White matter lesions in watershed territories studied with MRI and parenchymography: a comparative study

Abstract

Brain aging affects an increasing segment of the population and the role of chronic cerebrovascular disease is considered to be one of the main parameters involved. For this purpose we compared retrospectively MRI data with digitized subtraction angiography (DSA) data in a group of 50 patients focusing onto the watershed area of the carotid artery vascular territories. In order to evaluate the presence of white matter lesions (WML) in the hemispheric watershed areas, coronal fluid-attenuated inversion-recovery or axial T2 weighted MRI images of patients with symptomatic cerebrovascular insufficiency areas were compared with the capillary phase of DSA studies in anterior-posterior projection. Presence of cerebrovascular occlusive disease was evaluated on DSA using North American symptomatic carotid endarterectomy trial criteria and including evaluation of collateral vascular supply. Pathological MRI findings in the region of the watershed territories correlated overall in 66% of cases with a defect or delayed filling on DSA. In the case of asymmetrical MRI findings, there was a pathological finding of the capillary phase in the watershed area in 92% of DSA studies. Hypoperfusion in the capillary phase of the watershed area as seen on DSA correlated with the stenosis degree of the concerned carotid artery. Our findings suggest that asymmetrical findings of WML in the watershed areas as seen on MRI are caused by hemodynamic effect and a differentiation between small vessel disease and a consequence of distant stenosis may be possible under such conditions.

White Matter Injury Due to Experimental Chronic Cerebral Hypoperfusion Is Associated with C5 Deposition

“…Broad C5 upregulation might suggest a lower susceptibility threshold for white matter, rather than an anatomically specific regional pathology. This is consistent with the characteristic pattern of cerebral hypoperfusion secondary to carotid artery stenosis, which typically causes ischemic changes in watershed vascular territories[38]. Astrocyte and microglial activation within the corpus callosum suggests an inflammatory process.…”

Brain white matter changes in CPAP‐treated obstructive sleep apnea patients with residual sleepiness

“…The reasons underlying the asymmetry are unclear, but are likely related to the relative perfusion difference between the left and right hemispheres. Asymmetrical injury to WM in the watershed areas shows a very high correlation with cerebrovascular insufficiency . In addition, it has been suggested that the left hemisphere may be more vulnerable than the right to detrimental influences, including hypoxia .…”

“…Asymmetrical injury to WM in the watershed areas shows a very high correlation with cerebrovascular insufficiency. 33 In addition, it has been suggested that the left hemisphere may be more vulnerable than the right to detrimental influences, including hypoxia. 34 In our study sample, all of the 29 participants were right-handed, which may also be a contributing factor to the observed asymmetry.…”

Blood Pressure and Cerebral White Matter Share Common Genetic Factors in Mexican Americans

“…The biological pathway of the indirect mechanisms remains unclear. Stenosis of small cerebral vessels, especially in the watershed areas29 and high metabolic demands of oligodendrocytes of associative WM contribute to a high vulnerability of the frontal WM to the indirect PWE mechanism30. Oligodendrocytes of the associative frontal WM are among the most metabolically active cells in the adult CNS and therefore, are highly susceptible to damages from hypoxia30.…”