Volumetric White Matter Hyperintensity Ranges Correspond to Fazekas Scores on Brain MRI

Andere, Ariana J; Jindal, Gaurav; Molino, Janine; Collins, Scott; Merck, Derek; Burton, Tina; Stretz, Christoph; Yaghi, Shadi; Sacchetti, Daniel; Jamal, Sleiman El; Reznik, Michael; Furie, Karen L.; Cutting, Shawna

doi:10.1016/j.jstrokecerebrovasdis.2022.106333

Cited by 18 publications

(14 citation statements)

References 12 publications

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“…The presence of bi-hemispheric infarctions ( p = 0.001), presence ( p = 0.006), size ( p = 0.016) and number ( p = 0.005) of cerebral-microbleed (CMB) were higher risk of PRES. There was no significant association between the presence or severity of white matter hyperintensities [as measured by Fazekas score ( 13 )] and the risk of PRES.…”

Section: Results and Summarymentioning

confidence: 96%

Posterior reversible encephalopathy syndrome post stem cell transplantation in sickle cell disease: case series and literature review

BinAmir,

AlAhmari,

AlQahtani

et al. 2024

Front. Med.

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IntroductionPosterior reversible encephalopathy syndrome (PRES) is a serious neurological syndrome that may develop following immunosuppressive therapy for stem cell transplantation (SCT). We report 8 patients with sickle cell disease (SCD) who developed PRES, which is likely to be related to immunosuppression.MethodsThis is retrospective cohort analysis of the SCD registry at the King Faisal Specialist Hospital and Research Center (KFSHRC) in Riyadh, Saudi Arabia. Inclusion criteria included all adults SCD patients who underwent SCT from 2011 until 2022. We explored all cases of PRES in patients with SCT. PRES was diagnosed with MRI imaging showing reversible vasogenic cerebral edema associated with neurological symptoms including severe headache, seizures, encephalopathy, delirium, and visual disturbances.ResultsDuring ten years follow-up (2011–2022) we found 8 patients with PRES (age range between 14 to 37 years at diagnosis) PRES occurred 8 to 124 days following SCT in 7 cases and one patient developed PRES 8 months prior to SCT. All patients were on immunosuppressive medications, including tacrolimus, cyclosporine, sirolimus and or mycophenolate mofetil. Headache, seizures, visual hallucinations, confusion, and drowsiness were the most common presenting symptoms. MRI showed abnormalities in the occipital, parietal and frontal lobes in most cases. Recovery was complete in all patients and no recurrences were noted. Two patients had graft versus host disease (GVHD). We compared risk factors for PRES among the 8 cases and 136 SCT in SCD patients who did not develop PRES. There was a significant association between PRES and imaging abnormalities, including previous bi-hemispheric infarctions (p = 0.001), and cerebral microbleeds (CBMs). PRES was strongly associated with presence (p = 0.006), size (p = 0.016) and number (p = 0.005) of CMBs.ConclusionPRES can develop days to weeks following SCT in patients with SCD, and is associated with immunosuppressive therapy, previous bi-hemispheric infarctions and CMB. Prompt recognition and intervention leads to good recovery.

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Section: Results and Summarymentioning

confidence: 96%

Posterior reversible encephalopathy syndrome post stem cell transplantation in sickle cell disease: case series and literature review

BinAmir,

AlAhmari,

AlQahtani

et al. 2024

Front. Med.

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“…Over decades, measurements of white matter lesions have evolved from visual rating methods to semi-automated volumetry to tractography. Some evidence suggests high reliability and more efficacy of semi-automatic volume measurement than visual rating methods ( 45 , 46 ). We used visual rating scale in this study, CHIPS in particular, which was validated by high correlation to the volumetric analysis of the cholinergic pathways ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

White matter hyperintensities in cholinergic pathways are associated with dementia severity in e4 carriers but not in non-carriers

Chuang²,

Wu³

et al. 2023

Front. Neurol.

