Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar 21;88(12):1157-1164.
doi: 10.1212/WNL.0000000000003746. Epub 2017 Feb 22.

MRI-visible perivascular spaces in cerebral amyloid angiopathy and hypertensive arteriopathy

Andreas Charidimou  1 , Gregoire Boulouis  2 , Marco Pasi  2 , Eitan Auriel  2 , Ellis S van Etten  2 , Kellen Haley  2 , Alison Ayres  2 , Kristin M Schwab  2 , Sergi Martinez-Ramirez  2 , Joshua N Goldstein  2 , Jonathan Rosand  2 , Anand Viswanathan  2 , Steven M Greenberg  2 , M Edip Gurol  2
Affiliations

MRI-visible perivascular spaces in cerebral amyloid angiopathy and hypertensive arteriopathy

Andreas Charidimou et al. Neurology. .

Abstract

Objective: To assess MRI-visible enlarged perivascular spaces (EPVS) burden and different topographical patterns (in the centrum semiovale [CSO] and basal ganglia [BG]) in 2 common microangiopathies: cerebral amyloid angiopathy (CAA) and hypertensive arteriopathy (HA).

Methods: Consecutive patients with spontaneous intracerebral hemorrhage (ICH) from a prospective MRI cohort were included. Small vessel disease MRI markers, including cerebral microbleeds (CMBs), cortical superficial siderosis (cSS), and white matter hyperintensities (WMH), were rated. CSO-EPVS/BG-EPVS were assessed on a validated 4-point visual rating scale (0 = no EPVS, 1 = <10, 2 = 11-20, 3 = 21-40, and 4 = >40 EPVS). We tested associations of predefined high-degree (score >2) CSO-EPVS and BG-EPVS with other MRI markers in multivariable logistic regression. We subsequently evaluated associations with CSO-EPVS predominance (i.e., CSO-EPVS > BG-EPVS) and BG-EPVS predominance pattern (i.e., BG-EPVS > CSO-EPVS) in adjusted multinomial logistic regression (reference group, BG-EPVS = CSO-EPVS).

Results: We included 315 patients with CAA-ICH and 137 with HA-ICH. High-degree CSO-EPVS prevalence was greater in CAA-related ICH vs HA-related ICH (43.8% vs 17.5%, p < 0.001). In multivariable logistic regression, high-degree CSO-EPVS was associated with lobar CMB (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.10-1.61, p = 0.003) and cSS (OR 2.08, 95% CI 1.30-3.32, p = 0.002). Deep CMBs (OR 2.85, 95% CI 1.75-4.64, p < 0.0001) and higher WMH volume (OR 1.02, 95% CI 1.01-1.04, p = 0.010) were predictors of high-degree BG-EPVS. A CSO-EPVS-predominant pattern was more common in CAA-ICH than in HA-ICH (75.9% vs 39.4%, respectively, p < 0.0001). CSO-PVS predominance was associated with lobar CMB burden and cSS, while BG-EPVS predominance was associated with HA-ICH and WMH volumes.

Conclusions: Different patterns of MRI-visible EPVS provide insights into the dominant underlying microangiopathy type in patients with spontaneous ICH.

PubMed Disclaimer

Figures

Figure
Figure. Different enlarged perivascular spaces (EPVS) burden in the centrum semiovale (CSO) and basal ganglia (BG)
(A.a and B.a) Representative examples of high degree of CSO-EPVS in patients with cerebral amyloid angiopathy–intracerebral hemorrhage (CAA-ICH). Arrowheads point to individual EPVS. (A.b and B.b) Examples of mild BG-EPVS (A.b) and high-degree BG-EPVS in 2 patients with deep hypertensive arteriopathy (HA)–ICH. (C) Box plot of the distribution of the 3 EPVS predominance patterns in patients with CAA-ICH vs HA-ICH.
See this image and copyright information in PMC

References

    1. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010;9:689–701. - PubMed
    1. Charidimou A, Pantoni L, Love S. The concept of sporadic cerebral small vessel disease: a road map on key definitions and current concepts. Int J Stroke 2016;11:6–18. - PubMed
    1. Charidimou A, Gang Q, Werring DJ. Sporadic cerebral amyloid angiopathy revisited: recent insights into pathophysiology and clinical spectrum. J Neurol Neurosurg Psychiatry 2012;83:124–137. - PubMed
    1. Viswanathan A, Greenberg SM. Cerebral amyloid angiopathy in the elderly. Ann Neurol 2011;70:871–880. - PMC - PubMed
    1. Fisher CM. Pathological observations in hypertensive cerebral hemorrhage. J Neuropathol Exp Neurol 1971;30:536–550. - PubMed