Enlarged Perivascular Spaces on MRI Are a Feature of Cerebral Small Vessel Disease

Doubal, Fergus; MacLullich, Alasdair M.J.; Ferguson, Karen; Dennis, Martin; Wardlaw, Joanna M.

doi:10.1161/strokeaha.109.564914

Cited by 711 publications

(738 citation statements)

References 25 publications

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“…A higher global PVS score was correlated with a greater burden of WMH in lobar regions and the basal ganglia, which supports the view that PVS, along with WMH, are markers for cerebral small-vessel disease. 9,19,33 More interesting, we found a correlation between the PVS score in the basal ganglia and WMH load not only in the same region but also in lobar areas, while we did not find any correlation between the lobar PVS score and WMH load either in the lobar areas or in the basal ganglia. This is in line with the view that PVS, especially in the basal ganglia, are caused mainly by hypertensive arteriopathy, like WMH, while lobar PVS are mainly due to cerebral amyloid angiopathy or amyloid accumulation in the brain with normal aging.…”

Section: Discussioncontrasting

confidence: 55%

“…When we started studying PVS, there were several scales for visual assessment available, even though few scales have been used in Ͼ1 study, probably because most of these scales had great benefits, but also drawbacks. Most of the previous scales were only concerned with the PVS number and used a fixed diameter of 2 24 or 3 mm 19 to separate PVS from lacunes, even though PVS can sometimes grow very large. 25 For instance, one scale measured the mean diameters of all PVS in 1 axial section at the level of the cella media of the lateral ventricles, which means that the scale mainly evaluated the frontal and parietal white matter.…”

Section: Discussionmentioning

confidence: 99%

“…This drawback was overcome in a later study. 19 The scale by Patankar et al 7 rated the number of PVS in 4 different regions, which makes this scale very appealing; thus, it has been used by other groups. 26,27 However, this scale has a great disadvantage in a complicated grading, where each region has a different grading scale with 2 different schemes for the basal ganglia.…”

Section: Discussionmentioning

confidence: 99%

“…6,13 In the past decade, studying PVS as an imaging marker for cerebral small-vessel disease represents one of the research frontiers in brain aging. 8 Some studies have reported that PVS are correlated with the load of both white matter hyperintensities (WMH) and periventricular hyperintensities (PVH) independent of age and vascular risk factors, 19 suggesting that PVS may be an imaging marker for cerebral small-vessel disease. However, it has been unclear whether PVS in various anatomic regions are differentially associated with global and regional WMH because PVS in different regions may have different origins and etiopathologies.…”

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confidence: 99%

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Perivascular Spaces in Old Age: Assessment, Distribution, and Correlation with White Matter Hyperintensities

Laveskog

Wang²,

Bronge

et al. 2017

AJNR Am J Neuroradiol

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Perivascular Spaces in Old Age: Assessment, Distribution, and Correlation with White Matter Hyperintensities

Laveskog

Wang²,

Bronge

et al. 2017

AJNR Am J Neuroradiol

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“…3,4 On T1WI, the VRSs appear as hypointensities, 4,5 and their pathologic dilation has been reported in vascular, neuroinflammatory, metabolic, and genetic diseases and in traumatic brain injury. [5][6][7][8][9] Several mechanisms may underlie the neuropathologic enlargement of VRS, including increased permeability of the arterial wall, brain atrophy and tissue fibrosis, perivascular demyelination, and obstruction of lymphatic drainage pathways and/or CSF circulation. 3,10 VRSs have been identified as a biomarker indicative of microvascular disease and are strongly related to systemic vascular disease; a possible association of VRS with vascular risk factors has been proposed.…”

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confidence: 98%

Assessment of the Virchow-Robin Spaces in Alzheimer Disease, Mild Cognitive Impairment, and Normal Aging, Using High-Field MR Imaging

Chen

Song²,

Zhang³

2011

AJNR Am J Neuroradiol

106

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BACKGROUND AND PURPOSE:VRSs are the perivascular spaces surrounding the deep perforating arteries in the brain. Although VRS variations with age and disease pathologies have been reported previously, the radiologic characteristics of the VRS in relation to AD are poorly understood. This study investigated the prevalence, spatial distribution, and severity of the VRS in AD, MCI, and older adults who were CN. It also investigated the relationship of the VRS to white matter changes.

