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Wei C, Tan C, Zhang X, Shen X, Xu Z, Li J, Xu G. Chronic gastritis may predict risk of cerebral small vessel disease. BMC Gastroenterol 2023; 23:429. [PMID: 38062366 PMCID: PMC10702041 DOI: 10.1186/s12876-023-03009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND PURPOSE Chronic gastritis, especially that caused by helicobacter pylori (HP) infection, has been associated with increased risk of ischemic stroke. But the relationship between chronic gastritis and cerebral small vessel disease (CSVD) remains largely undetermined. This study aimed to determine the potential predictors for CSVD, with chronic gastritis and its proxies as alternatives. METHOD Patients aged 18 years or older with indications for electronic gastroscopy were enrolled. Presence of CSVD was evaluated with brain magnetic resonance imaging (MRI) results. Degree of CSVD was scored according to established criteria. Logistic regression analysis was used for identifying possible risk factors for CSVD. RESULTS Of the 1191 enrolled patients, 757 (63.6%) were identified as with, and 434 (36.4%) as without CSVD. Multivariate analysis indicated that patients with chronic atrophic gastritis had an increased risk for CSVD than those without (adjusted odds ratio = 1.58; 95% CI, 1.08-2.32; P < 0.05). CONCLUSIONS Chronic atrophic gastritis is associated with the presence of CSVD. We should routinely screen the presence of CSVD for patients with chronic atrophic gastritis.
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Affiliation(s)
- Cunsheng Wei
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Chang Tan
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Xuemei Zhang
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Xin Shen
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Zongliang Xu
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Junrong Li
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China.
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
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2
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Hernández-Díaz ZM, Peña-Sánchez M, Pimienta-Medina M, González-García S, Brown Martínez M, Arteche Prior M, Martin Arias Y, Hodelin-Maynard EH, Abreu Duque A, Gonzalez-Quevedo A. Asymptomatic cerebral small vessel disease in adults with low cardiovascular risk. BMJ Neurol Open 2023; 5:e000356. [PMID: 36817511 PMCID: PMC9936274 DOI: 10.1136/bmjno-2022-000356] [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: 08/17/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Cerebral small vessel disease (CSVD) frequently occurs in individuals with vascular risk factors. This condition might go unrecognised or result in only mild functional deficits. Objective To evaluate the relationship between cardiovascular (CV) risk calculated with the HEARTS app and CSVD burden in a population without cardio-cerebrovascular diseases, and to estimate the prevalence of CSVD in low risk (LR) individuals. Methods Asymptomatic subjects with vascular risk factors were included from primary health areas in Havana. The WHO's revised CV disease risk prediction chart (HEARTS app) was applied to all individuals, who were classified into two groups: LR and moderate/high risk (M/HR). Brain MRI was performed in all subjects. Results 170 patients were included: 43 (25.3%) classified as low CV risk and 127 (74.7%) had M/HR CV risk. Half of the neurologically healthy individuals included displayed cerebral small vessel involvement (51.2%). White matter hyperintensities (WMH) and enlarged perivascular spaces were the most frequent lesions observed in both groups. WMH were more severe and more severe global score for CSVD were more frequent in the M/HR group (57.5%). It was noteworthy that 32.6% of LR-patients also exhibited more severe CSVD. The multivariate regression analysis revealed an independent association of arterial hypertension and age with the severity of CSVD. Conclusions CV risk stratification through the HEARTS app has limited utility for predicting brain health in individuals with low CV risk. Identifying silent CSVD in individuals with apparently low CV risk is important, especially if they suffer from arterial hypertension.
