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. 2015 Oct;35(10):1610-5.
doi: 10.1038/jcbfm.2015.92. Epub 2015 May 13.

Reduced blood flow in normal white matter predicts development of leukoaraiosis

Manya Bernbaum  1   2   3 , Bijoy K Menon  1   2   3   4   5   6 , Gordon Fick  6 , Eric E Smith  1   2   3   4   5   6 , Mayank Goyal  2   3   4   5 , Richard Frayne  1   2   3   4   5 , Shelagh B Coutts  1   2   3   4   5
Affiliations

Reduced blood flow in normal white matter predicts development of leukoaraiosis

Manya Bernbaum et al. J Cereb Blood Flow Metab. 2015 Oct.

Abstract

The purpose of this study was to investigate whether low cerebral blood flow (CBF) is associated with subsequent development of white matter hyperintensities (WMH). Patients were included from a longitudinal magnetic resonance (MR) imaging study of minor stroke/transient ischemic attack patients. Images were co-registered and new WMH at 18 months were identified by comparing follow-up imaging with baseline fluid-attenuated inversion recovery (FLAIR). Regions-of-interest (ROIs) were placed on FLAIR images in one of three categories: (1) WMH seen at both baseline and follow-up imaging, (2) new WMH seen only on follow-up imaging, and (3) regions of normal-appearing white matter at both time points. Registered CBF maps at baseline were used to measure CBF in the ROIs. A multivariable model was developed using mixed-effects logistic regression to determine the effect of baseline CBF on the development on new WMH. Forty patients were included. Mean age was 61±11 years, 30% were female. Low baseline CBF, female sex, and presence of diabetes were independently associated with the presence of new WMH on follow-up imaging. The odds of having new WMH on follow-up imaging reduces by 0.61 (95% confidence interval=0.57 to 0.65) for each 1 mL/100 g per minute increase in baseline CBF. We conclude that regions of white matter with low CBF develop new WMH on follow-up imaging.

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Conflict of interest statement

The CATCH study was funded by grants from Canadian Institute of Health Research (CIHR), Alberta-Innovates Health Solutions (AI-HS), and a Pfizer Cardiovascular research award program. BKM holds a Heart and Stroke Foundation of Canada Professorship in Stroke Imaging and has received grant funding from the CIHR, AI-HS/Pfizer, and the Faculty of Medicine, University of Calgary. MG has received honoraria from Penumbra and Covidien. RF is the Hopewell Professor of Brain Imaging. SBC receives salary support from the AI-HS and the Heart and Stroke Foundation of Canada's Distinguished Clinician Scientist award, supported in partnership with the CIHR Institute of Circulatory and Respiratory Health and AstraZeneca Canada. EES receives salary support from CIHR and AI-HS, holds the Kathy Taylor Chair in Vascular Dementia, and has received grant funding from CIHR, National Institute of Neurological Disorders, Heart and Stroke Foundation of Alberta, and the Alzheimer Society of Canada.

Figures

Figure 1
Figure 1
Template used to place regions of interest in normal-appearing white matter at both time points. Slices used were (from left to right): first slice superior to the ventricles, slice with the widest ventricles, and two slices inferior to the slice with the widest ventricles. In blue are regions in the centrum semiovale and in yellow are regions in the periventricular region. These indicated regions served as the template for CBF measurements in normal-appearing white matter (see text). CBF, cerebral blood flow.
Figure 2
Figure 2
Co-registered baseline (left) and follow-up (right) FLAIR images. The anterior ROI is in NAWM at baseline that becomes WMH at follow-up. Posterior ROI is in a WMH at both time points. FLAIR, fluid-attenuated inversion recovery; NAWM, normal-appearing white matter; ROI, region of interest; WMH, white matter hyperintensity.
Figure 3
Figure 3
Baseline FLAIR (upper left), follow-up FLAIR (upper right), DSC PWI (bottom left) and CBF (bottom right) showing ROI (blue circle in FLAIR and yellow circle on CBF map; expanded for clarity) placed in NAWM at baseline that becomes WMH at follow-up. CBF at baseline in ROI (yellow circle) was 12 mL/100 gm per minute. CBF, cerebral blood flow; DSC, dynamic susceptibility contrast; FLAIR, fluid-attenuated inversion recovery; NAWM, normal-appearing white matter; PWI, perfusion-weighted imaging; ROI, region of interest; WMH, white matter hyperintensity.
Figure 4
Figure 4
CBF distribution in ROIs with new WMH on follow-up versus those with old WMH (i.e., at both baseline and follow-up imaging) and those with NAWM on follow-up imaging. All regions with a baseline cerebral blood flow (CBF) <10 mL/100 g per minute had WMH on follow-up imaging. CBF, cerebral blood flow; NAWM, normal-appearing white matter; ROI, region of interest; WMH, white matter hyperintensity.
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References

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