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Assessment of Risk Factors and Clinical Importance of Enlarged Perivascular Spaces by Whole-Brain Investigation in the Multi-Ethnic Study of Atherosclerosis

et al. 2023

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ImportanceEnlarged perivascular spaces (ePVSs) have been associated with cerebral small-vessel disease (cSVD). Although their etiology may differ based on brain location, study of ePVSs has been limited to specific brain regions; therefore, their risk factors and significance remain uncertain.ObjectiveToperform a whole-brain investigation of ePVSs in a large community-based cohort.Design, Setting, and ParticipantsThis cross-sectional study analyzed data from the Atrial Fibrillation substudy of the population-based Multi-Ethnic Study of Atherosclerosis. Demographic, vascular risk, and cardiovascular disease data were collected from September 2016 to May 2018. Brain magnetic resonance imaging was performed from March 2018 to July 2019. The reported analysis was conducted between August and October 2022. A total of 1026 participants with available brain magnetic resonance imaging data and complete information on demographic characteristics and vascular risk factors were included.Main Outcomes and MeasuresEnlarged perivascular spaces were quantified using a fully automated deep learning algorithm. Quantified ePVS volumes were grouped into 6 anatomic locations: basal ganglia, thalamus, brainstem, frontoparietal, insular, and temporal regions, and were normalized for the respective regional volumes. The association of normalized regional ePVS volumes with demographic characteristics, vascular risk factors, neuroimaging indices, and prevalent cardiovascular disease was explored using generalized linear models.ResultsIn the 1026 participants, mean (SD) age was 72 (8) years; 541 (53%) of the participants were women. Basal ganglia ePVS volume was positively associated with age (β = 3.59 × 10−3; 95% CI, 2.80 × 10−3 to 4.39 × 10−3), systolic blood pressure (β = 8.35 × 10−4; 95% CI, 5.19 × 10−4 to 1.15 × 10−3), use of antihypertensives (β = 3.29 × 10−2; 95% CI, 1.92 × 10−2 to 4.67 × 10−2), and negatively associated with Black race (β = −3.34 × 10−2; 95% CI, −5.08 × 10−2 to −1.59 × 10−2). Thalamic ePVS volume was positively associated with age (β = 5.57 × 10−4; 95% CI, 2.19 × 10−4 to 8.95 × 10−4) and use of antihypertensives (β = 1.19 × 10−2; 95% CI, 6.02 × 10−3 to 1.77 × 10−2). Insular region ePVS volume was positively associated with age (β = 1.18 × 10−3; 95% CI, 7.98 × 10−4 to 1.55 × 10−3). Brainstem ePVS volume was smaller in Black than in White participants (β = −5.34 × 10−3; 95% CI, −8.26 × 10−3 to −2.41 × 10−3). Frontoparietal ePVS volume was positively associated with systolic blood pressure (β = 1.14 × 10−4; 95% CI, 3.38 × 10−5 to 1.95 × 10−4) and negatively associated with age (β = −3.38 × 10−4; 95% CI, −5.40 × 10−4 to −1.36 × 10−4). Temporal region ePVS volume was negatively associated with age (β = −1.61 × 10−2; 95% CI, −2.14 × 10−2 to −1.09 × 10−2), as well as Chinese American (β = −2.35 × 10−1; 95% CI, −3.83 × 10−1 to −8.74 × 10−2) and Hispanic ethnicities (β = −1.73 × 10−1; 95% CI, −2.96 × 10−1 to −4.99 × 10−2).Conclusions and RelevanceIn this cross-sectional study of ePVSs in the whole brain, increased ePVS burden in the basal ganglia and thalamus was a surrogate marker for underlying cSVD, highlighting the clinical importance of ePVSs in these locations.

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Enlarged Perivascular Spaces on MRI Are a Feature of Cerebral Small Vessel Disease

Cited by 711 publications

References 25 publications

Perivascular Spaces in Old Age: Assessment, Distribution, and Correlation with White Matter Hyperintensities

Perivascular Spaces in Old Age: Assessment, Distribution, and Correlation with White Matter Hyperintensities

Assessment of the Virchow-Robin Spaces in Alzheimer Disease, Mild Cognitive Impairment, and Normal Aging, Using High-Field MR Imaging

Assessment of Risk Factors and Clinical Importance of Enlarged Perivascular Spaces by Whole-Brain Investigation in the Multi-Ethnic Study of Atherosclerosis

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