubal
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE Project, Computing (SSEN), University of Dundee, Dundee, UK
| | - Ian J. Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Joanna Wardlaw
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, and VAMPIRE Project, University of Edinburgh, Edinburgh, EH16 4SB, UK
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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12
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van de Kreeke JA, Nguyen HT, Konijnenberg E, Tomassen J, den Braber A, Ten Kate M, Sudre CH, Barkhof F, Boomsma DI, Tan HS, Verbraak FD, Visser PJ. Retinal and Cerebral Microvasculopathy: Relationships and Their Genetic Contributions. Invest Ophthalmol Vis Sci 2019; 59:5025-5031. [PMID: 30326071 DOI: 10.1167/iovs.18-25341] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Retinal microvasculopathy may reflect small vessel disease in the brain. Here we test the relationships between retinal vascular parameters and small vessel disease, the influence of cardiovascular risk factors on these relationships, and their common genetic background in a monozygotic twin cohort. Methods We selected 134 cognitively healthy individuals (67 monozygotic twin pairs) aged ≥60 years from the Netherlands Twin Register for the EMIF-AD PreclinAD study. We measured seven retinal vascular parameters averaged over both eyes using fundus images analyzed with Singapore I Vessel Assessment. Small vessel disease was assessed on MRI by a volumetric measurement of periventricular and deep white matter hyperintensities. We calculated associations between RVPs and WMH, estimated intratwin pair correlations, and performed twin-specific analyses on relationships of interest. Results Deep white matter hyperintensities volume was positively associated with retinal tortuosity in veins (P = 0.004) and fractal dimension in arteries (P = 0.001) and veins (P = 0.032), periventricular white matter hyperintensities volume was positively associated with retinal venous width (P = 0.028). Intratwin pair correlations were moderate to high for all small vessel disease/retinal vascular parameter variables (r = 0.49-0.87, P < 0.001). Cross-twin cross-trait analyses showed that retinal venous tortuosity of twin 1 could predict deep white matter hyperintensities volume of the co-twin (r = 0.23, P = 0.030). Within twin-pair differences for retinal venous tortuosity were associated with within twin-pair differences in deep white matter hyperintensities volume (r = 0.39, P = 0.001). Conclusions Retinal arterial fractal dimension and venous tortuosity have associations with deep white matter hyperintensities volume. Twin-specific analyses suggest that retinal venous tortuosity and deep white matter hyperintensities volume have a common etiology driven by both shared genetic factors and unique environmental factors, supporting the robustness of this relationship.
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Affiliation(s)
- Jacoba A van de Kreeke
- Ophthalmology Department, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - H Ton Nguyen
- Ophthalmology Department, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Elles Konijnenberg
- Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jori Tomassen
- Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anouk den Braber
- Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mara Ten Kate
- Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Frederik Barkhof
- Radiology Department, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Netherlands Twin Register, Amsterdam, Netherlands
| | - H Stevie Tan
- Ophthalmology Department, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Frank D Verbraak
- Ophthalmology Department, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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13
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McGrory S, Ballerini L, Doubal FN, Staals J, Allerhand M, Valdes-Hernandez MDC, Wang X, MacGillivray T, Doney ASF, Dhillon B, Starr JM, Bastin ME, Trucco E, Deary IJ, Wardlaw JM. Retinal microvasculature and cerebral small vessel disease in the Lothian Birth Cohort 1936 and Mild Stroke Study. Sci Rep 2019; 9:6320. [PMID: 31004095 PMCID: PMC6474900 DOI: 10.1038/s41598-019-42534-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/28/2019] [Indexed: 01/06/2023] Open
Abstract
Research has suggested that the retinal vasculature may act as a surrogate marker for diseased cerebral vessels. Retinal vascular parameters were measured using Vessel Assessment and Measurement Platform for Images of the Retina (VAMPIRE) software in two cohorts: (i) community-dwelling older subjects of the Lothian Birth Cohort 1936 (n = 603); and (ii) patients with recent minor ischaemic stroke of the Mild Stroke Study (n = 155). Imaging markers of small vessel disease (SVD) (white matter hyperintensities [WMH] on structural MRI, visual scores and volume; perivascular spaces; lacunes and microbleeds), and vascular risk measures were assessed in both cohorts. We assessed associations between retinal and brain measurements using structural equation modelling and regression analysis. In the Lothian Birth Cohort 1936 arteriolar fractal dimension accounted for 4% of the variance in WMH load. In the Mild Stroke Study lower arteriolar fractal dimension was associated with deep WMH scores (odds ratio [OR] 0.53; 95% CI, 0.32–0.87). No other retinal measure was associated with SVD. Reduced fractal dimension, a measure of vascular complexity, is related to SVD imaging features in older people. The results provide some support for the use of the retinal vasculature in the study of brain microvascular disease.
