Differences in Signal Intensity and Enhancement on MR Images of the Perivascular Spaces in the Basal Ganglia versus Those in White Matter

White matter hyperintensities (WMH) seen on T2WI are a hallmark of multiple sclerosis (MS) as it indicates inflammation associated with the disease. Automatic detection of the WMH can be valuable in diagnosing and monitoring of treatment effectiveness. T2 fluid attenuated inversion recovery (FLAIR) MR images provided good contrast between the lesions and other tissue; however the signal intensity of gray matter tissue was close to the lesions in FLAIR images that may cause more false positives in the segment result. We developed and evaluated a tool for automated WMH detection only using high resolution 3D T2 fluid attenuated inversion recovery (FLAIR) MR images. We use a high spatial frequency suppression method to reduce the gray matter area signal intensity. We evaluate our method in 26 MS patients and 26 age matched health controls. The data from the automated algorithm showed good agreement with that from the manual segmentation. The linear correlation between these two approaches in comparing WMH volumes was found to beY=1.04X+1.74 (R2=0.96). The automated algorithm estimates the number, volume, and category of WMH.

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Association of enlarged perivascular spaces and anticoagulant-related intracranial hemorrhage

Neurology ◽

10.1212/wnl.0000000000010788 ◽

2020 ◽

Vol 95 (16) ◽

pp. e2192-e2199 ◽

Cited By ~ 1

Author(s):

Jonathan G. Best ◽

Carmen Barbato ◽

Gareth Ambler ◽

Houwei Du ◽

Gargi Banerjee ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

White Matter ◽

Basal Ganglia ◽

Intracranial Hemorrhage ◽

Cox Regression ◽

Significant Risk ◽

Cerebral White Matter ◽

Perivascular Spaces ◽

Univariable Analysis

ObjectiveTo investigate whether enlarged perivascular spaces (PVS) within the basal ganglia or deep cerebral white matter are risk factors for intracranial hemorrhage in patients taking oral anticoagulants (OACs), independent of established clinical and radiologic risk factors, we conducted a post hoc analysis of Clinical Relevance of Microbleeds in Stroke (CROMIS-2) (atrial fibrillation [AF]), a prospective inception cohort study.MethodsPatients with atrial fibrillation and recent TIA or ischemic stroke underwent standardized MRI prior to starting OAC. We rated basal ganglia PVS (BGPVS) and centrum semiovale PVS (CSOPVS), cerebral microbleeds (CMBs), white matter hyperintensities, and lacunes. We dichotomized the PVS rating using a threshold of >10 PVS in the relevant region of either cerebral hemisphere. The primary outcome was symptomatic intracranial hemorrhage (sICH). We identified risk factors for sICH using Cox regression.ResultsA total of 1,386 participants with available clinical and imaging variables were followed up for a mean of 2.34 years; 14 sICH occurred (11 intracerebral). In univariable analysis, diabetes, CMB presence, lacune presence, and >10 BGPVS, but not CSOPVS, were associated with sICH. In a multivariable model incorporating all variables with significant associations in univariable analysis, >10 BGPVS (hazard ratio [HR] 8.96, 95% [CI] 2.41–33.4, p = 0.001) and diabetes (HR 3.91, 95% CI 1.34–11.4) remained significant risk factors for sICH.ConclusionEnlarged BGPVS might be a novel risk factor for OAC-related ICH. The strength of this association and potential use in predicting ICH in clinical practice should be investigated in larger cohorts.

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Abstract TMP96: Automated Segmentation of White Matter Hyperintensities and Enlarged Perivascular Spaces in a Cohort of Patients With Acute Ischemic Stroke or Transient Ischemic Attack

Stroke ◽

10.1161/str.51.suppl_1.tmp96 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kimerly A Powell ◽

Katie M Gallagher ◽

Yousef Hannawi

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Basal Ganglia ◽

Acute Ischemic Stroke ◽

Transient Ischemic Attack ◽

White Matter Hyperintensities ◽

Perivascular Spaces ◽

Manual Segmentation ◽

Mri Sequences ◽

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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Cerebral Perivascular Spaces Visible on Magnetic Resonance Imaging: Development of a Qualitative Rating Scale and its Observer Reliability

Cerebrovascular Diseases ◽

10.1159/000375153 ◽

2015 ◽

Vol 39 (3-4) ◽

pp. 224-231 ◽

Cited By ~ 102

Author(s):

Gillian M. Potter ◽

Francesca M. Chappell ◽

Zoe Morris ◽

Joanna M. Wardlaw

Keyword(s):