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Affiliation(s)
| | | | | | | | | | | | - Yasmany Martin Arias
- Neuroimaging, International Centre for Neurological Restoration, La Habana, Cuba
| | | | - Armando Abreu Duque
- Neuroimaging, International Centre for Neurological Restoration, La Habana, Cuba
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3
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Verburgt E, Janssen E, Jacob MA, Cai M, Ter Telgte A, Wiegertjes K, Kessels RPC, Norris DG, Marques J, Duering M, Tuladhar AM, De Leeuw FE. Role of small acute hyperintense lesions in long-term progression of cerebral small vessel disease and clinical outcome: a 14-year follow-up study. J Neurol Neurosurg Psychiatry 2023; 94:144. [PMID: 36270793 DOI: 10.1136/jnnp-2022-330091] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Small hyperintense lesions are found on diffusion-weighted imaging (DWI) in patients with sporadic small vessel disease (SVD). Their exact role in SVD progression remains unclear due to their asymptomatic and transient nature. The main objective is to investigate the role of DWI+lesions in the radiological progression of SVD and their relationship with clinical outcomes. METHODS Participants with SVD were included from the Radboud University Nijmegen Diffusion tensor MRI Cohort. DWI+lesions were assessed on four time points over 14 years. Outcome measures included neuroimaging markers of SVD, cognitive performance and clinical outcomes, including stroke, all-cause dementia and all-cause mortality. Linear mixed-effect models and Cox regression models were used to examine the outcome measures in participants with a DWI+lesion (DWI+) and those without a DWI+lesion (DWI-). RESULTS DWI+lesions were present in 45 out of 503 (8.9%) participants (mean age: 66.7 years (SD=8.3)). Participants with DWI+lesions and at least one follow-up (n=33) had higher white matter hyperintensity progression rates (β=0.36, 95% CI=0.05 to 0.68, p=0.023), more incident lacunes (incidence rate ratio=2.88, 95% CI=1.80 to 4.67, p<0.001) and greater cognitive decline (β=-0.03, 95% CI=-0.05 to -0.01, p=0.006) during a median follow-up of 13.2 (IQR: 8.8-13.8) years compared with DWI- participants. No differences were found in risk of all-cause mortality, stroke or dementia. CONCLUSION Presence of a DWI+lesion in patients with SVD is associated with greater radiological progression of SVD and cognitive decline compared with patients without DWI+lesions.
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Affiliation(s)
- Esmée Verburgt
- Department of Neurology, Radboudumc, Nijmegen, Gelderland, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Gelderland, The Netherlands
| | - Esther Janssen
- Department of Neurology, Radboudumc, Nijmegen, Gelderland, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Gelderland, The Netherlands
| | - Mina A Jacob
- Department of Neurology, Radboudumc, Nijmegen, Gelderland, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Gelderland, The Netherlands
| | - Mengfei Cai
- Department of Neurology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Annemieke Ter Telgte
- Research Center on Vascular Ageing and Stroke (VASCage GmbH), Innsbruck, Austria
| | - Kim Wiegertjes
- Department of Neurology, Radboudumc, Nijmegen, Gelderland, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Gelderland, The Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Gelderland, The Netherlands.,Vincent Van Gogh Instituut, Venray, Limburg, The Netherlands
| | - David G Norris
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Gelderland, The Netherlands
| | - Jose Marques
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Gelderland, The Netherlands
| | - Marco Duering
- Medical Image Analysis Center (MIAC AG) and qbig, Department of Biomedical Engineering, University of Basel, Basel, Basel-Stadt, Switzerland
| | - Anil M Tuladhar
- Department of Neurology, Radboudumc, Nijmegen, Gelderland, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Gelderland, The Netherlands
| | - Frank-Erik De Leeuw
- Department of Neurology, Radboudumc, Nijmegen, Gelderland, The Netherlands .,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Gelderland, The Netherlands
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4
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Wiegertjes K, Voigt S, Jolink WMT, Koemans EA, Schreuder FHBM, van Walderveen MAA, Wermer MJH, Meijer FJA, Duering M, de Leeuw FE, Klijn CJM. Diffusion-Weighted Lesions After Intracerebral Hemorrhage: Associated MRI Findings. Front Neurol 2022; 13:882070. [PMID: 35785361 PMCID: PMC9240258 DOI: 10.3389/fneur.2022.882070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
The current study aimed to investigate whether diffusion-weighted imaging-positive (DWI+) lesions after acute intracerebral hemorrhage (ICH) are associated with underlying small vessel disease (SVD) or linked to the acute ICH. We included patients ≥18 years with spontaneous ICH confirmed on neuroimaging and performed 3T MRIs after a median of 11 days (interquartile range [IQR] 6–43). DWI+ lesions were assessed in relation to the hematoma (perihematomal vs. distant and ipsilateral vs. contralateral). Differences in clinical characteristics, ICH characteristics, and MRI markers of SVD between participants with or without DWI+ lesions were investigated using non-parametric tests. We observed 54 DWI+ lesions in 30 (22%) of the 138 patients (median age [IQR] 65 [55–73] years; 71% men, 59 lobar ICH) with available DWI images. We found DWI+ lesions ipsilateral (54%) and contralateral (46%) to the ICH, and 5 (9%) DWI+ lesions were located in the immediate perihematomal region. DWI+ lesion presence was associated with probable CAA diagnosis (38 vs. 15%, p = 0.01) and larger ICH volumes (37 [8–47] vs. 12 [6–24] ml, p = 0.01), but not with imaging features of SVD. Our findings suggest that DWI+ lesions after ICH are a feature of both the underlying SVD and ICH-related mechanisms.
