P2-261: A Threshold of White Matter Hyperintensities Volume Ratio Doubling the Risk of Cognitive Decline in Patients with Stroke or Transient Ischemic Attack

Introduction: Cerebral Small Vessel Disease (CSVD) is a major cause of acute ischemic stroke (AIS), intracerebral hemorrhage and cognitive impairment. Methods to quantify the disease burden have been largely limited to white matter hyperintensities (WMH) as the disease surrogate and focused mainly on MRI sequences acquired for research purposes. We develop here novel methods to quantify WMH and enlarged perivascular spaces (EPVs) based on clinically acquired MRI sequences in patients with transient ischemic attack (TIA) or AIS. Methods: Subjects presenting with TIA or AIS and had brain MRI within 24 hour of hospital admission were selected for this study. Preprocessing pipeline was developed locally that included bias correction, image rescaling, rigid body registration to the Montreal Neurological Institute (MNI) space, skull stripping and intensity normalization. WMH segmentation was performed using a combination of global thresholding of FLAIR sequences that was spatially restricted to the white matter regions which were defined using a population-based atlas of age matched controls. EPVs in the basal ganglia were segmented on T2 sequences using adaptive thresholding of basal ganglia mask that was created from the ICBM template image and age-matched population average atlas. Segmented objects less than 3 mm in diameter were labelled as EPVs. Validation of the accuracy of EPVs segmentation was performed by expert counting of EPVs and WMH was validated using volume similarity against expert manual segmentation of WMH. Results: 41 patients (age 61.2±16.1, 65% males, 19.5% had TIAs, and 79.5% had AIS) were included. WMH volume was (manual: 21.34±20.48 mls vs automated: 15.74±14.56 mls) achieving a volume similarity of 0.92±0.01. EPVs in the basal ganglia counts were 16.32±5.4 using the automated method. Validation through comparison with manual segmentation of the axial slice with the highest EPVs (Doubal Method) showed significant correlation (Spearman’s rho=0.53, P = 0.0004). Conclusions: We describe successful segmentation of WMH and EPVs on clinically acquired MRI sequences in patients with TIA or AIS. This method will have applications to quantify CSVD burden in large clinical trials and clinical practice.

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Abstract TP563: White Matter Hyperintensities are Associated With Intracranial Internal Carotid Artery Calcifications in a Cohort of Patients With Acute Ischemic Stroke or Transient Ischemic Attack

Stroke ◽

10.1161/str.50.suppl_1.tp563 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Nikitaa Nath ◽

Monica Sarkar ◽

Melissa Le Roux ◽

Kimerly A Powell ◽

Michel T Torbey ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Acute Ischemic Stroke ◽

Transient Ischemic Attack ◽

White Matter Hyperintensities ◽

Internal Carotid ◽

Ischemic Attack

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Predictors for cognitive decline in patients with confluent white matter hyperintensities

Alzheimer s & Dementia ◽

10.1016/j.jalz.2011.10.004 ◽

2012 ◽

Vol 8 ◽

pp. S96-S103 ◽

Cited By ~ 13

Author(s):

Vincent Mok ◽

Yunyun Xiong ◽

Kelvin K. Wong ◽

Adrian Wong ◽

Reinhold Schmidt ◽

...

Keyword(s):

White Matter ◽

Cognitive Decline ◽

White Matter Hyperintensities

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Role of white matter hyperintensities, hemoglobin and vitamin B‐12 on cognitive decline: Two‐year follow‐up data from the Tata Longitudinal Study of Ageing (TLSA)

Alzheimer s & Dementia ◽

10.1002/alz.045683 ◽

2020 ◽

Vol 16 (S6) ◽

Author(s):

Aditi Balakrishnan ◽

Vivek Tiwari ◽

M.L. Abhishek ◽

Naren P. Rao ◽

Vijayalakshmi Ravindranath ◽

...