White Matter ◽

Basal Ganglia ◽

White Matter Hyperintensities ◽

Rating Scale ◽

Kappa Statistics ◽

Perivascular Spaces ◽

Ageing Population ◽

Centrum Semiovale ◽

Observer Reliability ◽

Morphological Criteria

Background: Perivascular spaces (PVS) are an important component of cerebral small vessel disease (SVD), several inflammatory disorders, hypertension and blood-brain barrier breakdown, but are difficult to quantify. A recent international collaboration of SVD experts has highlighted the need for a robust, easy-to-use PVS rating scale for the effective investigation of the diagnostic and prognostic significance of PVS. The purpose of the current study was to develop and extend existing PVS scales to provide a more comprehensive scale for the measurement of PVS in the basal ganglia, centrum semiovale and midbrain, and to test its intra- and inter-rater agreement, assessing reasons for discrepancy. Methods: We reviewed previously published PVS scales, including site of PVS assessed, rating method, and size and morphological criteria. Retaining key features, we devised a more comprehensive scale in order to improve the reliability of PVS rating. Two neuroradiologists tested the new scale in MRI brain scans of 60 patients from two studies (stroke, ageing population), chosen to represent a full range of PVS, and demonstrating concomitant features of SVD such as lacunes and white matter hyperintensities. We rated basal ganglia, centrum semiovale, and midbrain PVS. Basal ganglia and centrum semiovale PVS were rated 0 (none), 1 (1-10), 2 (11-20), 3 (21-40) and 4 (>40), and midbrain PVS were rated 0 (none visible) or 1 (visible). We calculated kappa statistics for rating, assessed consistency in use of PVS categories (Bhapkar test) and reviewed sources of discrepancy. Results: Intra- and inter-rater kappa statistics were highest for basal ganglia PVS (range 0.76-0.87 and 0.8-0.9, respectively) than for centrum semiovale PVS (range 0.68-0.75 and 0.61-0.8, respectively) or midbrain PVS (inter-rater range 0.51-0.52). Inter-rater consistency was better for basal ganglia compared to centrum semiovale PVS (Bhapkar statistic 2.49-3.72, compared to 6.79-21.08, respectively). Most inter-rater disagreements were due to very faint PVS, coexisting extensive white matter hyperintensities (WMH) or the presence of lacunes. Conclusions: We developed a more inclusive and robust visual PVS rating scale allowing rating of all grades of PVS severity on structural brain imaging. The revised PVS rating scale has good observer reliability for basal ganglia and centrum semiovale PVS, best for basal ganglia PVS, and moderate reliability for midbrain PVS. Agreement is influenced by PVS severity and the presence of background features of SVD. The current scale can be used in further studies to assess the clinical implications of PVS.

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Portal-systemic encephalopathy: presence of basal ganglia lesions with high signal intensity on MR images.

Radiology ◽

10.1148/radiology.179.2.2014310 ◽

1991 ◽

Vol 179 (2) ◽

pp. 551-555 ◽

Cited By ~ 127

Author(s):

E Inoue ◽

S Hori ◽

Y Narumi ◽

M Fujita ◽

K Kuriyama ◽

...

Keyword(s):

Basal Ganglia ◽

Signal Intensity ◽

High Signal Intensity ◽

High Signal ◽

Mr Images ◽

Portal Systemic Encephalopathy

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Cranial MR findings in Wilson's disease

Acta Radiologica ◽

10.1080/02841859709172059 ◽

1997 ◽

Vol 38 (2) ◽

pp. 250-258 ◽

Cited By ~ 69

Author(s):

I. Saatci ◽

M. Topcu ◽

F. F. Baltaoglu ◽

G. Köse ◽

K. Yalaz ◽

...

Keyword(s):