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Affiliation(s)
- Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sabine Voigt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Wilmar M. T. Jolink
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Emma A. Koemans
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Floris H. B. M. Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Marieke J. H. Wermer
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Brain Center, Utrecht University, Utrecht, Netherlands
| | | | - Marco Duering
- Department of Biomedical Engineering, Medical Image Analysis Center (MIAC AG) and qbig, University of Basel, Basel, Switzerland
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Catharina J. M. Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
- *Correspondence: Catharina J. M. Klijn
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5
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Wei C, Yu X, Wang L, Jiang J, Dai Q, Kang Y, Li J, Chen X. Can hyperuricemia predict the progression risk of cerebral small vessel disease? Neurol Res 2022; 44:910-917. [PMID: 35475780 DOI: 10.1080/01616412.2022.2067707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS Uric acid (UA) may play a crucial role in the process of cerebral small vessel disease (SVD), but few follow-up studies have focused on the effect of UA in the progression of SVD. The present study aimed to ascertain whether serum UA levels are associated with the risk of SVD progression. METHODS We performed an observational clinical study in adults older than 45 years with cranial magnetic resonance imaging (MRI) from 30 October 2015, to 28 January 2021. The patients were divided into two groups according to whether their total burden of SVD scores increased or not during the follow-up: SVD progression (increased by at least one point) and without SVD progression (increased 0 points). Cox regression and Kaplan-Meier survival analyses were used for univariate analysis between groups to identify the risk factors for SVD progression. RESULTS Ultimately, 261 eligible patients were included in the final analysis. Of the 261 eligible patients, 73 were included in the SVD progression group, and 188 were included in the group without SVD progression. Correlation analysis found that the levels of UA and the ratio of hyperuricemia (HUA) showed statistically significant correlations with SVD progression risk (r = 0.197 and Crammer's V = 0.213, respectively, P < 0.01). Cox regression and Kaplan-Meier survival analyses showed that after adjustment for covariates, HUA was an independent risk factor for the incidence of SVD progression. The risk of SVD progression in patients with HUA was higher than that in those without HUA (HR (95% CI), 1.77 (1.03-3.05), P < 0.05). CONCLUSIONS High serum UA levels are independently related to the risk of SVD progression, thus highlighting not only the influence of traditional risk factors such as hypertension and age on SVD but also the UA levels of patients for individualized treatment.
