Edinburgh Imaging

03 Jan 20. Featured Paper

Small vessel disease is associated with altered cerebrovascular pulsatility but not resting cerebral blood flow.

Link to paper on Journal of Cerebral Blood Flow & Metabolism.



Yulu Shi, Michael J Thrippleton, Gordon W Blair, David A Dickie, Ian Marshall, Iona Hamilton, Fergus N Doubal, Francesca Chappell, Joanna M Wardlaw



Cerebral small vessel disease (SVD) contributes to 25% of ischemic strokes & 45% of dementias.

We aimed to investigate the role of cerebral blood flow (CBF) & intracranial pulsatility in SVD.

We scanned 60 patients with minor ischemic stroke, representing a range of white matter hyperintensities (WMH).

We rated WMH & perivascular spaces (PVS) using semi-quantitative scales & measured WMH volume.

We measured flow & pulsatility in the main cerebral vessels & cerebrospinal fluid (CSF) using phase-contrast MRI.

We investigated the association between flow, pulsatility & SVD features.

In 56/60 patients (40 male, 67.8±8.3 years) with complete data, median WMH volume was 10.7 mL (range 1.4–75.0 mL), representing median 0.77% (0.11–5.17%) of intracranial volume.

Greater pulsatility index (PI) in venous sinuses was associated with larger WMH volume (e.g. superior sagittal sinus, β = 1.29, ;P < 0.01) & more basal ganglia PVS (e.g. odds ratio = 1.38, 95% confidence interval 1.06, 1.79, per 0.1 increase in superior sagittal sinus PI) independently of age, sex & blood pressure.

CSF pulsatility & CBF were not associated with SVD features.

Our results support a close association of SVD features with increased intracranial pulsatility rather than with low global CBF, & provide potential targets for mechanistic research, treatment & prevention of SVD.