Multimodal MRI in Cerebral Small Vessel Disease

Abstract

Background and Purpose-Cerebral small vessel disease is the most common cause of vascular dementia. Interest in using MRI parameters as surrogate markers of disease to assess therapies is increasing. In patients with symptomatic sporadic small vessel disease, we determined which MRI parameters best correlated with cognitive function on cross-sectional analysis and which changed over a period of 1 year. Methods-Thirty-five patients with lacunar stroke and leukoaraiosis were recruited. They underwent multimodal MRI (brain volume, fluid-attenuated inversion recovery lesion load, lacunar infarct number, fractional anisotropy, and mean diffusivity from diffusion tensor imaging) and neuropsychological testing. Twenty-seven agreed to reattend for repeat MRI and neuropsychology at 1 year. Results-An executive function score correlated most strongly with diffusion tensor imaging (fractional anisotropy histogram, rϭϪ0.640, Pϭ0.004) and brain volume (rϭ0.501, Pϭ0.034). Associations with diffusion tensor imaging were stronger than with all other MRI parameters. On multiple regression of all imaging parameters, a model that contained brain volume and fractional anisotropy, together with age, gender, and premorbid IQ, explained 74% of the variance of the executive function score (Pϭ0.0001). Changes in mean diffusivity and fractional anisotropy were detectable over the 1-year follow-up; in contrast, no change in other MRI parameters was detectable over this time period. Conclusion-A multimodal MRI model explains a large proportion of the variation in executive function in cerebral small vessel disease. In particular, diffusion tensor imaging correlates best with executive function and is the most sensitive to change. This supports the use of MRI, in particular diffusion tensor imaging, as a surrogate marker in treatment trials.

Cooling dialysate during in-center hemodialysis: Beneficial and deleterious effects

“…A form of magnetic resonance imaging (MRI) called diffusion tensor imaging (DTI) was used to evaluate the structural integrity of the brain white matter at baseline and after 12 mo of thrice-weekly dialysis. DTI was chosen as an imaging modality as it has previously been used to detect clinically significant changes in cerebral small vessel disease [29] . Additionally, MAP extrema points were measured over the course of 12 mo.…”

Longitudinal change of small-vessel disease-related brain abnormalities

“…78 Diffusion tensor imaging changes correlate more closely to cognitive functioning than the volume of visible small-vessel disease-related changes such as WMLs. So far, only few longitudinal studies on the relationship between increase of microstructural damage and cognitive decline are available.…”

Multimodal MRI of Cerebral Small Vessel Disease

“…A number of imaging studies using quantitative brain volumetry demonstrated atrophy in both focal and diffuse cerebrovascular diseases [124][125][126][127] . Brain atrophy correlated strongly with the clinical status and cognitive scores, and proved to be a sensitive marker of disease progression in cSVD 104,128,129 . It is now widely accepted that purely subcortical cSVD can lead to cortical volume loss 129,130 .…”

“…Accordingly, MD histogram parameters have been reported to correlate more with clinical scores than WMH visual rating scales and volumetric data in cSVD both cross sectionally and longitudinally. Furthermore they were more sensitive than clinical scales in detecting change over time [101][102][103][104][105][106] . There are data indicating that the much simpler, quicker and widely available (DWI) derived ADC can be used similarly to DTI derived MD to quantify brain damage due to cSVD (findings of Gunda et al to be published) (Figure 3 and 4).…”