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Affiliation(s)
- Cunsheng Wei
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaorong Yu
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lin Wang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Junying Jiang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qi Dai
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yue Kang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Junrong Li
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xuemei Chen
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
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6
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Incidental DWI Lesions in Patients with Recent Small Subcortical Infarctions. J Stroke Cerebrovasc Dis 2022; 31:106304. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/02/2022] [Indexed: 01/16/2023] Open
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7
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Jansen MG, Griffanti L, Mackay CE, Anatürk M, Melazzini L, Lange AMGD, Filippini N, Zsoldos E, Wiegertjes K, Leeuw FED, Singh-Manoux A, Kivimäki M, Ebmeier KP, Suri S. Association of cerebral small vessel disease burden with brain structure and cognitive and vascular risk trajectories in mid-to-late life. J Cereb Blood Flow Metab 2022; 42:600-612. [PMID: 34610763 PMCID: PMC8943617 DOI: 10.1177/0271678x211048411] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We characterize the associations of total cerebral small vessel disease (SVD) burden with brain structure, trajectories of vascular risk factors, and cognitive functions in mid-to-late life. Participants were 623 community-dwelling adults from the Whitehall II Imaging Sub-study with multi-modal MRI (mean age 69.96, SD = 5.18, 79% men). We used linear mixed-effects models to investigate associations of SVD burden with up to 25-year retrospective trajectories of vascular risk and cognitive performance. General linear modelling was used to investigate concurrent associations with grey matter (GM) density and white matter (WM) microstructure, and whether these associations were modified by cognitive status (Montreal Cognitive Asessment [MoCA] scores of < 26 vs. ≥ 26). Severe SVD burden in older age was associated with higher mean arterial pressure throughout midlife (β = 3.36, 95% CI [0.42-6.30]), and faster cognitive decline in letter fluency (β = -0.07, 95% CI [-0.13--0.01]), and verbal reasoning (β = -0.05, 95% CI [-0.11--0.001]). Moreover, SVD burden was related to lower GM volumes in 9.7% of total GM, and widespread WM microstructural decline (FWE-corrected p < 0.05). The latter association was most pronounced in individuals who demonstrated cognitive impairments on MoCA (MoCA < 26; F3,608 = 2.14, p = 0.007). These findings highlight the importance of managing midlife vascular health to preserve brain structure and cognitive function in old age.
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Affiliation(s)
- Michelle G Jansen
- Donders Centre for Cognition, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ludovica Griffanti
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK
| | - Clare E Mackay
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK
| | - Melis Anatürk
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Centre for Medical Image Computing, Department of Computer Science, 4919University College London, University College London, London, UK
| | - Luca Melazzini
- Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Ann-Marie G de Lange
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Department of Psychology, 6305University of Oslo, University of Oslo, Oslo, Norway
| | | | - Enikő Zsoldos
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, 4919University College London, University College London, London, UK.,INSERM, Epidemiology of Ageing and Neurogenerative Diseases, Université de Paris, Paris, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, 4919University College London, University College London, London, UK
| | - Klaus P Ebmeier
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK
| | - Sana Suri
- Department of Psychiatry, 6396University of Oxford, University of Oxford, Oxford, UK.,Wellcome Centre for Integrative Neuroimaging (Oxford Centres for Functional MRI of the Brain & Human Brain Activity) University of Oxford, Oxford, UK
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8
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de Brito Robalo BM, Biessels GJ, Chen C, Dewenter A, Duering M, Hilal S, Koek HL, Kopczak A, Yin Ka Lam B, Leemans A, Mok V, Onkenhout LP, van den Brink H, de Luca A. Diffusion MRI harmonization enables joint-analysis of multicentre data of patients with cerebral small vessel disease. Neuroimage Clin 2021; 32:102886. [PMID: 34911192 PMCID: PMC8609094 DOI: 10.1016/j.nicl.2021.102886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/16/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Acquisition-related differences in diffusion magnetic resonance imaging (dMRI) hamper pooling of multicentre data to achieve large sample sizes. A promising solution is to harmonize the raw diffusion signal using rotation invariant spherical harmonic (RISH) features, but this has not been tested in elderly subjects. Here we aimed to establish if RISH harmonization effectively removes acquisition-related differences in multicentre dMRI of elderly subjects with cerebral small vessel disease (SVD), while preserving sensitivity to disease effects. METHODS Five cohorts of patients with SVD (N = 397) and elderly controls (N = 175) with 3 Tesla MRI on different systems were included. First, to establish effectiveness of harmonization, the RISH method was trained with data of 13 to 15 age and sex-matched controls from each site. Fractional anisotropy (FA) and mean diffusivity (MD) were compared in matched controls between sites using tract-based spatial statistics (TBSS) and voxel-wise analysis, before and after harmonization. Second, to assess sensitivity to disease effects, we examined whether the contrast (effect sizes of FA, MD and peak width of skeletonized MD - PSMD) between patients and controls within each site remained unaffected by harmonization. Finally, we evaluated the association between white matter hyperintensity (WMH) burden, FA, MD and PSMD using linear regression analyses both within individual cohorts as well as with pooled scans from multiple sites, before and after harmonization. RESULTS Before harmonization, significant differences in FA and MD were observed between matched controls of different sites (p < 0.05). After harmonization these site-differences were removed. Within each site, RISH harmonization did not alter the effect sizes of FA, MD and PSMD between patients and controls (relative change in Cohen's d = 4 %) nor the strength of association with WMH volume (relative change in R2 = 2.8 %). After harmonization, patient data of all sites could be aggregated in a single analysis to infer the association between WMH volume and FA (R2 = 0.62), MD (R2 = 0.64), and PSMD (R2 = 0.60). CONCLUSIONS We showed that RISH harmonization effectively removes acquisition-related differences in dMRI of elderly subjects while preserving sensitivity to SVD-related effects. This study provides proof of concept for future multicentre SVD studies with pooled datasets.