Keyword(s):

Longitudinal Study ◽

White Matter ◽

Cognitive Decline ◽

White Matter Hyperintensities ◽

Vitamin B ◽

Vitamin B 12

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Prestroke Statins, Progression of White Matter Hyperintensities, and Cognitive Decline in Stroke Patients with Confluent White Matter Hyperintensities

Neurotherapeutics ◽

10.1007/s13311-014-0270-5 ◽

2014 ◽

Vol 11 (3) ◽

pp. 606-611 ◽

Cited By ~ 24

Author(s):

Yunyun Xiong ◽

Adrian Wong ◽

Margherita Cavalieri ◽

Reinhold Schmidt ◽

Winnie W. C. Chu ◽

...

Keyword(s):

White Matter ◽

Cognitive Decline ◽

White Matter Hyperintensities ◽

Stroke Patients

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Transient Ischemic Attack Results in Delayed Brain Atrophy and Cognitive Decline

Stroke ◽

10.1161/strokeaha.117.019276 ◽

2018 ◽

Vol 49 (2) ◽

pp. 384-390 ◽

Cited By ~ 17

Author(s):

Andrew Bivard ◽

Thomas Lillicrap ◽

Bénédicte Maréchal ◽

Carlos Garcia-Esperon ◽

Elizabeth Holliday ◽

...

Keyword(s):

Cognitive Decline ◽

Transient Ischemic Attack ◽

Brain Atrophy ◽

Ischemic Attack

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Abstract TP181: Serum Eiocosapentaenoic Acids Is Protective Against White Matter Lesions

Stroke ◽

10.1161/str.44.suppl_1.atp181 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Daiki Takano ◽

Takashi Yamazaki ◽

Tetsuya Maeda ◽

Yuichi Satoh ◽

Yasuko Ikeda ◽

...

Keyword(s):

White Matter ◽

Cognitive Decline ◽

White Matter Hyperintensities ◽

Small Vessel Disease ◽

White Matter Lesions ◽

White Matter Hyperintensity ◽

Partial Regression Coefficient ◽

The Relationship ◽

Total Pufa ◽

Periventricular Hyperintensity

[Introduction] White matter hyperintensities (WMH) are considered manifestation of arteriosclerotic small vessel disease and WMH burden increases risk of ischemic stroke and cognitive decline. There are only a few evidences concerning the relationship between polyunsaturated fatty acids (PUFA) and WMH. The present study was designed to elucidate the association between WMH and PUFA profile including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and arachidonic acid (AA) in patients with Alzheimer’s disease (AD). [Methods] The present study was based on 119 patients who were diagnosed as having a probable AD according to the NINCDS-ADRDA criteria. Their mean age was 78.3 years old. All subjects underwent neuropsychological evaluation including mini mental state exam (MMSE) and 1.5-Tesla MRI. Fasting blood samples were also collected for the PUFA measurements. We measured the ratio of serum EPA, DHA and AA concentration to the total PUFA concentration. The WMH were evaluated on T2-weight images and classified into periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH). The severity of WMH was graded 5 categories. We investigated the relationship between WMH and PUFA profiles. [Results] The EPA ratio correlated negatively with both PVH (rs=-0.2036, p=0.0264) and DWMH grade (rs=-0.3155, p=0.0005). It remained still significant after adjustment for age, sex, statins use, antithrombotics use, mean blood pressure and presence of hypertension (standardized partial regression coefficient(β)=-0.2516, p=0.0122 for PVH, β=-0.3598, p=0.0001 for DWMH). Neither DHA nor AA ratio correlated with DWMH or PVH grade. The EPA ratio but not DHA or AA ratio correlated positively with total MMSE score (rs=0.2310, p=0.0115). [Conclusions] Our data revealed that the serum EPA was protective against WMH as well as cognitive decline in AD patients. Pathophysiology underlying WMH is complex and the possible mechanisms involved in the pathogenesis of WMH encompass incomplete brain ischemia, increased permeability of blood-brain barrier, and inflammation responses. The relationship between serum EPA and WMH can be partly explained by those anti-ischemic and anti-arteriosclerotic effects of EPA.

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