The Association Between Perivascular Spaces and Cerebral Blood Flow, Brain Volume, and Cardiovascular Risk

Liu, Sirui; Hou, Bo; You, Hui; Zhang, Yiwei; Zhu, Yi-Cheng; Ma, Chao; Zuo, Zhentao; Feng, Feng

doi:10.3389/fnagi.2021.599724

Cited by 8 publications

(6 citation statements)

References 46 publications

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“…Liu et al [ 58 ] investigated the relationship between pseudo-continuous ASL CBF and BG ePVS in a healthy sample. They found a negative association between gray matter CBF and BG ePVS, with significant hypoperfusion observed in those with high grade BG ePVS in multiple cortical regions.…”

Section: Resultsmentioning

confidence: 99%

Imaging the neurovascular unit in health and neurodegeneration: a scoping review of interdependencies between MRI measures

Rowsthorn,

Pham,

Nazem-Zadeh

et al. 2023

Fluids Barriers CNS

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The neurovascular unit (NVU) is a complex structure that facilitates nutrient delivery and metabolic waste clearance, forms the blood–brain barrier (BBB), and supports fluid homeostasis in the brain. The integrity of NVU subcomponents can be measured in vivo using magnetic resonance imaging (MRI), including quantification of enlarged perivascular spaces (ePVS), BBB permeability, cerebral perfusion and extracellular free water. The breakdown of NVU subparts is individually associated with aging, pathology, and cognition. However, how these subcomponents interact as a system, and how interdependencies are impacted by pathology remains unclear. This systematic scoping review identified 26 studies that investigated the inter-relationships between multiple subcomponents of the NVU in nonclinical and neurodegenerative populations using MRI. A further 112 studies investigated associations between the NVU and white matter hyperintensities (WMH). We identify two putative clusters of NVU interdependencies: a ‘vascular’ cluster comprising BBB permeability, perfusion and basal ganglia ePVS; and a ‘fluid’ cluster comprising ePVS, free water and WMH. Emerging evidence suggests that subcomponent coupling within these clusters may be differentially related to aging, neurovascular injury or neurodegenerative pathology.

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Section: Resultsmentioning

confidence: 99%

Imaging the neurovascular unit in health and neurodegeneration: a scoping review of interdependencies between MRI measures

Rowsthorn,

Pham,

Nazem-Zadeh

et al. 2023

Fluids Barriers CNS

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“… 62 Recent arterial spin labelling (ASL) studies have shown that perivascular perfusion alterations are associated with cerebral blood flow in the aging population. 63 Such alterations in blood flow and perfusion can have profound effects on tissue health and integrity. Hetzer et al .…”

Section: Discussionmentioning

confidence: 99%

Associations between vascular health, brain stiffness and global cognitive function