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Affiliation(s)
- Bruno M de Brito Robalo
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands; Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Christopher Chen
- Memory, Aging and Cognition Center, Department of Pharmacology, National University of Singapore, Singapore.
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany.
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
| | - Saima Hilal
- Memory, Aging and Cognition Center, Department of Pharmacology, National University of Singapore, Singapore.
| | - Huiberdina L Koek
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Anna Kopczak
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany.
| | - Bonnie Yin Ka Lam
- Division of Neurology, Department of Medicine and Therapeutics, Gerald Choa Neuroscience Centre, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Vincent Mok
- Division of Neurology, Department of Medicine and Therapeutics, Gerald Choa Neuroscience Centre, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.
| | - Laurien P Onkenhout
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Hilde van den Brink
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Alberto de Luca
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands; Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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9
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Noz MP, Ter Telgte A, Wiegertjes K, Tuladhar AM, Kaffa C, Kersten S, Bekkering S, van der Heijden CDCC, Hoischen A, Joosten LAB, Netea MG, Duering M, de Leeuw FE, Riksen NP. Pro-inflammatory Monocyte Phenotype During Acute Progression of Cerebral Small Vessel Disease. Front Cardiovasc Med 2021; 8:639361. [PMID: 34055930 PMCID: PMC8155247 DOI: 10.3389/fcvm.2021.639361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The etiology of cerebral small vessel disease (SVD) remains elusive, though evidence is accumulating that inflammation contributes to its pathophysiology. We recently showed retrospectively that pro-inflammatory monocytes are associated with the long-term progression of white matter hyperintensities (WMHs). In this prospective high-frequency imaging study, we hypothesize that the incidence of SVD progression coincides with a pro-inflammatory monocyte phenotype. Methods: Individuals with SVD underwent monthly magnetic resonance imaging (MRI) for 10 consecutive months to detect SVD progression, defined as acute diffusion-weighted imaging-positive (DWI+) lesions, incident microbleeds, incident lacunes, and WMH progression. Circulating inflammatory markers were measured, cytokine production capacity of monocytes was assessed after ex vivo stimulation, and RNA sequencing was performed on isolated monocytes in a subset of participants. Results: 13 out of 35 individuals developed SVD progression (70 ± 6 years, 54% men) based on incident lesions (n = 7) and/or upper quartile WMH progression (n = 9). Circulating E-selectin concentration (p < 0.05) and the cytokine production capacity of interleukin (IL)-1β and IL-6 (p < 0.01) were higher in individuals with SVD progression. Moreover, RNA sequencing revealed a pro-inflammatory monocyte signature including genes involved in myelination, blood–brain barrier, and endothelial–leukocyte interaction. Conclusions: Circulating monocytes of individuals with progressive SVD have an inflammatory phenotype, characterized by an increased cytokine production capacity and a pro-inflammatory transcriptional signature.
