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Meta-Analysis
. 2010 Jul 26:341:c3666.
doi: 10.1136/bmj.c3666.

The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis

Stéphanie Debette  1 , H S Markus
Affiliations
Meta-Analysis

The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis

Stéphanie Debette et al. BMJ. .

Abstract

Objectives: To review the evidence for an association of white matter hyperintensities with risk of stroke, cognitive decline, dementia, and death.

Design: Systematic review and meta-analysis.

Data sources: PubMed from 1966 to 23 November 2009.

Study selection: Prospective longitudinal studies that used magnetic resonance imaging and assessed the impact of white matter hyperintensities on risk of incident stroke, cognitive decline, dementia, and death, and, for the meta-analysis, studies that provided risk estimates for a categorical measure of white matter hyperintensities, assessing the impact of these lesions on risk of stroke, dementia, and death.

Data extraction: Population studied, duration of follow-up, method used to measure white matter hyperintensities, definition of the outcome, and measure of the association of white matter hyperintensities with the outcome.

Data synthesis: 46 longitudinal studies evaluated the association of white matter hyperintensities with risk of stroke (n=12), cognitive decline (n=19), dementia (n=17), and death (n=10). 22 studies could be included in a meta-analysis (nine of stroke, nine of dementia, eight of death). White matter hyperintensities were associated with an increased risk of stroke (hazard ratio 3.3, 95% confidence interval 2.6 to 4.4), dementia (1.9, 1.3 to 2.8), and death (2.0, 1.6 to 2.7). An association of white matter hyperintensities with a faster decline in global cognitive performance, executive function, and processing speed was also suggested.

Conclusion: White matter hyperintensities predict an increased risk of stroke, dementia, and death. Therefore white matter hyperintensities indicate an increased risk of cerebrovascular events when identified as part of diagnostic investigations, and support their use as an intermediate marker in a research setting. Their discovery should prompt detailed screening for risk factors of stroke and dementia.

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Conflict of interest statement

Competing interests: All authors have completed the unified competing interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that: (1) SD was supported by a grant from the European Neurological Society, a Fulbright grant, and an award from the Bettencourt-Schueller and the Lilly foundations; (2) SD and HSM have no relationship with companies that might have an interest in the submitted work in the previous 3 years; (3) that their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) that they have no non-financial interests that may be relevant to the submitted work.

Figures

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Fig 1 White matter hyperintensities on magnetic resonance imaging (axial fluid attenuated inversion recovery sequence) in two 80 year old patients: (left) minor white matter hyperintensities; (right) extensive white matter hyperintensities predominating in periventricular region. White matter lesions are considered present if hyperintense on T2 weighted, fluid attenuated inversion recovery, and proton density images, without prominent hypointensity on T1 weighted images
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Fig 2 Inverse variance meta-analysis of studies testing association of white matter hyperintensities with incident stroke
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Fig 3 Inverse variance meta-analysis of studies testing association of white matter hyperintensities with incident dementia
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Fig 4 Inverse variance meta-analysis of studies testing association of white matter hyperintensities with mortality
See this image and copyright information in PMC

Comment in

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