Pavuluri,

Huston,

Ehman

et al. 2024

Brain Communications

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Vascular brain injury results in loss of structural and functional connectivity and leads to cognitive impairment. Its various manifestations, including microinfarcts, microhemorrhages, and white matter hyperintensities (WMH), result in microstructural tissue integrity loss and secondary neurodegeneration. Among these, tissue microstructural alteration is a relatively early event compared to atrophy along the aging and neurodegeneration continuum. Understanding its association with cognition may provide the opportunity to further elucidate the relationship between vascular health and clinical outcomes. Magnetic Resonance Elastography (MRE) offers a non-invasive approach to evaluate tissue mechanical properties, providing a window into the microstructural integrity of the brain. This retrospective study evaluated brain stiffness as a potential biomarker for vascular brain injury and its role in mediating the impact of vascular dysfunction on cognitive impairment. Seventy-five participants from the Mayo Clinic Study of Aging underwent brain imaging using a 3T-MR imager with a spin-echo echo planar imaging sequence for MRE, T1 and T2-weighted pulse sequences. This study evaluated the effects of vascular biomarkers (WMH and cardiometabolic condition score [CMC]) on brain stiffness using voxel-wise analysis. Partial correlation analysis explored associations between brain stiffness, WMH, CMC, and global cognition. Mediation analysis determined the role of stiffness in mediating the relationship between vascular biomarkers and cognitive performance. Statistical significance was set at P values <0.05. Diagnostic accuracy of MRE stiffness for WMH and CMC was evaluated using Receiver Operator Characteristic curves. Voxel-wise linear-regression analysis indicated WMH negatively correlates with brain stiffness, specifically in periventricular regions with high WMH levels. A negative association between cardiovascular risk factors and stiffness was also observed across the brain. No significant patterns of stiffness changes were associated with amyloid-load. Global stiffness (µ) negatively correlated with both WMH and CMC when all other covariables including amyloid load were controlled. The positive correlation between WMH and CMC weakened and became statistically insignificant when controlling for other covariables. Brain stiffness and global cognition were positively correlated, maintaining statistical significance after adjusting for all covariables. These findings suggest mechanical alterations are associated with cognitive dysfunction and vascular brain injury. Brain stiffness significantly mediated the indirect effects of WMH and CMC on global cognition. Local cerebrovascular diseases (assessed by WMH) and systemic vascular risk factors (assessed by CMC) impact brain stiffness with spatially and statistically distinct effects. Global brain stiffness is a significant mediator between vascular disease measures and cognitive function, highlighting the value of MRE-based mechanical assessments in understanding this relationship.

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“…More recent studies have focused on the imaging feature and function of PVS and its correlation with clinical disorders. [9][10][11] However, there is no comprehensive study on the composition of cheese sign, ignoring the various lesions more than the PVS.…”

Section: Discussionmentioning

confidence: 99%

Assessment of cheese sign and its association with vascular risk factors: Data from PUMCH dementia cohort

Huang,

Hou,

Wang

et al. 2023

Chinese Medical Journal

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Background: In the clinic, practitioners encounter many patients with an abnormal pattern of dense punctate magnetic resonance imaging (MRI) signal in the basal ganglia, a phenomenon known as "cheese sign". This sign is reported as common in cerebrovascular diseases, dementia, and old age. Recently, cheese sign has been speculated to consist of dense perivascular space (PVS). This study aimed to assess the lesion types of cheese sign and analyze the correlation between this sign and vascular disease risk factors. Methods: A total of 812 patients from Peking Union Medical College Hospital (PUMCH) dementia cohort were enrolled. We analyzed the relationship between cheese sign and vascular risk. For assessing cheese sign and defining its degree, the abnormal punctate signals were classified into basal ganglia hyperintensity (BGH), PVS, lacunae/infarctions and microbleeds, and counted separately. Each type of lesion was rated on a four-level scale, and then the sum was calculated; this total was defined as the cheese sign score. Fazekas and Age-Related White Matter Changes (ARWMC) scores were used to evaluate the paraventricular, deep, and subcortical gray/white matter hyperintensities. Results: A total of 118 patients (14.5%) in this dementia cohort were found to have cheese sign. Age (odds ratio [OR]: 1.090, 95% confidence interval [CI]: 1.064–1.120, P <0.001), hypertension (OR: 1.828, 95% CI: 1.123–2.983, P = 0.014), and stroke (OR: 1.901, 95% CI: 1.092–3.259, P = 0.025) were risk factors for cheese sign. There was no significant relationship between diabetes, hyperlipidemia, and cheese sign. The main components of cheese sign were BGH, PVS, and lacunae/infarction. The proportion of PVS increased with cheese sign severity. Conclusions: The risk factors for cheese sign were hypertension, age, and stroke. Cheese sign consists of BGH, PVS, and lacunae/infarction.

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The Association Between Perivascular Spaces and Cerebral Blood Flow, Brain Volume, and Cardiovascular Risk

Cited by 8 publications

References 46 publications

Imaging the neurovascular unit in health and neurodegeneration: a scoping review of interdependencies between MRI measures

Imaging the neurovascular unit in health and neurodegeneration: a scoping review of interdependencies between MRI measures

Associations between vascular health, brain stiffness and global cognitive function

Assessment of cheese sign and its association with vascular risk factors: Data from PUMCH dementia cohort

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