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Affiliation(s)
- Marlies P Noz
- Department of Internal Medicine, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, Netherlands
| | - Annemieke Ter Telgte
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Charlotte Kaffa
- Center for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Simone Kersten
- Department of Internal Medicine, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Siroon Bekkering
- Department of Internal Medicine, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, Netherlands
| | - Charlotte D C C van der Heijden
- Department of Internal Medicine, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, Netherlands
| | - Alexander Hoischen
- Department of Internal Medicine, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai G Netea
- Department of Internal Medicine, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, Netherlands.,Department for Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Marco Duering
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.,Institute for Stroke and Dementia Research, University Hospital of Munich, Munich, Germany.,Munich Cluster for Systems Neurology, Munich, Germany
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Niels P Riksen
- Department of Internal Medicine, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, Netherlands
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10
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Sharma M, Hart RG, Smith EE, Bosch J, Eikelboom JW, Connolly SJ, Dyal L, Reeh KW, Casanova A, Diaz R, Lopez-Jaramillo P, Ertl G, Störk S, Dagenais GR, Lonn EM, Ryden L, Tonkin AM, Varigos JD, Bhatt DL, Branch KR, Probstfield JL, Kim JH, O’Donnell M, Vinereanu D, A.A. Fox K, Liang Y, Liu L, Zhu J, Pogosova N, Maggioni AP, Avezum A, Piegas LS, Keltai K, Keltai M, Berkowitz SD, Yusuf S. Rivaroxaban for Prevention of Covert Brain Infarcts and Cognitive Decline. Stroke 2020; 51:2901-2909. [DOI: 10.1161/strokeaha.120.029762] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background and Purpose:
Covert brain infarcts are associated with cognitive decline. It is not known whether therapies that prevent symptomatic stroke prevent covert infarcts. COMPASS compared rivaroxaban with and without aspirin with aspirin for the prevention of stroke, myocardial infarction, and vascular death in participants with stable vascular disease and was terminated early because of benefits of rivaroxaban 2.5 mg twice daily plus aspirin over aspirin. We obtained serial magnetic resonance imagings and cognitive tests in a consenting subgroup of COMPASS patients to examine treatment effects on infarcts, cerebral microbleeds, and white matter hyperintensities.
Methods:
Baseline and follow-up magnetic resonance imagings were completed in 1445 participants with a mean (SD) interval of 2.0 (0.7) years. Whole-brain T1, T2 fluid-attenuated inversion recovery, T2* sequences were centrally interpreted by blinded, trained readers. Participants had serial measurements of cognition and function. The primary end point was the proportion of participants with incident covert infarcts. Secondary end points were the composite of clinical stroke and covert brain infarcts, cerebral microbleeds, and white matter hyperintensities.
Results:
At baseline, 493 (34.1%) participants had infarcts. Incident covert infarcts occurred in 55 (3.8%) participants. In the overall trial rivaroxaban plus aspirin reduced ischemic stroke by 49% (0.7% versus 1.4%; hazard ratio [95% CI], 0.51 [0.38–0.68]). In the magnetic resonance imaging substudy the effects of rivaroxaban+aspirin versus aspirin were: covert infarcts: 2.7% versus 3.5% (odds ratio [95% CI], 0.77 [0.37–1.60]); Covert infarcts or ischemic stroke: 2.9% versus 5.3% (odds ratio [95% CI], 0.53 [0.27–1.03]). Incident microbleeds occurred in 6.6% of participants and 65.7% of participants had an increase in white matter hyperintensities volume with no effect of treatment for either end point. There was no effect on cognitive tests.
Conclusions:
Covert infarcts were not significantly reduced by treatment with rivaroxaban and aspirin but estimates for the combination of ischemic stroke and covert infarcts were consistent with the effect on ischemic stroke in the overall trial.
Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01776424.
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Affiliation(s)
- Mukul Sharma
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Robert G. Hart
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Eric E. Smith
- Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.)
| | - Jacqueline Bosch
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada (J.B.)
| | - John W. Eikelboom
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Stuart J. Connolly
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Leanne Dyal
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Kevin W Reeh
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Amparo Casanova
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Rafael Diaz
- Estudios Clinicos Latino America and Instituto Cardiovascular de Rosario, Argentina (R.D.)
| | | | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg, Germany (G.E., S.S.)