White Matter ◽

Basal Ganglia ◽

Substantia Nigra ◽

Frontal Lobe ◽

Globus Pallidus ◽

Signal Intensity ◽

Hepatic Dysfunction ◽

Neurological Involvement ◽

Hepatic Involvement ◽

T2 Hyperintensity

Purpose: to define various cranial Mr appearances in Wilson's disease (WD). Material and Methods: MR examinations of 30 patients (9–44 years old) with WD were retrospectively reviewed. Six patients were asymptomatic siblings. Three other patients had isolated hepatic involvement, one with no symptoms. the remaining 21 patients had neurological involvement, 7 of whom had the mixed form of the disease. Nine patients had hepatic dysfunction, the 3 with isolated hepatic involvement and 6 of the 7 with the mixed form. Results: All symptomatic patients (n=23) had abnormal MR examinations. Atrophy was present in the majority of them. the most frequently involved sites were putamen (18/21) and pons (18/21) in patients with neurological abnormality. the putaminal lesions showed a consistent pattern of symmetric, bilateral, concentric-laminar T2 hyperintensity. Putaminal lesions were lacking in only 3 patients with neurological involvement, all of whom were relatively old and had had the disease for a longer duration. Most of the patients with hepatic dysfunction (8/9) had increased T1 signal intensity in the basal ganglia, particularly in the globus pallidus. Pontine involvement always included the dorsal aspect of the pons, however, in some cases the central portion of pons was also affected but ventrolateral longitudinal fibers were spared. Midbrain (16/21), thalamic (10/21) and caudate nucleus lesions (9/21) were also encountered. in a few patients cortical and subcortical white matter lesions were present with a predilection to the frontal lobe, particularly the precentral region. in one patient, a hemorrhagic focus was identified within the white matter lesion. Conclusion: on T2-weighted images, WD is suggested by: atrophy; putaminal lesions with a pattern of symmetric, bilateral, concentric-laminar T2 hyperintensity; and the involvement of the pars compacta of the substantia nigra, periaqueductal gray matter, the pontine tegmentum and the thalamus. the hepatic component of WD may cause increased T1 signal intensity in basal ganglia. in the adult age group, the basal ganglia lesions may be different from those in the pediatric group; the putaminal lesions may not be present; the globus pallidus and substantia nigra may show increased hypointensity on T2-weighted images. Cortical and subcortical lesions may also be present with a predilection to the frontal lobe.

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A Girl of Unusual Diffuse White Matter and Basal Ganglia Lesions Following Streptococcus Pneumoniae Meningoencephalitis

Journal of the korean child neurology society ◽

10.26815/jkcns.2016.24.4.266 ◽

2016 ◽

Vol 24 (4) ◽

pp. 266-271

Author(s):

이훈상 ◽

이윤진 ◽

김영미 ◽

Yeon Gyu Min ◽

김경민 ◽

...

Keyword(s):

Streptococcus Pneumoniae ◽

White Matter ◽

Basal Ganglia ◽

Diffuse White Matter

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Perivascular spaces and brain waste clearance systems: relevance for neurodegenerative and cerebrovascular pathology

Neuroradiology ◽

10.1007/s00234-021-02718-7 ◽

2021 ◽

Author(s):

Kaylene Gouveia-Freitas ◽

António J. Bastos-Leite

Keyword(s):

Basal Ganglia ◽

Lymphatic Vessels ◽

Vascular Wall ◽

Lymphatic Drainage ◽

Basement Membranes ◽

Amyloid Angiopathy ◽

Perivascular Spaces ◽

Functional Abnormality ◽

Ischaemic Injury ◽

Cerebrovascular Pathology

AbstractPerivascular spaces (PVS) of the brain, often called Virchow-Robin spaces, comprise fluid, cells and connective tissue, and are externally limited by astrocytic endfeet. PVS are involved in clearing brain waste and belong to the “glymphatic” system and/or the “intramural periarterial drainage” pathway through the basement membranes of the arteries. Related brain waste clearance systems include the blood–brain barrier, scavenger cells, cerebrospinal fluid, perineural lymphatic drainage pathways and the newly characterised meningeal lymphatic vessels. Any functional abnormality of PVS or related clearance systems might lead to accumulation of brain waste. It has been postulated that PVS enlargement can be secondary to accumulation of β-amyloid. Lack of integrity of the vascular wall, microbleeds, cerebral amyloid angiopathy (CAA) and enlarged PVS often occur in the preclinical stages of Alzheimer’s disease, preceding substantial brain atrophy. PVS enlargement in the form of état criblé at the basal ganglia has also been considered to reflect focal atrophy, most probably secondary to ischaemic injury, based upon both pathological and imaging arguments. In addition, distinct topographic patterns of enlarged PVS are related to different types of microangiopathy: CAA is linked to enlarged juxtacortical PVS, whereas subjects with vascular risk factors tend to have enlarged PVS in the basal ganglia. Therefore, enlarged PVS are progressively being regarded as a marker of neurodegenerative and cerebrovascular pathology. The present review addresses the evolving concept of PVS and brain waste clearance systems, the potential relevance of their dysfunction to neurodegenerative and cerebrovascular pathology, and potential therapeutic approaches of interest.

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