01 Jun 21. Featured Paper

Correlations in post-mortem imaging-histopathology studies of sporadic human cerebral small vessel disease: a systematic review

Link to paper on Neuropathology & Applied Neurobiology

Authors

Catherine A Humphreys, Colin Smith, Joanna M Wardlaw

Abstract

Aims: Sporadic human cerebral small vessel disease (SVD) commonly causes stroke & dementia but its pathogenesis is poorly understood.

There are recognised neuroimaging & histopathological features.

However, relatively few studies have examined the relationship between the radiological & pathological correlates of SVD; better correlation would promote greater insight into the underlying biological changes.

Methods: We performed a systematic review to collate & appraise the information derived from studies that correlated histological with neuroimaging-defined SVD lesions.

We searched for studies describing post-mortem imaging & histological tissue examination in adults, extracted data from published studies, categorised the information & compiled this narrative.

Results: We identified 38 relevant studies, including at least 1146 subjects, 342 of these with SVD: 29 studies focussed on neuroradiological white matter lesions (WML), six on microinfarcts & three on dilated perivascular spaces (PVS) & lacunes.

The histopathology terminology was diverse with few robust definitions.

Reporting & methodology varied widely between studies, precluding formal meta-analysis.

PVS & ‘oedema’ were frequent findings in WML, being described in at least 94 & 18 radiological WML respectively, in addition to myelin pallor.

Histopathological changes extended beyond the radiological lesion margins in at least 33 radiological WML.

At least 43 radiological lesions not seen pathologically & at least 178 histological lesions were not identified on imaging.

Conclusions: Histopathological assessment of human SVD is hindered by inconsistent methodological approaches & unstandardised definitions.

The data from this systematic review will help to develop standardised definitions to promote consistency in human SVD research.

Keywords

• Cerebral small vessel disease
• Neuroimaging
• Neuropathology
• Radiology
• Systematic review
• Vascular dementia