Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden

Julie Staals, Stephen D J Makin, Fergus N Doubal, Martin S Dennis, Joanna M Wardlaw, Julie Staals, Stephen D J Makin, Fergus N Doubal, Martin S Dennis, Joanna M Wardlaw

Abstract

Objectives: In this cross-sectional study, we tested the construct validity of a "total SVD score," which combines individual MRI features of small-vessel disease (SVD) in one measure, by testing associations with vascular risk factors and stroke subtype.

Methods: We analyzed data from patients with lacunar or nondisabling cortical stroke from 2 prospective stroke studies. Brain MRI was rated for the presence of lacunes, white matter hyperintensities, cerebral microbleeds, and perivascular spaces independently. The presence of each SVD feature was summed in an ordinal "SVD score" (range 0-4). We tested associations with vascular risk factors, stroke subtype, and cerebral atrophy using ordinal regression analysis.

Results: In 461 patients, multivariable analysis found that age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.08-1.12), male sex (OR 1.58, 95% CI 1.10-2.29), hypertension (OR 1.50, 95% CI 1.02-2.20), smoking (OR 2.81, 95% CI 1.59-3.63), and lacunar stroke subtype (OR 2.45, 95% CI 1.70-3.54) were significantly and independently associated with the total SVD score. The score was not associated with cerebral atrophy.

Conclusions: The total SVD score may provide a more complete estimate of the full impact of SVD on the brain, in a simple and pragmatic way. It could have potential for patient or risk stratification or early efficacy assessment in clinical trials of interventions to prevent SVD progression and may (after further testing) have a useful role in clinical practice.

© 2014 American Academy of Neurology.

Figures

Figure. Total small-vessel disease score features and…
Figure. Total small-vessel disease score features and categories

References

    1. Wardlaw J, Smith C, Dichgans M. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol 2013;12:483–497
    1. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010;9:689–701
    1. Nitkunan A, Lanfranconi S, Charlton RA, Barrick TR, Markus HS. Brain atrophy and cerebral small vessel disease: a prospective follow-up study. Stroke 2011;42:133–138
    1. Appelman AP, Exalto LG, Van der Graaf Y, Biessels GJ, Mali WP, Geerlings MI. White matter lesions and brain atrophy: more than shared risk factors? A systematic review. Cerebrovasc Dis 2009;28:227–242
    1. Aribisala BS, Valdés Hernández MC, Royle NA, et al. Brain atrophy associations with white matter lesions in the ageing brain: the Lothian Birth Cohort 1936. Eur Radiol 2013;23:1084–1092
    1. Ovbiagele B, Saver JL. Cerebral white matter hyperintensities on MRI: current concepts and therapeutic implications. Cerebrovasc Dis 2006;22:83–90
    1. Doubal FN, MacLullich AM, Ferguson KJ, Dennis MS, Wardlaw JM. Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease. Stroke 2010;41:450–454
    1. Greenberg SM, Vernooij MW, Cordonnier C, et al. Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol 2009;8:165–174
    1. Vermeer SE, Longstreth WT, Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol 2007;6:611–619
    1. Brenner D, Labreuche J, Pico F, et al. The renin-angiotensin-aldosterone system in cerebral small vessel disease. J Neurol 2008;255:993–1000
    1. Pico F, Labreuche J, Touboul PJ, Leys D, Amarenco P. Intracranial arterial dolichoectasia and small-vessel disease in stroke patients. Ann Neurol 2005;57:472–479
    1. Klarenbeek P, van Oostenbrugge RJ, Rouhl RP, Knottnerus IL, Staals J. Ambulatory blood pressure in patients with lacunar stroke: association with total MRI burden of cerebral small vessel disease. Stroke 2013;44:2995–2999
    1. Huijts M, Duits A, van Oostenbrugge RJ, Kroon AA, de Leeuw PW, Staals J. Accumulation of MRI markers of cerebral small vessel disease is associated with decreased cognitive function: a study in first-ever lacunar stroke and hypertensive patients. Front Aging Neurosci 2013;5:72.
    1. Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013;12:822–838
    1. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521–1526
    1. Jackson CA, Hutchison A, Dennis MS, Wardlaw JM, Lewis SC, Sudlow CL. Differences between ischemic stroke subtypes in vascular outcomes support a distinct lacunar ischemic stroke arteriopathy: a prospective, hospital-based study. Stroke 2009;40:3679–3684
    1. Potter G, Doubal F, Jackson C, Sudlow C, Dennis M, Wardlaw J. Associations of clinical stroke misclassification (“clinical-imaging dissociation”) in acute ischemic stroke. Cerebrovasc Dis 2010;29:395–402
    1. Warlow C, van Gijn J, Dennis M, et al. Is it a vascular event and where is the lesion? Identifying and interpreting the symptoms and signs of cerebrovascular disease. In: Warlow C, van Gijn J, Dennis M, et al. Stroke: Practical Management, 3rd ed Malden, MA: Blackwell Publishing; 2008:35–130
    1. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol 1987;149:351–356
    1. Farrell C, Chappell F, Armitage PA, et al. Development and initial testing of normal reference MR images for the brain at ages 65–70 and 75–80 years. Eur Radiol 2009;19:177–183
    1. Cordonnier C, Potter GM, Jackson CA, et al. Improving interrater agreement about brain microbleeds: development of the Brain Observer MicroBleed Scale (BOMBS). Stroke 2009;40:94–99
    1. Van Dijk EJ, Prins ND, Vrooman HA, Hofman A, Koudstaal PJ, Breteler MM. Progression of cerebral small vessel disease in relation to risk factors and cognitive consequences: Rotterdam Scan Study. Stroke 2008;39:2712–2719
    1. Gons RA, van Norden AG, de Laat KF, et al. Cigarette smoking is associated with reduced microstructural integrity of cerebral white matter. Brain 2011;134:2116–2124
    1. Poels M, Vernooij MW, Ikram MA, et al. Prevalence and risk factors of cerebral microbleeds: an update of the Rotterdam Scan Study. Stroke 2010;41:S103–S106
    1. Jackson CA, Hutchison A, Dennis MS, et al. Differing risk factor profiles of ischemic stroke subtypes: evidence for a distinct lacunar arteriopathy? Stroke 2010;41:624–629
    1. Longstreth WT, Jr, Manolio TA, Arnold A, et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke 1996;27:1274–1282
    1. Launer LJ. Epidemiology of white matter lesions. Top Magn Reson Imaging 2004;15:365–367
    1. Poels M, Steyerberg EW, Wieberdink RG, et al. Assessment of cerebral small vessel disease predicts individual stroke risk. J Neurol Neurosurg Psychiatry 2012;83:1174–1179
    1. Schmidt R, Scheltens P, Erkinjuntti T, et al. White matter lesion progression: a surrogate endpoint for trials in cerebral small-vessel disease. Neurology 2004;63:139–144
    1. Patel B, Markus HS. Magnetic resonance imaging in cerebral small vessel disease and its use as a surrogate disease marker. Int J Stroke 2011;6:47–59
    1. LADIS Study Group. 2001–2011: a decade of the LADIS (Leukoaraiosis and DISability) Study: what have we learned about white matter changes and small-vessel disease? Cerebrovasc Dis 2011;32:577–588
    1. Fazekas F, Kleinert R, Offenbacher H, et al. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology 1993;43:1683–1689
    1. Jouvent E, Viswanathan A, Chabriat H. Cerebral atrophy in cerebrovascular disorders. J Neuroimaging 2010;20:213–218

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren