Distribution and influencing factors of enlarged perivascular spaces in acute ischemic stroke_West China Medical Journal

Authors：

CHEN Yan ¹ , TAN Xin ² ,  WU Bo ²

1. Department of Neurology, Jianyang Municipal People’s Hospital, Jianyang, Sichuan 641400, P. R. China;
2. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WU Bo, Email: dragonwbtxf@hotmail.com

Keywords：

Ischemic stroke; Enlarged perivascular spaces; Multivariate analysis

DOI：

10.7507/1002-0179.201805033

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Objectives To observe the distribution of enlarged perivascular spaces (EPVSs) in acute ischemic stroke, and determine the factors that influence basal ganglia and centrum semiovale EPVSs. Methods We prospectively registered consecutive patients with acute ischemic stroke at the neurological wards of Jianyang Municipal People’s Hospital and West China Hospital of Sichuan University from February 1st to November 1st, 2014. Patients with ischemic stroke within 14 days of symptom onset, having magnetic resonance image (MRI) scan were included. Basal ganglia and centrum semiovale EPVSs, white matter hyperintensity, cerebral atrophy and lacunar infraction were rated using validated scales by reading MRI. Clinical information was obtained using standardized forms. The distribution of EPVSs was observed and analyzed. The evalution of EPVSs was analyzed in relation to age, vascular risk factor, cerebral atrophy, white matter hyperintensity, lacunar infraction, etc, by using univariate and multivariate logistical regression to evaluate the influencing factors for basal ganglia and centrum semiovale EPVSs. Results A total of 170 patients with acute ischemic stroke within 14 days from onset were included; in whom, 97.6% had EPVSs in basal ganglia and all had EPVSs in centrum semiovale. The most common scores of basal ganglia EPVSs were 1 point and 2 points. The most common scores of centrum semiovale EPVSs were 2 and 3 points. In logistic regression, age [odds ratio (OR)=1.043, 95% confidence interval (CI) (1.015, 1.071), P=0.002], periventricular white matter hyperintensity [OR=4.203, 95%CI (1.525, 11.583), P=0.006] and hypertension [OR=3.965, 95%CI (1.927, 8.157), P<0.001] were independently associated with increased severity of basal ganglia EPVSs. Only periventricular white matter hyperintensity [OR=2.248, 95%CI (1.054, 4.795), P=0.036] was independently associated with increased severity of centrum semiovale EPVSs in logistic regression. Conclusions EPVSs are common in ischemic stroke. There is a lower prevalence of EPVS in the basal ganglia compared with the centrum semiovale. Compared with centrum semiovale EPVSs, basal ganglia EPVSs are more associated with hypertensive cerebral small vessel disease, which may be a marker for hypertensive cerebral small vessel disease.

Citation： CHEN Yan, TAN Xin, WU Bo. Distribution and influencing factors of enlarged perivascular spaces in acute ischemic stroke. West China Medical Journal, 2018, 33(6): 673-677. doi: 10.7507/1002-0179.201805033 Copy

1.	Kwee RM, Kwee TC. Virchow-Robin spaces at MR imaging. Radiographics, 2007, 27(4): 1071-1086.
2.	Wang G. Perivascular space and neurological disorders. Neurosci Bull, 2009, 25(1): 33-37.
3.	Huijts M, Duits A, van Oostenbrugge RJ, et al. Accumulation of MRI markers of cerebral small vessel disease is associated with decreased cognitive function. A study in first-ever lacunar stroke and hypertensive patients. Front Aging Neurosci, 2013, 5: 72.
4.	Hurford R, Charidimou A, Fox Z, et al. MRI-visible perivascular spaces: relationship to cognition and small vessel disease MRI markers in ischaemic stroke and TIA. J Neurol Neurosurg Psychiatry, 2014, 85(5): 522-525.
5.	Doubal FN, Maclullich AM, Ferguson KJ, et al. Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease. Stroke, 2010, 41(3): 450-454.
6.	Maclullich AJ, Wardlaw JM, Ferguson KJ, et al. Enlarged perivascular spaces are associated with cognitive function in healthy elderly men. J Neurol Neurosurg Psychiatry, 2004, 75(11): 1519-1523.
7.	Inglese M, Bomsztyk E, Gonen O, et al. Dilated perivascular spaces: hallmarks of mild traumatic brain injury. AJNR Am J Neuroradiol, 2005, 26(4): 719-724.
8.	WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke, 1989, 20(10): 1407-1431.
9.	Bokura H, Kobayashi S, Yamaguchi S. Distinguishing silent lacunar infarction from enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathological study. J Neurol, 1998, 245(2): 116-122.
10.	Fazekas F, Chawluk JB, Alavi A, et al. Mr signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol, 1987, 149(2): 351-356.
11.	Rasquin SM, Verhey FR, van Oostenbrugge RJ, et al. Demographic and CT scan features related to cognitive impairment in the first year after stroke. J Neurol Neurosurg Psychiatry, 2004, 75(11): 1562-1567.
12.	Potter GM, Doubal FN, Jackson CA, et al. Enlarged perivascular spaces and cerebral small vessel disease. Int J Stroke, 2015, 10(3): 376-381.
13.	Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol, 2013, 12(8): 822-838.
14.	Yakushiji Y, Charidimou A, Hara M, et al. Topography and associations of perivascular spaces in healthy adults The Kashima Scan Study. Neurology, 2014, 83(23): 2116-2123.
15.	Martinez-Ramirez S, Pontes-Neto OM, Dumas AP, et al. Topography of dilated perivascular spaces in subjects from a memory clinic cohort. Neurology, 2013, 80(17): 1551-1556.
16.	Zhang C, Chen Q, Wang Y, et al. Risk factors of dilated Virchow-Robin spaces are different in various brain regions. PLoS One, 2014, 9(8): e105505.
17.	Charidimou A, Meegahage R, Fox Z, et al. Enlarged perivascular spaces as a marker of underlying arteriopathy in intracerebral haemorrhage: a multicentre MRI cohort study. J Neurol Neurosurg Psychiatry, 2013, 84(6): 624-629.
18.	Klarenbeek P, van Oostenbrugge RJ, Lodder J, et al. Higher ambulatory blood pressure relates to enlarged Virchow-Robin spaces in first-ever lacunar stroke patients. J Neurol, 2013, 260(1): 115-121.
19.	Weller R, Subash M, Preston S, et al. Perivascular drainage of amyloid-b peptides from the brain and its failure in cerebral amyloid angiopathy and Alzheimer’s disease. Brain Pathology, 2008, 18(2): 253-266.
20.	Vinters HV. Cerebral amyloid angiopathy//Pardridge WM. Introduction to the blood-brain barrier: methodology, biology and pathology. Cambridge: Cambridge University Press, 2006: 379.

