Abstract TP135: White Matter Hyperintensities in Relation to Severity of Intracranial Atherosclerotic Stenosis

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jong-Ho Park ◽  
Dong-Sun Kim ◽  
Hyun Jeong Han
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Multivariable Analysis ◽  
Cerebral Hypoperfusion ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Increased Risk

Background & Objectives: White matter hyperintensities (WMH) is regarded as a small-vessel disease because the accompanying silent infarcts are predominantly lacunes and share the same pathological basis with WMH. Endothelial dysfunction is known to play a cardinal role in progression of WMH. Accordingly, atherosclerotic burden might be associated with the development of WMH. Because metabolic syndrome (MetS) is associated with an increased risk of WMH and with intracranial atherosclerotic stenosis (ICAS), we assessed the hypothesis that WMH might be related to ICAS in ischemic stroke patients. We compared a severity of WMH among the ICAS, extracranial (ECAS), and no cerebral atherosclerotic stenosis (NCAS) groups. Methods: We conducted a cross-sectional study in 605 Korean patients with acute ischemic stroke (mean age 67.7±12.8; 347 males), who underwent brain MRI/MRA. The severity of deep WMH (d-WMH, n=495) and periventricular WMH (pv-WMH, n=521) was rated separately. Irrespective of index stroke mechanisms, patients were classified into three groups: ICAS (n=294), extracranial (ECAS, n=63), and no cerebral atherosclerotic stenosis (NCAS, n=248). Stenosis groups and demographics, including the presence of MetS, were compared between patients with d-/pv-WMH and without. Results: The ICAS group showed a higher d-WMH / pv-WMH grade (1.61±0.85 / 1.64±0.80) than both the ECAS (1.29±0.87 / 1.21±0.77) and NCAS (1.15±0.92 / 1.21±0.82) groups ( P <0.001 for all). Patients with more severe ICAS were more likely to have higher grades of d-WMH and pv-WMH ( P <0.001 for all). Patients with higher grades of d-WMH and pv-WMH had a higher incidence of ICAS ( P <0.001 for all) but not of ECAS or NCAS. Patients with a greater number of MetS components were more likely to have higher grades of d-WMH and pv-PWMH ( P <0.001 for all). With a multivariable analysis, a dose-response relationship was observed between the presence of ICAS and the WMH: (1) for d-WMH, OR=3.25 (95% CI, 1.18-8.96) for 2 ICAS, OR=6.39 (1.84-22.14) for ≥3 ICAS, (2) for pv-WMH, OR=2.22 (95% CI, 1.25-3.95) for 2 ICAS, OR=3.40 (1.89-6.09) for ≥3 ICAS versus 1 ICAS. Conclusions: ICAS, rather than ECAS or NCAS is a predictor of d-/pv-WMH. ICAS burden might be the substrate for chronic cerebral hypoperfusion.

scholarly journals MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation

Neurology ◽  
2019 ◽  
Vol 92 (21) ◽  
pp. e2432-e2443 ◽  
Author(s):  
Joan Martí-Fàbregas ◽  
Santiago Medrano-Martorell ◽  
Elisa Merino ◽  
Luis Prats-Sánchez ◽  
Rebeca Marín ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Intracranial Hemorrhage ◽  
White Matter Hyperintensities ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Hazard Ratio ◽  
Superficial Siderosis ◽  
Increased Risk

