Lenticulostriate Arterial Lumina Are Normal in Cerebral Autosomal-Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy

Abstract

Background and Purpose-Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary small vessel disease. Although postmortem studies have demonstrated mural thickening in leptomeningeal arteries and lenticulostriate perforating arteries, it is unclear whether this also leads to luminal narrowing. High-field MRI scanners enable in vivo imaging of the lumen of the lenticulostriate arteries. The aim of this study is to examine the luminal diameters of lenticulostriate arteries in living patients with CADASIL and to investigate whether luminal narrowing is correlated with the number of lacunar infarcts in the basal ganglia. Methods-Twenty-two NOTCH3 mutation carriers and 11 healthy control subjects were examined using high-resolution 3-dimensional time-of-flight MR angiography imaging on a 7-T MRI scanner. Scans were analyzed for the presence of focal stenotic segments. The total number, length, and total cross-sectional area of lenticulostriate arteries were measured and compared between mutation carriers and control subjects. These measurements were correlated with age, disease duration, and number of lacunar infarcts in the basal ganglia. Results-No stenotic segments were observed. No differences between mutation carriers and control subjects were found in total number of end branches (mutation carriers: mean, 14.6; control subjects: mean, 12.8), length of the lenticulostriate system, or total cross-sectional area of lenticulostriate artery lumina. Measurements of lenticulostriate artery lumina were not associated with lacunar infarct load in the basal ganglia area or with basal ganglia hyperintensities. Conclusions-Three-dimensional time-of-flight MR angiographic on 7 T showed no differences in luminal diameters of lenticulostriate arteries between patients with CADASIL and control subjects. (Stroke. 2010;41:2812-2816.)

Measurements of lenticulostriate arteries using 7T MRI: new imaging markers for subcortical vascular dementia

“…A recent study examining hypertensive patients also showed them to have fewer stems and branches of LSAs than in NC [4]. In contrast, one 7 T MRI study found no difference between patients with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and NC in the measurements of LSAs [19]. This discrepancy may be explained by differences in analysis methods (a three-dimensional model in our study versus a two-dimensional model in the previous study) and subject populations (patients with sporadic SVaD in our sample versus patients with a genetic form of small vessel disease in the previous study).…”

Seven-Tesla Time-of-Flight Angiography Using a 16-Channel Parallel Transmit System With Power-Constrained 3-dimensional Spoke Radiofrequency Pulse Design

“…The benefits of using ultra-high magnetic field (UHF) MR scanners for time of flight (TOF) angiography have been shown in studies performed at 7T by several groups 1-8 . These benefits relate with higher spatial resolution, better vessel-to-background contrast as well as increased small vessel conspicuity and are mostly the result of longer T 1 relaxation time 9 and of higher SNR 10 inherently observed as the magnetic field increases.…”

High-Field Imaging of Neurodegenerative Diseases

“…In addition the increase in SNR can be traded for a very high spatial resolution. In a recent study this was confirmed by visualization of significant lengths of the lenticulostriate arteries (22) in patients with CADASIL and control subjects. Figure 1 shows an example of a coronal maximum intensity projection of the lenticulostriate arteries in a healthy control subject and in a patient with CADASIL.…”

“…No significant differences were found between patients and controls in any of the measures. In addition no association was found between the luminal diameters and lacunar infarct load in the basal ganglia and basal ganglia hypointensities on separately acquired T 2 -, T 2 * - or T 1 -weighted scans (22). These results suggest that basal ganglia damage in CADASIL is likely not caused by vascular mechanisms.…”