03 Jan 20. Featured Paper

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

Authors

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

Abstract

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.

Keywords

• Cerebral blood flow
• Cerebral small vessel disease
• Cerebrovascular pulsatility
• Magnetic resonance imaging
• Perivascular spaces
• Stroke
• White matter hyperintensities