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Affiliation(s)
- Sarah McGrory
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. .,Department of Psychology, University of Edinburgh, Edinburgh, UK.
| | - Lucia Ballerini
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Fergus N Doubal
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mike Allerhand
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | | | - Xin Wang
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tom MacGillivray
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alex S F Doney
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, UK
| | - Baljean Dhillon
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK.,UK Dementia Research Institute at the University of Edinburgh, Chancellor's Building, Edinburgh, UK
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14
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Jung NY, Han JC, Ong YT, Cheung CYL, Chen CP, Wong TY, Kim HJ, Kim YJ, Lee J, Lee JS, Jang YK, Kee C, Lee KH, Kim EJ, Seo SW, Na DL. Retinal microvasculature changes in amyloid-negative subcortical vascular cognitive impairment compared to amyloid-positive Alzheimer's disease. J Neurol Sci 2018; 396:94-101. [PMID: 30447606 DOI: 10.1016/j.jns.2018.10.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE To investigate small vessel abnormalities in patients with cognitive impairment, we compared retinal microvascular alterations between patients with cognitive impairment related to Alzheimer's disease (ADCI) and those with subcortical vascular cognitive impairment (SVCI). METHODS We prospectively recruited 29 amyloid-positive ADCI patients, 28 amyloid-negative SVCI patients that were confirmed by 11C-PiB-PET scan and 34 individuals with normal cognition (NC). The three groups were compared in terms of retinal vascular variables (retinal fractal dimension, vascular caliber, tortuosity and branching angle) by using a semi-automated, computer-assisted analysis of digital fundus photographs. We also investigated the relationship between retinal variables and white matter hyperintensities (WMH) on MRI. RESULTS Compared to NC individuals, the SVCI patients had smaller total and arteriolar fractal dimensions, whereas there was no significant difference of fractal dimension between ADCI and NC. Other retinal variables did not differ among the three groups. A significant correlation existed between fractal dimension and WMH volume. CONCLUSIONS Retinal microvascular alterations, especially retinal fractal dimension, may be useful markers that reflect cerebral microvascular changes in patients with SVCI as opposed to ADCI, who had no definite difference in retinal variables compared to the NC group.
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Affiliation(s)
- Na-Yeon Jung
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Republic of Korea; Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yi Ting Ong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Carol Yim-Lui Cheung
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong
| | | | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Yeo Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Juyoun Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jin San Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Young Kyoung Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.
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15
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Cheung CYL, Ikram MK, Chen C, Wong TY. Imaging retina to study dementia and stroke. Prog Retin Eye Res 2017; 57:89-107. [PMID: 28057562 DOI: 10.1016/j.preteyeres.2017.01.001] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/07/2016] [Accepted: 01/01/2017] [Indexed: 02/07/2023]
Abstract
With increase in life expectancy, the number of persons suffering from common age-related brain diseases, including neurodegenerative (e.g., dementia) and cerebrovascular (e.g., stroke) disease is expected to rise substantially. As current neuro-imaging modalities such as magnetic resonance imaging may not be able to detect subtle subclinical changes (resolution <100-500 μm) in dementia and stroke, there is an urgent need for other complementary techniques to probe the pathophysiology of these diseases. The retina - due to its anatomical, embryological and physiological similarities with the brain - offers a unique and accessible "window" to study correlates and consequences of subclinical pathology in the brain. Retinal components such as the microvasculature and retinal ganglion cell axons can now be visualized non-invasively using different retinal imaging techniques e.g., ocular fundus photography and optical coherence tomography. Advances in retinal imaging may provide new and potentially important insights into cerebrovascular neurodegenerative processes in addition to what is currently possible with neuro-imaging. In this review, we present an overview of the current literature on the application of retinal imaging in the study of dementia and stroke. We discuss clinical implications of these studies, novel state-of-the-art retinal imaging techniques and future directions aimed at evaluating whether retinal imaging can be an additional investigation tool in the study of dementia and stroke.