ObjectiveWe tested the hypothesis that the risk of intracranial hemorrhage (ICH) in patients with cardioembolic ischemic stroke who are treated with oral anticoagulants (OAs) can be predicted by evaluating surrogate markers of hemorrhagic-prone cerebral angiopathies using a baseline MRI.MethodsPatients were participants in a multicenter and prospective observational study. They were older than 64 years, had a recent cardioembolic ischemic stroke, and were new users of OAs. They underwent a baseline MRI analysis to evaluate microbleeds, white matter hyperintensities, and cortical superficial siderosis. We collected demographic variables, clinical characteristics, risk scores, and therapeutic data. The primary endpoint was ICH that occurred during follow-up. We performed bivariate and multivariate Cox regression analyses.ResultsWe recruited 937 patients (aged 77.6 ± 6.5 years; 47.9% were men). Microbleeds were detected in 207 patients (22.5%), moderate/severe white matter hyperintensities in 419 (45.1%), and superficial siderosis in 28 patients (3%). After a mean follow-up of 23.1 ± 6.8 months, 18 patients (1.9%) experienced an ICH. In multivariable analysis, microbleeds (hazard ratio 2.7, 95% confidence interval [CI] 1.1–7, p = 0.034) and moderate/severe white matter hyperintensities (hazard ratio 5.7, 95% CI 1.6–20, p = 0.006) were associated with ICH (C index 0.76, 95% CI 0.66–0.85). Rate of ICH was highest in patients with both microbleed and moderate/severe WMH (3.76 per 100 patient-years, 95% CI 1.62–7.4).ConclusionPatients taking OAs who have advanced cerebral small vessel disease, evidenced by microbleeds and moderate to severe white matter hyperintensities, had an increased risk of ICH. Our results should help to determine the risk of prescribing OA for a patient with cardioembolic stroke.ClinicalTrials.gov identifierNCT02238470.

MMP9 rs17576 Is Simultaneously Correlated with Symptomatic Intracranial Atherosclerotic Stenosis and White Matter Hyperintensities in Chinese Population

2020 ◽  
pp. 1-8
Author(s):  
Xianjing Feng ◽  
Fang Yu ◽  
Xiaoqing Zhou ◽  
Zeyu Liu ◽  
Di Liao ◽  
...  
Keyword(s):  
White Matter ◽  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Macrovascular Disease ◽  
Genome Project ◽  
Allele Frequencies ◽  
Healthy Controls ◽  
Nucleotide Polymorphisms ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis

<b><i>Purpose:</i></b> The aim of this study was screening for single nucleotide polymorphisms (SNPs) associated with white matter hyperintensities (WMHs) in symptomatic intracranial atherosclerotic stenosis (sICAS) patients and exploring a possible connection in the genetic background between macrovascular disease and small vessel disease. <b><i>Methods:</i></b> There were 400 sICAS patients enrolled in the study. Fazekas scores were applied to WMH classification. Healthy controls were referred to 1,000 Genome Project and GeneSky company who provided 1,007 Chinese healthy controls. Fast target sequencing technology was used to select the SNPs of 102 genes related to the pathogenesis of sICAS in the sICAS patients. <b><i>Results:</i></b> The allele frequencies of 88 SNPs were significantly different between the sICAS group and the healthy controls (<i>p</i> &#x3c; 0.05). The allele frequencies of 53 SNPs were significantly different between the sICAS patients with and without WMHs (<i>p</i> &#x3c; 0.05). Further analysis found that matrix metalloproteinase 9 (<i>MMP9</i>) rs17576 was simultaneously related to sICAS and WMHs. The frequency of the rs17576 A allele was significantly lower in sICAS patients when compared to the normal controls (<i>p</i> = 0.03, OR [95% CI] = 0.75 [0.625–0.91]). Also, the frequency of the rs17576 genotypes was significantly different under codominant (<i>p</i> = 0.009), dominant (<i>p</i> = 0.014), and recessive (<i>p</i>= 0.023) models. The frequency of the rs17576 A allele was significantly higher in sICAS with WMH patients, compared to those without WMHs (<i>p</i> = 0.022, OR [95% CI] = 1.54 [1.06–2.22]); the frequency of the rs17576 genotypes was significantly different under codominant (<i>p</i> = 0.019) and recessive (<i>p</i> = 0.032) models. Logistic regression analysis showed that age, hypertension, and <i>MMP9</i> rs17576 AA genotype were independent risk factors for sICAS with WMHs. <b><i>Conclusion:</i></b> <i>MMP9</i> rs17576 may be simultaneously associated with the risk of sICAS and WMHs.