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg, Germany (G.E., S.S.)
| | - Gilles R. Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Quebec, Quebec City, Canada (G.R.D.)
| | - Eva M. Lonn
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
| | - Lars Ryden
- Karolinska Institutet, Stockholm, Sweden (L.R.)
| | | | | | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard, Medical School, Boston, MA (D.L.B.)
| | - Kelley R.H. Branch
- University of Washington Medical Centre, Seattle (K.R.H.B.)
- University of Washington, Seattle (K.R.H.B., J.L.P.)
| | | | - Jae-Hyung Kim
- The Catholic University of Korea, Seoul, Korea (J.-H.K.)
| | | | - Dragos Vinereanu
- University of Medicine and Pharmacology Carol Davila University and Emergency Hospital, Bucharest, Romania (D.V.)
| | - Keith A.A. Fox
- Centre for Cardiovascular Science, University of Edinburgh, Scotland, United Kingdom (K.A.A.F.)
| | - Yan Liang
- FuWai Hospital, Beijing, China (Y.L., L.L., J.Z.)
| | - Lisheng Liu
- FuWai Hospital, Beijing, China (Y.L., L.L., J.Z.)
| | - Jun Zhu
- FuWai Hospital, Beijing, China (Y.L., L.L., J.Z.)
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow, Russia (N.P.)
| | | | - Alvaro Avezum
- Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil (A.A.)
| | | | | | - Matyas Keltai
- Semmelweis University, Budapest, Hungary (K.K., M.K.)
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada (M.S., R.G.H., J.B., J.W.E., S.J.C., L.D., K.W.R., A.C., E.M.L., S.Y.)
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11
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Ter Telgte A, Scherlek AA, Reijmer YD, van der Kouwe AJ, van Harten T, Duering M, Bacskai BJ, de Leeuw FE, Frosch MP, Greenberg SM, van Veluw SJ. Histopathology of diffusion-weighted imaging-positive lesions in cerebral amyloid angiopathy. Acta Neuropathol 2020; 139:799-812. [PMID: 32108259 DOI: 10.1007/s00401-020-02140-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/25/2020] [Accepted: 02/21/2020] [Indexed: 11/24/2022]
Abstract
Small subclinical hyperintense lesions are frequently encountered on brain diffusion-weighted imaging (DWI) scans of patients with cerebral amyloid angiopathy (CAA). Interpretation of these DWI+ lesions, however, has been limited by absence of histopathological examination. We aimed to determine whether DWI+ lesions represent acute microinfarcts on histopathology in brains with advanced CAA, using a combined in vivo MRI-ex vivo MRI-histopathology approach. We first investigated the histopathology of a punctate cortical DWI+ lesion observed on clinical in vivo MRI 7 days prior to death in a CAA case. Subsequently, we assessed the use of ex vivo DWI to identify similar punctate cortical lesions post-mortem. Intact formalin-fixed hemispheres of 12 consecutive cases with CAA and three non-CAA controls were subjected to high-resolution 3 T ex vivo DWI and T2 imaging. Small cortical lesions were classified as either DWI+/T2+ or DWI-/T2+. A representative subset of lesions from three CAA cases was selected for detailed histopathological examination. The DWI+ lesion observed on in vivo MRI could be matched to an area with evidence of recent ischemia on histopathology. Ex vivo MRI of the intact hemispheres revealed a total of 130 DWI+/T2+ lesions in 10/12 CAA cases, but none in controls (p = 0.022). DWI+/T2+ lesions examined histopathologically proved to be acute microinfarcts (classification accuracy 100%), characterized by presence of eosinophilic neurons on hematoxylin and eosin and absence of reactive astrocytes on glial fibrillary acidic protein-stained sections. In conclusion, we suggest that small DWI+ lesions in CAA represent acute microinfarcts. Furthermore, our findings support the use of ex vivo DWI as a method to detect acute microinfarcts post-mortem, which may benefit future histopathological investigations on the etiology of microinfarcts.
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Affiliation(s)
- Annemieke Ter Telgte
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, USA
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ashley A Scherlek
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, USA
| | - Yael D Reijmer
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andre J van der Kouwe
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Thijs van Harten
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco Duering
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute for Stroke and Dementia Research (ISD), University Hospital LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Brian J Bacskai
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, USA
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matthew P Frosch
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, USA
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Susanne J van Veluw
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, USA.
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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