Enlarged Perivascular Spaces and Cerebral Small Vessel Disease in Spontaneous Intracerebral Hemorrhage Patients

Wang, Xin; Feng, Hao; Wang, Yu; Zhou, Jian

doi:10.3389/fneur.2019.00881

Cited by 15 publications

(12 citation statements)

References 52 publications

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“…Our findings concerning the relationship of BG-E P V S w i t h a g e , h y p e r t e n s i o n a n d W M H w e r e consistent across different populations including lacunar stroke (28), intracerebral hemorrhage (12), and cognitive impairment (29). Besides, the stronger association between lacunar stroke and EPVS in BG than that in CS was similar to previous studies (3,30,31).…”

Section: Discussionsupporting

confidence: 88%

“…As EPVS scores were not normally distributed, we dichotomized EPVS into mild total EPVS (score 0-2) vs. moderate-tosevere total EPVS [3][4][5][6][7][8], mild BG-EPVS [0-1] vs. moderateto-severe BG-EPVS [2][3][4], and mild CS-EPVS [0-1] vs. moderate-to-severe CS-EPVS [2][3][4], respectively. Potential variables identified from the recent literature (11,12,27) were adjusted: age, sex, hypertension, diabetes mellitus, dyslipidemia, AF, prior stroke/TIA, smoking, drinking, lacunar stroke, PWMH, DWMH, and lacunes.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, some studies in aging adults demonstrated that EPVS were associated with an increased risk of incident stroke, dementia, and depression (8)(9)(10). Moreover, growing evidence indicates that EPVS are more prevalent in stroke patients (11,12), and a high EPVS burden can predict poor outcomes after stroke (11,13,14). However, few studies have explored the relationship of EPVS to hemorrhagic transformation (HT) following ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

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Enlarged perivascular spaces and hemorrhagic transformation after acute ischemic stroke

Song¹,

Cheng²,

Wang³

et al. 2021

Ann Transl Med

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Background: Enlarged perivascular spaces (EPVS) are considered to be neuroimaging markers of cerebral small vessel disease (CSVD). It remains unknown whether EPVS are associated with hemorrhagic transformation (HT) after acute ischemic stroke (AIS). We performed this retrospective cohort study to explore the associations of EPVS with clinical risk factors and other CSVD imaging features, and to investigate the relationship between EPVS and HT in patients with AIS.Methods: AIS patients admitted within 24 hours of stroke onset between January 2016 and December 2017 were consecutively enrolled. EPVS, lacunes, and white matter hyperintensities (WMH) were rated with validated rating scales on magnetic resonance images after the stroke. HT was defined as hemorrhage determined by follow-up brain imaging during the patients' hospital stay. Logistic regression was used to determine the risk factors and associations with other CSVD markers of EPVS in the basal ganglia (BG) and centrum semiovale (CS) regions, and the impact of EPVS on HT was further explored.Results: Among 494 included patients (mean age 66.4 years, 58.1% male), 81 (16.4%) experienced HT. In the multivariate logistic analyses, increasing age [odd ratio (OR) 1.041, 95% confidence interval (CI), 1.017-

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Enlarged perivascular spaces and hemorrhagic transformation after acute ischemic stroke

Song¹,

Cheng²,

Wang³

et al. 2021

Ann Transl Med

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“…The mechanisms underlying dilatation of PVS and the actual function of PVS have yet to be adequately clarified. Etiologies related to the enlargement of PVS include aging, hypertension, stroke, cerebral small vessel diseases including lacunar stroke and white matter hyperintensities, systemic inflammation, and multiple sclerosis [13] . Recent studies have shown that PVS are involved in the drainage of interstitial fluid, soluble waste proteins, and metabolic products, including Aβ protein, from the brain in cooperation with brain arteries and glial cells facilitated by aquaporin 4 water channels [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Cognitive impairment due to widespread enlarged perivascular spaces

