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Research paper
Enlarged perivascular spaces as a marker of underlying arteriopathy in intracerebral haemorrhage: a multicentre MRI cohort study
  1. Andreas Charidimou1,
  2. Rukshan Meegahage1,
  3. Zoe Fox2,3,
  4. Andre Peeters4,
  5. Yves Vandermeeren5,6,
  6. Patrice Laloux5,6,
  7. Jean-Claude Baron7,8,
  8. Hans Rolf Jäger9,10,
  9. David J Werring1
  1. 1Stroke Research Group, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
  2. 2Biomedical Research Centre, UCL Institute of Neurology, London, UK
  3. 3Education Unit, UCL Institute of Neurology, London, UK
  4. 4Department of Neurology, Cliniques Universitaires UCL Saint Luc, Brussels, Belgium
  5. 5Department of Neurology, CHU Mont-Godinne, Université Catholique de Louvain, Brussels, Belgium
  6. 6Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
  7. 7Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
  8. 8UMR 894 INSERM-Université Paris 5, Paris, France
  9. 9Lysholm Department of Neuroradiology, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
  10. 10Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
  1. Correspondence to Dr David J Werring, Stroke Research Group, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Box 6, Queen Square, London WC1N 3BG, UK; d.werring{at}ucl.ac.uk

Abstract

Background and purpose Small vessel disease (mainly hypertensive arteriopathy and cerebral amyloid angiopathy (CAA)) is an important cause of spontaneous intracerebral haemorrhage (ICH), a devastating and still poorly understood stroke type. Enlarged perivascular spaces (EPVS) are a promising neuroimaging marker of small vessel disease. Based on the underlying arteriopathy distributions, we hypothesised that severe centrum semiovale EPVS are more common in lobar ICH attributed to CAA than other ICH. We evaluated EPVS prevalence, severity and distribution, and their clinical–radiological associations.

Methods Retrospective multicentre cohort study of 121 ICH patients. Clinical information was obtained using standardised forms. Basal ganglia and centrum semiovale EPVS on T2-weighted MRI (graded 0–4 (>40 EPVS)), white-matter changes, cerebral microbleeds (CMBs) and lacunes were rated using validated scales.

Results Patients with probable or possible CAA (n=76) had a higher prevalence of severe (>40) centrum semiovale EPVS compared with other ICH patients (35.5% vs 17.8%; p=0.041). In logistic regression age (OR: 1.43; 95% CI 1.01 to 2.02; p=0.045), deep CMBs (OR: 3.27; 95% CI 1.27 to 8.45; p=0.014) and mean white-matter changes score (OR: 1.29; 95% CI 1.17 to 1.43; p<0.0001) were independently associated with increased basal ganglia EPVS severity; only age was associated with increased centrum semiovale EPVS severity (OR: 1.50; 95% CI 1.08 to 2.10; p=0.017).

Conclusions EPVS are common in ICH. Different mechanisms may account for EPVS according to their anatomical distribution. Severe centrum semiovale EPVS may be secondary to, and indicative of, CAA with value as a new neuroimaging marker. By contrast, basal ganglia EPVS severity is associated with markers of hypertensive arteriopathy.

  • Amyloid
  • Cerebrovascular Disease
  • Clinical Neurology
  • MRI

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