05 May 20. Featured Paper
Intracranial hemodynamic relationships in patients with cerebral small vessel disease.
Objective: To investigate cerebrovascular reactivity (CVR), blood flow, vascular & CSF pulsatility, & their independent relationship with cerebral small vessel disease (SVD) features in patients with minor ischemic stroke & MRI evidence of SVD.
Methods: We recruited patients with minor ischemic stroke & assessed CVR using blood oxygen level–dependent MRI during a hypercapnic challenge, cerebral blood flow (CBF), vascular & CSF pulsatility using phase-contrast MRI, & structural magnetic resonance brain imaging to quantify white matter hyperintensities (WMHs) & perivascular spaces (PVSs).
We used multiple regression to identify parameters associated with SVD features, controlling for patient characteristics.
Results: Fifty-three of 60 patients completed the study with a full data set (age 68.0% ± 8.8 years, 74% male, 75% hypertensive).
After controlling for age, sex, & systolic blood pressure, lower white matter CVR was associated with higher WMH volume (−0.01%/mm Hg per log10 increase in WMH volume, p = 0.02), basal ganglia PVS (−0.01%/mm Hg per point increase in the PVS score, p = 0.02), & higher venous pulsatility (superior sagittal sinus −0.03%/mm Hg, p = 0.02, per unit increase in the pulsatility index) but not with CBF (p = 0.58).
Conclusions: Lower CVR, higher venous pulsatility, & lower foramen magnum CSF stroke volume indicate that dynamic vascular dysfunctions underpin PVS dysfunction & WMH development.
- Cerebrovascular reactivity (CVR)
- Magnetic resonance (MR)
- Perivascular spaces (PVSs)
- Small vessel disease (SVD)
- White matter hyperintensities (WMHs)