Yamaguchi

Wada

Kimihira

et al. 2021

Radiology Case Reports

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Perivascular spaces, also known as Virchow-Robin spaces, are usually considered as a normal, asymptomatic finding. However, this finding can occasionally demonstrate an atypical appearance and can be symptomatic. We report herein a rare case of cognitive impairment associated with extremely enlarged perivascular spaces. A 68-year-old Japanese woman visited our hospital with a 1-year history of progressive memory impairment. In addition to temporal disorientation and short-term memory impairment, neuropsychological testing showed frontal lobe-related symptoms such as slowed thinking processes, reduced verbal fluency, attention deficit, and reduced working memory. Magnetic resonance imaging of the brain showed widespread enlarged perivascular spaces almost symmetrically in the subcortical white matter of bilateral hemispheres, prominently in bilateral insulas, and frontal opercula. On 99mTc-ethyl cysteinate dimer single photon emission computed tomography, hypoperfusion was apparent in bilateral insulas and frontal opercula where enlarged periventricular spaces were prominent, whereas cerebral perfusion was preserved in areas where enlargement of perivascular spaces was mild or absent. Because symptoms were consistent with the distribution of the enlarged perivascular spaces and hypoperfusion in the brain, cognitive impairment due to enlarged perivascular spaces was diagnosed. Clinicians should note enlarged perivascular spaces as a potential cause of neurological deficits including cognitive impairment.

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“…The clinical significance of the current study is two-fold. First, EPVS rating, specifically in the basal ganglia, has been shown to correlate strongly with other measures of CSVD, cognitive impairment at 1 year after ischemic stroke, and stroke risk factors in hemorrhagic stroke cohorts 5 , 6 . Additionally, previous studies have found that EPVS rating scores in the basal ganglia are commonly not normally distributed and have found that a meaningful categorization for logistic regression to be 10 punctate EPVS, where < 10 is considered none-to-mild and ≥ 10 is considered moderate-to-severe 7 .…”

Section: Introductionmentioning

confidence: 98%

Automated grading of enlarged perivascular spaces in clinical imaging data of an acute stroke cohort using an interpretable, 3D deep learning framework

Williamson

Khandwala

Wang³

et al. 2022

Sci Rep

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Enlarged perivascular spaces (EPVS), specifically in stroke patients, has been shown to strongly correlate with other measures of small vessel disease and cognitive impairment at 1 year follow-up. Typical grading of EPVS is often challenging and time consuming and is usually based on a subjective visual rating scale. The purpose of the current study was to develop an interpretable, 3D neural network for grading enlarged perivascular spaces (EPVS) severity at the level of the basal ganglia using clinical-grade imaging in a heterogenous acute stroke cohort, in the context of total cerebral small vessel disease (CSVD) burden. T2-weighted images from a retrospective cohort of 262 acute stroke patients, collected in 2015 from 5 regional medical centers, were used for analyses. Patients were given a label of 0 for none-to-mild EPVS (< 10) and 1 for moderate-to-severe EPVS (≥ 10). A three-dimensional residual network of 152 layers (3D-ResNet-152) was created to predict EPVS severity and 3D gradient class activation mapping (3DGradCAM) was used for visual interpretation of results. Our model achieved an accuracy 0.897 and area-under-the-curve of 0.879 on a hold-out test set of 15% of the total cohort (n = 39). 3DGradCAM showed areas of focus that were in physiologically valid locations, including other prevalent areas for EPVS. These maps also suggested that distribution of class activation values is indicative of the confidence in the model’s decision. Potential clinical implications of our results include: (1) support for feasibility of automated of EPVS scoring using clinical-grade neuroimaging data, potentially alleviating rater subjectivity and improving confidence of visual rating scales, and (2) demonstration that explainable models are critical for clinical translation.

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Enlarged Perivascular Spaces and Cerebral Small Vessel Disease in Spontaneous Intracerebral Hemorrhage Patients

Cited by 15 publications

References 52 publications

Enlarged perivascular spaces and hemorrhagic transformation after acute ischemic stroke

Enlarged perivascular spaces and hemorrhagic transformation after acute ischemic stroke

Cognitive impairment due to widespread enlarged perivascular spaces

Automated grading of enlarged perivascular spaces in clinical imaging data of an acute stroke cohort using an interpretable, 3D deep learning framework

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