scholarly journals White Matter Hyperintensities as a Risk Factor for Ischemic Stroke in Patients With Systemic Lupus Erythematosus

2021 ◽  
Vol 12 ◽  
Author(s):  
Eri Sano ◽  
Shigeki Arawaka
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
White Matter ◽  
Lupus Erythematosus ◽  
White Matter Hyperintensities ◽  
Brain Mri ◽  
Systemic Lupus ◽  
Increased Risk

Objective: The occurrence of ischemic stroke in patients with systemic lupus erythematosus (SLE) can cause extended periods of reduced daily activities. However, the risk factors for ischemic stroke in SLE patients are not fully elucidated. Herein, we examined the effect of white matter hyperintensities (WMH) on the occurrence of ischemic stroke in SLE patients.Methods: We analyzed the relationship between WMH burden and ischemic stroke using follow-up brain magnetic resonance imaging (MRI) data of 79 patients with SLE. Of these patients, 16 developed stroke during the observation period. WMH on MRI were classified into periventricular hyperintensities and deep white matter hyperintensities (DWMH), while the lesion extent was graded using the Fazekas scale.Results: Kaplan–Meier curves showed that ischemic stroke events were significantly associated with age at initial brain MRI of ≥40 years (p = 0.015) and history of anti-phospholipid syndrome (p = 0.030). Additionally, ischemic stroke events were significantly associated with a one grade deterioration of periventricular hyperintensities (p = 0.003) and a one grade deterioration of DWMH (p = 0.002). Multivariate analysis using the logistic regression model showed that a one grade deterioration of DWMH was an independent risk factor for ischemic stroke (hazard ratio, 6.0; 95% confidence interval, 1.3–27.4).Conclusions: Although several factors affect the occurrence of ischemic stroke, SLE patients show increased risk of ischemic stroke via development of DWMH. An observation of DWMH deterioration on follow-up brain MRI may be useful for assessing the risk of ischemic stroke in SLE patients.

White matter hyperintensities and cognitive performance in adult patients with bipolar I, bipolar II, and major depressive disorders

2014 ◽  
Vol 29 (4) ◽  
pp. 226-232 ◽  
Author(s):  
T. Kieseppä ◽  
R. Mäntylä ◽  
A. Tuulio-Henriksson ◽  
K. Luoma ◽  
O. Mantere ◽  
...  
Keyword(s):  
White Matter ◽  
White Matter Hyperintensities ◽  
Structural Equation Models ◽  
Brain Mri ◽  
Path Model ◽  
Control Group ◽  
Coefficient Estimate ◽  
Major Depressive ◽  
Brain White Matter ◽  
Increased Risk

AbstractPurpose:We evaluate for the first time the associations of brain white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) with neuropsychological variables among middle-aged bipolar I (BPI), II (BPII) and major depressive disorder (MDD) patients and controls using a path model.Methods:Thirteen BPI, 15 BPII, 16 MDD patients, and 21 controls underwent brain MRI and a neuropsychological examination. Two experienced neuroradiologists evaluated WMHs on the MRI scans. We constructed structural equation models to test the strength of the associations between deep WMH (DWMH) grade, neuropsychological performance and diagnostic group.Results:Belonging in the BPI group as opposed to the control group predicted higher DWMH grade (coefficient estimate 1.13, P = 0.012). The DWMH grade independently predicted worse performance on the Visual Span Forward test (coefficient estimate −0.48, P = 0.002). Group effects of BPI and MDD were significant in predicting poorer performance on the Digit Symbol test (coefficient estimate −5.57, P = 0.016 and coefficient estimate −5.66, P = 0.034, respectively).Limitations:Because of the small number of study subjects in groups, the negative results must be considered with caution.Conclusions:Only BPI patients had an increased risk for DWMHs. DWMHs were independently associated with deficits in visual attention.