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Background and objectivesAmong individuals with Alzheimer's disease (AD), APOE e4 carriers with increased white matter hyperintensities (WMHs) may selectively be at increased risk of cognitive impairment. Given that the cholinergic system plays a crucial role in cognitive impairment, this study aimed to identify how APOE status modulates the associations between dementia severity and white matter hyperintensities in cholinergic pathways.MethodsFrom 2018 to 2022, we recruited participants (APOE e4 carriers, n = 49; non-carriers, n = 117) from the memory clinic of Cardinal Tien Hospital, Taipei, Taiwan. Participants underwent brain MRI, neuropsychological testing, and APOE genotyping. In this study, we applied the visual rating scale of the Cholinergic Pathways Hyperintensities Scale (CHIPS) to evaluate WMHs in cholinergic pathways compared with the Fazekas scale. Multiple regression was used to assess the influence of CHIPS score and APOE carrier status on dementia severity based on Clinical Dementia Rating—Sum of Boxes (CDR-SB).ResultsAfter adjusting for age, education and sex, higher CHIPS scores tended to be associated with higher CDR-SB in APOE e4 carriers but not in the non-carrier group.ConclusionsCarriers and non-carriers present distinct associations between dementia severity and WMHs in cholinergic pathways. In APOE e4 carriers, increased white matter in cholinergic pathways are associated with greater dementia severity. In non-carriers, WMHs exhibit less predictive roles for clinical dementia severity. WMHs on the cholinergic pathway may have a different impact on APOE e4 carriers vs. non-carriers.

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“…Severe WMH were defined as a volume of 16.1 milliliter or more, corresponding to a Fazekas score of 3. 25,26 All scans were appraised by trained research physicians for the presence of cerebral microbleeds (i.e., small round to ovoid hypointense areas on T2*-weighted images), lacunes (i.e., focal cavitating lesions ≥3 and <15 mm), and cortical infarcts. 27 These ratings were done blinded to clinical data.…”

Section: Methodsmentioning

confidence: 99%

Generalizability of trial criteria on amyloid-lowering therapy against Alzheimer’s disease to individuals with MCI or early AD in the general population

Claus,

vom Hofe,

van Ijlzinga Veenstra

et al. 2024

Preprint

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BackgroundTreatment with monoclonal antibodies against amyloid-β slowed cognitive decline in recent randomized clinical trials in patients with mild cognitive impairment (MCI) and early dementia due to Alzheimer’s disease (AD). However, stringent trial eligibility criteria may affect generalizability of these findings to clinical practice.MethodsWe extracted eligibility criteria for trials of aducanumab, lecanemab and donanemab from published reports, and applied these to participants with MCI or early clinical AD dementia from the population-based Rotterdam Study. Participants underwent questionnaires, genotyping, brain MRI, cognitive testing, and cardiovascular assessment. We had continuous linkage with medical records and pharmacy dispensary data. We determined amyloid status using an established and validated prediction model based on age andAPOEgenotype. We assessed progression to dementia within 5 years among participants with MCI, stratified for eligibility.ResultsOf 968 participants (mean age: 75 years, 56% women), 779 had MCI and 189 early clinical AD dementia. Across the three drug trials, around 40% of participants would be ineligible because of predicted amyloid negativity. At least one clinical exclusion criterion was present in 76.3% (95% CI; 73.3-79.3) of participants for aducanumab, 75.8% (73.0-78.7) for lecanemab, and 59.8% (56.4–63.3) for donanemab. Criteria that most often led to exclusion were a history of cardiovascular disease (35.2%), use of anticoagulant (31.2%), use of psychotropic or immunological medications (20.4%), history of anxiety or depression (15.9%), or lack of social support (15.6%). One-third of participants were ineligible based on brain MRI findings alone, which was similar across trials and due predominantly to various manifestations of cerebral small-vessel disease. Combining amyloid, clinical, and imaging criteria, eligibility ranged from 9% (7.0-11.1) for aducanumab, 8% (6.2-9.9) lecanemab to 15% (12.4-17.5) for donanemab. Risk of progression to dementia tended to be higher for ineligible than for eligible participants for lecanemab (hazard ratio [95%CI]: 1.64 [0.92-2.91]), aducanumab (HR: 1.17 [0.65-2.12]), and only marginally for donanemab (HR: 1.03 [0.67-1.59]).ConclusionsFindings from recent RCTs reporting protective effects of monoclonal antibodies against amyloid-β are applicable to less than 15% of community-dwelling individuals with MCI or early AD. These findings underline that evidence for drug efficacy and safety is lacking for the vast majority of patients with MCI/AD in routine clinical practice.

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Volumetric White Matter Hyperintensity Ranges Correspond to Fazekas Scores on Brain MRI

Cited by 18 publications

References 12 publications

Posterior reversible encephalopathy syndrome post stem cell transplantation in sickle cell disease: case series and literature review

Posterior reversible encephalopathy syndrome post stem cell transplantation in sickle cell disease: case series and literature review

White matter hyperintensities in cholinergic pathways are associated with dementia severity in e4 carriers but not in non-carriers

Generalizability of trial criteria on amyloid-lowering therapy against Alzheimer’s disease to individuals with MCI or early AD in the general population

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