European journal of radiology · 2025
Unraveling heterogeneous mechanisms of cerebral small vessel disease: A whole-brain vessel wall imaging study.
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Wang Junjun, Cheng Lin, Mo Yejia, Yang Di, Liu Xiaoli, Qiao Song, Zhang Jianjun, Wan Shu
Аннотация
OBJECTIVE: Cerebral small vessel disease (CSVD) impairs cognitive function, yet its treatment remains challenging due to the variability in MRI findings. This study aimed to investigate the heterogeneous mechanisms underlying CSVD by integrating whole-brain vessel wall imaging (WB-VWI) and blood biomarkers.
METHODS: A retrospective analysis was conducted on patients who underwent WB-VWI between January 2020 and September 2024. Vessel wall characteristics and CSVD manifestations, including white matter hyperintensities (WMH), lacunes, and enlarged perivascular spaces (EPVS), were evaluated using MRI. Correlation and regression analyses examined the associations between vessel wall characteristics and CSVD manifestations, while mediation analysis explored the role of vessel wall characteristics in linking blood biomarkers to CSVD.
RESULTS: 206 patients were analyzed finally. After adjusting for confounders, a higher plaque burden index was associated with greater WMH burden (β = 1.916, padj < 0.001), more lacunes (β = 1.980, padj = 0.013), and increased basal ganglia EPVS (Estimate = 2.910, padj = 0.035). Multivariable regression revealed that only vessel wall enhanced ratio was positively correlated with WMH burden (β = 0.568, padj < 0.001). Additionally, neutrophil percentage correlated with both plaque burden index (r = 0.233, p = 0.001) and WMH burden (r = 0.308, p < 0.001), with plaque burden index mediating the relationship between neutrophils and WMH burden (β = 0.0061, Bootstrapped 95 % CI: 0.0019-0.0105).
CONCLUSION: Atherosclerosis may be a common underlying factor in the imaging manifestations of CSVD, with inflammation contributing to its heterogeneity. Further research is needed to clarify these mechanisms.
METHODS: A retrospective analysis was conducted on patients who underwent WB-VWI between January 2020 and September 2024. Vessel wall characteristics and CSVD manifestations, including white matter hyperintensities (WMH), lacunes, and enlarged perivascular spaces (EPVS), were evaluated using MRI. Correlation and regression analyses examined the associations between vessel wall characteristics and CSVD manifestations, while mediation analysis explored the role of vessel wall characteristics in linking blood biomarkers to CSVD.
RESULTS: 206 patients were analyzed finally. After adjusting for confounders, a higher plaque burden index was associated with greater WMH burden (β = 1.916, padj < 0.001), more lacunes (β = 1.980, padj = 0.013), and increased basal ganglia EPVS (Estimate = 2.910, padj = 0.035). Multivariable regression revealed that only vessel wall enhanced ratio was positively correlated with WMH burden (β = 0.568, padj < 0.001). Additionally, neutrophil percentage correlated with both plaque burden index (r = 0.233, p = 0.001) and WMH burden (r = 0.308, p < 0.001), with plaque burden index mediating the relationship between neutrophils and WMH burden (β = 0.0061, Bootstrapped 95 % CI: 0.0019-0.0105).
CONCLUSION: Atherosclerosis may be a common underlying factor in the imaging manifestations of CSVD, with inflammation contributing to its heterogeneity. Further research is needed to clarify these mechanisms.