scholarly journals Linking cortical atrophy to white matter hyperintensities of presumed vascular origin

2020 ◽  
pp. 0271678X2097417
Author(s):  
Carola Mayer ◽  
Benedikt M Frey ◽  
Eckhard Schlemm ◽  
Marvin Petersen ◽  
Kristin Engelke ◽  
...  
Keyword(s):  
White Matter ◽  
Cortical Thickness ◽  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Population Based ◽  
Vascular Lesions ◽  
Cortical Atrophy ◽  
Increased Risk ◽  
Cortical Regions ◽  
The Relationship

We examined the relationship between white matter hyperintensities (WMH) and cortical neurodegeneration in cerebral small vessel disease (CSVD) by investigating whether cortical thickness is a remote effect of WMH through structural fiber tract connectivity in a population at increased risk of CSVD. We measured cortical thickness on T1-weighted images and segmented WMH on FLAIR images in 930 participants of a population-based cohort study at baseline. DWI-derived whole-brain probabilistic tractography was used to define WMH connectivity to cortical regions. Linear mixed-effects models were applied to analyze the relationship between cortical thickness and connectivity to WMH. Factors associated with cortical thickness (age, sex, hemisphere, region, individual differences in cortical thickness) were added as covariates. Median age was 64 [IQR 46–76] years. Visual inspection of surface maps revealed distinct connectivity patterns of cortical regions to WMH. WMH connectivity to the cortex was associated with reduced cortical thickness ( p = 0.009) after controlling for covariates. This association was found for periventricular WMH ( p = 0.001) only. Our results indicate an association between WMH and cortical thickness via connecting fiber tracts. The results imply a mechanism of secondary neurodegeneration in cortical regions distant, yet connected to subcortical vascular lesions, which appears to be driven by periventricular WMH.

scholarly journals Predicting the Evolution of White Matter Hyperintensities in Brain MRI using Generative Adversarial Networks and Irregularity Map

2019 ◽  
Author(s):  
Muhammad Febrian Rachmadi ◽  
Maria del C. Valdés-Hernández ◽  
Stephen Makin ◽  
Joanna M. Wardlaw ◽  
Taku Komura
Keyword(s):  
White Matter ◽  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Estimation Error ◽  
Brain Mri ◽  
Small Vessel ◽  
Generative Adversarial Networks ◽  
Disease Evolution ◽  
Vessel Disease

AbstractWe propose a Generative Adversarial Network (GAN) model named Disease Evolution Predictor GAN (DEP-GAN) to predict the evolution (i.e., progression and regression) of White Matter Hyperintensities (WMH) in small vessel disease. In this study, the evolution of WMH is represented by the “Disease Evolution Map” (DEM) produced by subtracting irregularity map (IM) images from two time points: baseline and follow-up. DEP-GAN uses two discriminators (critics) to enforce anatomically realistic follow-up image and DEM. To simulate the non-deterministic and unknown parameters involved in WMH evolution, we propose modulating an array of random noises to the DEP-GAN’s generator which forces the model to imitate a wider spectrum of alternatives in the results. Our study shows that the use of two critics and random noises modulation in the proposed DEP-GAN improves its performance predicting the evolution of WMH in small vessel disease. DEP-GAN is able to estimate WMH volume in the follow-up year with mean (std) estimation error of −1.91 (12.12) ml and predict WMH evolution with mean rate of 72.01% accuracy (i.e., 88.69% and 23.92% better than Wasserstein GAN).