1. Kwee RM, Kwee TC. Virchow-Robin spaces at MR imaging. Radiographics, 2007, 27(4): 1071-1086.
2. Wang G. Perivascular space and neurological disorders. Neurosci Bull, 2009, 25(1): 33-37.
3. Huijts M, Duits A, van Oostenbrugge RJ, et al. Accumulation of MRI markers of cerebral small vessel disease is associated with decreased cognitive function. A study in first-ever lacunar stroke and hypertensive patients. Front Aging Neurosci, 2013, 5: 72.
4. Hurford R, Charidimou A, Fox Z, et al. MRI-visible perivascular spaces: relationship to cognition and small vessel disease MRI markers in ischaemic stroke and TIA. J Neurol Neurosurg Psychiatry, 2014, 85(5): 522-525.
5. Doubal FN, Maclullich AM, Ferguson KJ, et al. Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease. Stroke, 2010, 41(3): 450-454.
6. Maclullich AJ, Wardlaw JM, Ferguson KJ, et al. Enlarged perivascular spaces are associated with cognitive function in healthy elderly men. J Neurol Neurosurg Psychiatry, 2004, 75(11): 1519-1523.
7. Inglese M, Bomsztyk E, Gonen O, et al. Dilated perivascular spaces: hallmarks of mild traumatic brain injury. AJNR Am J Neuroradiol, 2005, 26(4): 719-724.
8. WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke, 1989, 20(10): 1407-1431.
9. Bokura H, Kobayashi S, Yamaguchi S. Distinguishing silent lacunar infarction from enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathological study. J Neurol, 1998, 245(2): 116-122.
10. Fazekas F, Chawluk JB, Alavi A, et al. Mr signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol, 1987, 149(2): 351-356.
11. Rasquin SM, Verhey FR, van Oostenbrugge RJ, et al. Demographic and CT scan features related to cognitive impairment in the first year after stroke. J Neurol Neurosurg Psychiatry, 2004, 75(11): 1562-1567.
12. Potter GM, Doubal FN, Jackson CA, et al. Enlarged perivascular spaces and cerebral small vessel disease. Int J Stroke, 2015, 10(3): 376-381.
13. Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol, 2013, 12(8): 822-838.
14. Yakushiji Y, Charidimou A, Hara M, et al. Topography and associations of perivascular spaces in healthy adults The Kashima Scan Study. Neurology, 2014, 83(23): 2116-2123.
15. Martinez-Ramirez S, Pontes-Neto OM, Dumas AP, et al. Topography of dilated perivascular spaces in subjects from a memory clinic cohort. Neurology, 2013, 80(17): 1551-1556.
16. Zhang C, Chen Q, Wang Y, et al. Risk factors of dilated Virchow-Robin spaces are different in various brain regions. PLoS One, 2014, 9(8): e105505.
17. Charidimou A, Meegahage R, Fox Z, et al. Enlarged perivascular spaces as a marker of underlying arteriopathy in intracerebral haemorrhage: a multicentre MRI cohort study. J Neurol Neurosurg Psychiatry, 2013, 84(6): 624-629.
18. Klarenbeek P, van Oostenbrugge RJ, Lodder J, et al. Higher ambulatory blood pressure relates to enlarged Virchow-Robin spaces in first-ever lacunar stroke patients. J Neurol, 2013, 260(1): 115-121.
19. Weller R, Subash M, Preston S, et al. Perivascular drainage of amyloid-b peptides from the brain and its failure in cerebral amyloid angiopathy and Alzheimer’s disease. Brain Pathology, 2008, 18(2): 253-266.
20. Vinters HV. Cerebral amyloid angiopathy//Pardridge WM. Introduction to the blood-brain barrier: methodology, biology and pathology. Cambridge: Cambridge University Press, 2006: 379.

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