Dolui, Tisdall, Vidorreta, Jacobs, Nasrallah, Bryan, Wolk, Detre (2019) Characterizing a perfusion-based periventricular small vessel region of interest NeuroImage. Clinical 23() 101897


The periventricular white matter (PVWM) is supplied by terminal distributions of small vessels and is particularly susceptible to developing white matter lesions (WML) associated with cerebral small vessel disease (CSVD). We obtained group-averaged cerebral blood flow (CBF) maps from Arterial Spin Labeled (ASL) perfusion MRI data obtained in 436 middle-aged (50.4 ± 3.5 years) subjects in the NHLBI CARDIA study and in 61 elderly (73.3 ± 6.9 years) cognitively normal subjects recruited from the Penn Alzheimer's Disease Center (ADC) and found that the lowest perfused brain voxels are located within the PVWM. We constructed a white matter periventricular small vessel (PSV) region of interest (ROI) by empirically thresholding the group averaged CARDIA CBF map at CBF < 15 ml/100 g/min. Thereafter we compared CBF in the PSV ROI and in the remaining white matter (RWM) with the location and volume of WML measured with Fluid Attenuated Inversion Recovery (FLAIR) MRI. WM CBF was lower within WML than outside WML voxels (p < <0.0001) in both the PSV and RWM ROIs, however this difference was much smaller (p < <0.0001) in the PSV ROI than in the RWM suggesting a more homogenous reduction of CBF in the PSV region. Normalized WML volumes were significantly higher in the PSV ROI than in the RWM and in the elderly cohort as compared to the middle-aged cohort (p < <0.0001). Additionally, the PSV ROI showed a significantly (p = .001) greater increase in lesion volume than the RWM in the elderly ADC cohort than the younger CARDIA cohort. Considerable intersubject variability in PSV CBF observed in both study cohorts likely represents biological variability that may be predictive of future WML and/or cognitive decline. In conclusion, a data-driven PSV ROI defined by voxels with low perfusion in middle age defines a region with homogeneously reduced CBF that is particularly susceptible to progressive ischemic injury in elderly controls. PSV CBF may provide a mechanistically specific biomarker of CSVD. Copyright © 2019. Published by Elsevier Inc.

脑室周围白质(PVWM)由小血管的末端分布提供,并且特别容易发生与脑小血管病(CSVD)相关的白质病变(WML)。我们从NHLBI CARDIA研究中的436名中年(50.4±3.5岁)受试者和61名老年人(73.3±6.9岁)中获得的动脉旋转标记(ASL)灌注MRI数据获得了组平均脑血流量(CBF)图。从宾夕法尼亚阿尔茨海默病中心(ADC)招募的认知正常受试者发现最低灌注的脑体素位于PVWM内。我们通过经验阈值化CBF <15 ml / 100 g / min的组平均CARDIA CBF图来构建白质脑室周围小血管(PSV)感兴趣区域(ROI)。此后,我们将PSV ROI和剩余白质(RWM)中的CBF与流体衰减反转恢复(FLAIR)MRI测量的WML的位置和体积进行比较。在PSV和RWM ROI中,WML内的WM CBF低于WML体素(p <0.0001),但PSV ROI中的差异远小于RWM中的差异(p <0.0001),表明更均匀的减少PSV地区的CBF。与中年人群相比,PSV ROI中的归一化WML体积显着高于RWM和老年人群(p <0.0001)。此外,与年轻的CARDIA队列相比,PSV ROI显示病变体积的显着增加(p = .001)比老年ADC队列中的RWM更大。在两个研究队列中观察到的PSV CBF中相当大的主体间变异性可能代表可预测未来WML和/或认知衰退的生物学变异性。总之,由中年低灌注体素定义的数据驱动的PSV ROI定义了CBF均匀降低的区域,其对老年对照中的进行性缺血性损伤特别敏感。 PSV CBF可以提供CSVD的机械特异性生物标志物。版权所有©2019。由Elsevier Inc.出版