Abstract W P345: Increased Risk of Gastrointestinal Bleeding Associated With Antiplatelet Therapy in Patients With Cerebral Small Vessel Disease

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Sang-mi Noh ◽  
Jong S. Kim
Keyword(s):  
White Matter ◽  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Bleeding Risk ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Gi Bleeding ◽  
Stroke Patients ◽  
Vessel Disease ◽  
Increased Risk

Background: Gastrointestinal (GI) bleeding is a major complication of aniplatelets in patients with stroke. Although underlying gastrointestinal disease is an important factor for increased bleeding risk, the presence of cerebral small vessel disease (SVD) may also be a factor because it may indicate systemic small vessel pathologies. We assessed the association of cerebral SVD and GI bleeding in patients who are under treatment with antiplatelets for secondary stroke prevention. Methods: We compared stroke patients who visited our clinic between May 2007 and May 2013 who developed GI bleeding while receiving antiplatelets with age and sex matched patients who did not. Control subjects were randomly selected among those who were visited out-patients clinic on the same day as the study subjects. Patients who received anticoagulants were excluded. MRIs were evaluated for the presence of white matter changes (Fazeka scale) and microbleeds. Results: During the study period, 47 patients in the bleeding group and 94 patients in the control group were enrolled. No differences were found in baseline characteristics between the two groups including stroke subtypes and the number of antiplatelets (mono vs dual therapy). The prevalence of SVD (microbleeds or white matter hyperintensities) (p = 0.004), white matter hyperintensities (p = 0.008), but not microbleeds alone (p = 0.221), were significantly higher in the bleeding group. Multivariate analysis showed that the presence of SVD was independently associated with increased GI bleeding risk (OR 3.3, 95% confidence interval 1.5-7.3). Conclusions: Our data show the presence of cerebral SVD is a marker for increased GI bleeding risk in patients receiving antiplatelets in stroke patients, perhaps related with systemic small vessel pathology in this group of patients. Physicians may have to consider this association when antiplatelets are used for the secondary prevention of stroke.

White matter hyperintensities on T2-weighted MRI images among DNA-verified older familial hypercholesterolemia patients

2009 ◽  
Vol 50 (3) ◽  
pp. 320-326 ◽  
Author(s):  
L. Hyttinen ◽  
T. Autti ◽  
S. Rauma ◽  
S. Soljanlahti ◽  
A. F. Vuorio ◽  
...  
Keyword(s):  
White Matter ◽  
Familial Hypercholesterolemia ◽  
White Matter Hyperintensities ◽  
Genetic Disorder ◽  
Brain Mri ◽  
Statin Treatment ◽  
Magnetic Resonance Images ◽  
Healthy Controls ◽  
Middle Aged ◽  
Increased Risk

Background: Familial hypercholesterolemia (FH) is a genetic disorder, causing an increased risk of coronary heart disease (CHD) if untreated. Silent brain infarctions and white matter hyperintensities (WMHIs) observed on T2-weighted magnetic resonance images (MRI) are associated with increased risk for stroke and myocardial infarction. Age is a strong predictor of WMHIs. Purpose: To use MRI to assess the presence of clinically silent brain lesions in older FH patients, and to compare the occurrence and size of these lesions in older FH patients with middle-aged FH patients and healthy controls. Material and Methods: A total of 43 older (age ≥ 65 years) FH patients with the same FH North Karelia mutation, living in Finland, were identified. In this comprehensive cohort, 1.5T brain MRI was available for 33 individuals (age 65–84 years, M/F 9/24, mean duration of statin treatment 15.3 years). This group was divided into two age categories: 65–74 years (FHe1 group, n=23) and 75–84 years (FHe2 group, n=10). Infarcts, including lacunas, and WMHIs on T2-weighted images were recorded. Data from brain MRI were compared to those of a group of middle-aged FH patients with CHD ( n=19, age 48–64 years) and with middle-aged healthy controls ( n=29, age 49–63 years). Results: Only two (6%) of the older FH patients had clinically silent brain infarcts detected by MRI. The amount of large WMHIs (>5 mm in diameter) was similar in the FHe1 group compared with the groups of middle-aged FH patients and healthy controls, even though the FHe1 group was 13 years older. The total amount of WMHIs and the amount of large WMHIs were greatest in the FHe2 group. Conclusion: FH patients aged 65 to 74 years receiving long-term statin treatment (15 years) did not have more WMHIs on brain MRI compared to middle-aged FH patients and healthy controls.

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