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Affiliation(s)
- Carol Yim-Lui Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.
| | - M Kamran Ikram
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore; Departments of Neurology & Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore
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16
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Wei W, Xia Z, Gao H, Gong J, Yan L, Huang Y, Chen F, Zhang W. Correlation of retinopathy with leukoaraiosis in patients with anterior circulation infarcts. J Clin Neurosci 2016; 33:105-110. [PMID: 27496527 DOI: 10.1016/j.jocn.2016.02.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/02/2016] [Accepted: 02/14/2016] [Indexed: 11/25/2022]
Abstract
Although retinal and cerebral microvessels share similar embryological, anatomical and physiological characteristics, the correlation between retinopathy and leukoaraiosis (LA), a type of brain microvascular disease, is unclear. In the present study, the sample included 213 patients admitted to the department of neurology from January 2012 through October 2012. MRI and retinal photography were performed within 48hours of hospitalization, and patient demographics, comorbidities, preadmission medications and laboratory data were collected. MRI images were used to divide the patients into LA and non-LA groups. Using multivariate binary logistic regression, the effects of retinopathy on LA were investigated. Of the 213 patients enrolled, 168 were included in this study (LA, n=108; non-LA, n=60). Hypertension, coronary heart disease and carotid artery plaque were more common in the LA group, and these patients showed higher blood levels of C-reactive protein, homocysteine and triglycerides. The incidence of retinopathy was significantly increased in the LA group compared with the non-LA group, and there was a significant correlation between the severity of LA and incidence of retinopathy. Retinopathy is an independent risk factor for LA and can significantly increase the risk of LA when combined with age, coronary heart disease, C-reactive protein, carotid artery plaque or systolic pressure. Taken together, retinopathy is associated with LA in patients with anterior circulation infarcts. Retinopathy is an independent risk factor for LA and an increase the risk of LA, and thus facilitating the evaluation of LA.
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Affiliation(s)
- Wei Wei
- Department of Neurology, PLA Army General Hospital, No.5 Nan men Cang, Dongcheng District, Beijing 100700, China
| | - Zhenxi Xia
- Department of Neurology, PLA Army General Hospital, No.5 Nan men Cang, Dongcheng District, Beijing 100700, China
| | - Hongyan Gao
- Department of Medical Affairs, General Hospital of Beijing Command PLA, Dongcheng District, Beijing, China
| | - Jingjing Gong
- Department of Neurology, PLA Army General Hospital, No.5 Nan men Cang, Dongcheng District, Beijing 100700, China
| | - Liping Yan
- Department of Neurology, TangshanWorker Hospital, Tangshan, China
| | - Yonghua Huang
- Department of Neurology, PLA Army General Hospital, No.5 Nan men Cang, Dongcheng District, Beijing 100700, China.
| | - Fei Chen
- Department of Neurology, PLA Army General Hospital, No.5 Nan men Cang, Dongcheng District, Beijing 100700, China
| | - Weiwei Zhang
- Department of Neurology, PLA Army General Hospital, No.5 Nan men Cang, Dongcheng District, Beijing 100700, China
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Affiliation(s)
- Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, London, WC1E 6BT, UK
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Affiliation(s)
- J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, 1400 Western Rd, London, Ontario, Canada N6G 2V2.
