Prediction for the Total MRI Burden of Cerebral Small Vessel Disease With Retinal Microvascular Abnormalities in Ischemic Stroke/TIA Patients

Abstract

Background and Purpose: The association of retinal microvascular abnormalities with the total cerebral small vessel disease (cSVD) burden found on brain MRI has not been determined. In the present study, we examined whether the retinopathy score could predict the total cSVD burden in ischemic stroke/transient ischemic attack (TIA) patients. A simple practical diagnostic tool may help identify candidates for MRI screening. Methods: We consecutively collected clinical data including retinal photography and cerebral MRI of ischemic stroke/TIA patients from August 2016 to August 2017 at our stroke center. The retinopathy score was assessed by the Keith-Wagener-Barker grading system for analyzing retinal microvascular abnormalities. To evaluate the total cSVD burden, the total cSVD score was assessed by awarding one point for the presence of each marker of cSVD on MRI. The clinical characteristics and retinopathy score were analyzed across patients for each total cSVD score. The association between the retinopathy score and the total cSVD score was analyzed. Results: Among the 263 enrolled patients, the frequency of hypertension in patients with a total cSVD score of 2, 3, or 4 was higher than that in patients with a score of 0 (69.5, 71.7, and 89.2% vs. 45.2% respectively, all P < 0.05). The retinopathy score was related to the total cSVD score (r = 0.687, P < 0.001). Adjusted multivariate ordinal regression showed that the retinopathy score was independently correlated with the total cSVD score (odds ratio [OR], 4.18; 95% confidence interval [CI], 3.07-5.70) after adjustment for age, history of hypertension, previous stroke/TIA and current smoking. The c statistics were 0.30 (95% CI, 0.24-0.37; P < 0.05), 0.46 (95% CI, 0.39-0.53; P = 0.303), 0.79 (95% CI, 0.72-0.86; P < 0.001), and 0.81 (95% CI, 0.74-0.88; P < 0.001) for predicting the total cSVD score of 1, 2, 3, and 4 respectively. Conclusions: These results suggest that retinal microvascular abnormalities have predictive value for severe total cSVD burden in ischemic stroke/TIA patients.

Correlation Between Retinal Microvascular Abnormalities and Total Magnetic Resonance Imaging Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes

“…This study also found that age and hypertension were independent risk factors for increased total MRI burden of CSVD, which is consistent with the results of previous studies ( Hernandez-Diaz et al, 2019 ; Shu et al, 2020 ). Nam et al (2020) found that in patients with no history of cerebrovascular disease, a high triglyceride-glucose index was associated with a higher total burden of CSVD, suggesting that this index may be a convenient and useful predictor of CSVD.…”

“…The effectiveness and applicability of this scoring system for CSVD have been demonstrated in a growing number of studies (Lau et al, 2017;Yang et al, 2019;Shu et al, 2020). Previous research has shown that retinal microvascular dysfunction is related to diabetes mellitus; this dysfunction includes not only DR but also subtle abnormalities in the structure and function of retinal microvascular vessels, such as retinal venule dilation or arteriole reduction, and increased fractal dimension (Stehouwer, 2018;van Sloten et al, 2020).…”

“…It is a relatively new scoring system in recent years that can comprehensively evaluate the combined effect of CSVD lesions. The effectiveness and applicability of this scoring system for CSVD have been demonstrated in a growing number of studies ( Lau et al, 2017 ; Yang et al, 2019 ; Shu et al, 2020 ).…”

“…Magnetic resonance imaging (MRI) features of CSVD can include white matter hyperintensities (WMHs), lacunes, enlarged perivascular spaces (PVS), and cerebral microbleeds (CMBs), all of which may be a manifestation of cerebral microvascular dysfunction. In recent years, numerous studies have demonstrated a significant correlation between CSVD and retinal vascular changes ( McGrory et al, 2019 ; Shu et al, 2020 ). Sanahuja et al (2016) also found that the presence of DR is associated with more severe CSVD.…”

The association of global vessel width with cognitive decline and cerebral small vessel disease burden in the KaiLuan study

“…Different from the previous study, our research failed to detect any associations between the total CSVD burden score and conventional RMPs (CRAE, CRVE, FD, AVR). A possible explanation for the lack of association may be that other disorders that can have a profound effect on ocular biomarkers (such as hypertension, diabetes and coronary/cardiovascular disease), and may obscure a possible neurodegenerative effect ( 20 , 37 ). Another explanation can be that our study was based on the whole population (aged 23–83 years), while other age-related processes may affect ocular biomarkers ( 38 ).…”