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Ikram MK, Cheung CY, Lorenzi M, Klein R, Jones TLZ, Wong TY. Retinal vascular caliber as a biomarker for diabetes microvascular complications. Diabetes Care 2013; 36:750-9. [PMID: 23431093 PMCID: PMC3579354 DOI: 10.2337/dc12-1554] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Kamran Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
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Retinal vessel width measurement at branchings using an improved electric field theory-based graph approach. PLoS One 2012; 7:e49668. [PMID: 23209588 PMCID: PMC3507841 DOI: 10.1371/journal.pone.0049668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 10/12/2012] [Indexed: 11/19/2022] Open
Abstract
The retinal vessel width relationship at vessel branch points in fundus images is an important biomarker of retinal and systemic disease. We propose a fully automatic method to measure the vessel widths at branch points in fundus images. The method is a graph-based method, in which a graph construction method based on electric field theory is applied which specifically deals with complex branching patterns. The vessel centerline image is used as the initial segmentation of the graph. Branching points are detected on the vessel centerline image using a set of detection kernels. Crossing points are distinguished from branch points and excluded. The electric field based graph method is applied to construct the graph. This method is inspired by the non-intersecting force lines in an electric field. At last, the method is further improved to give a consistent vessel width measurement for the whole vessel tree. The algorithm was validated on 100 artery branchings and 100 vein branchings selected from 50 fundus images by comparing with vessel width measurements from two human experts.
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Wardlaw JM. Differing risk factors and outcomes in ischemic stroke subtypes: focus on lacunar stroke. FUTURE NEUROLOGY 2011. [DOI: 10.2217/fnl.11.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Lacunar stroke has been a recognized stroke subtype for many years but its pathophysiology remains unknown, so prevention and treatment are suboptimal. Most lacunar strokes result from an intrinsic cerebral small vessel disease, probably part of a systemic disorder. Hypertension, diabetes and other vascular risk factors (but not atrial fibrillation and ipsilateral carotid stenosis) are equally common in lacunar as in large artery atherothromboembolic stroke, which, together with other factors, suggests that the patient’s response to vascular risk factors, not the vascular risk factors per se, determines whether they develop small vessel or large artery stroke. Inflammation and endothelial failure are probably involved in the pathogenesis of lacunar stroke, but their role needs to be clarified. The cerebral venules as well as arterioles are abnormal in this condition. The disorder may not be primarily ischemic; instead, arteriolar thrombosis may be a late-stage phenomenon secondary to chronic arteriolar wall damage resulting from leakage of plasma components across the BBB. Accurate diagnosis of lacunar stroke, avoiding risk factor-based classifications, is required to underpin future research.
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Affiliation(s)
- Joanna M Wardlaw
- Brain Research Imaging Centre, Edinburgh, SINAPSE Collaboration, c/o Division of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
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Doubal FN, MacGillivray TJ, Patton N, Dhillon B, Dennis MS, Wardlaw JM. Fractal analysis of retinal vessels suggests that a distinct vasculopathy causes lacunar stroke. Neurology 2010; 74:1102-7. [PMID: 20368631 DOI: 10.1212/wnl.0b013e3181d7d8b4] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Lacunar strokes account for 25% of all ischemic strokes and may represent the cerebral manifestation of a systemic small vessel vasculopathy of unknown etiology. Altered retinal vessel fractal dimensions may act as a surrogate marker for diseased cerebral vessels. We used a cross-sectional study to investigate fractal properties of retinal vessels in lacunar stroke. METHODS We recruited patients presenting with lacunar stroke and patients with minor cortical stroke as controls. All patients were examined by a stroke expert and had MRI at presentation. Digital retinal photographs were taken of both eyes. Monofractal and multifractal analyses were performed with custom-written semiautomated software. RESULTS We recruited 183 patients. Seventeen were excluded owing to poor photographic quality, leaving 166 patients (86 with lacunar and 80 with cortical stroke). The mean age was 67.3 years (SD 11.5 years). The patients with lacunar stroke were younger but the prevalence of diabetes, hypertension, and white matter hyperintensities did not differ between the groups. The mean Dbox (monofractal dimension) was 1.42 (SD 0.02), the mean D0 (multifractal dimension) 1.67 (SD 0.03). With multivariate analysis, decreased Dbox and D0 (both representing decreased branching complexity) were associated with increasing age and lacunar stroke subtype after correcting for hypertension, diabetes, stroke severity, and white matter hyperintensity scores. CONCLUSIONS Lacunar stroke subtype and increasing age are associated with decreased fractal dimensions, suggesting a loss of branching complexity. Further studies should concentrate on longitudinal associations with other manifestations of cerebral small vessel disease.
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Affiliation(s)
- F N Doubal
- Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK.
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