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Risk factors analysis according to regional distribution of white matter hyperintensities in a stroke cohort

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Abstract

Objectives

The spectrum of distribution of white matter hyperintensities (WMH) may reflect different functional, histopathological, and etiological features. We examined the relationships between cerebrovascular risk factors (CVRF) and different patterns of WMH in MRI using a qualitative visual scale in ischemic stroke (IS) patients.

Methods

We assembled clinical data and imaging findings from patients of two independent cohorts with recent IS. MRI scans were evaluated using a modified visual scale from Fazekas, Wahlund, and Van Swieten. WMH distributions were analyzed separately in periventricular (PV-WMH) and deep (D-WMH) white matter, basal ganglia (BG-WMH), and brainstem (B-WMH). Presence of confluence of PV-WMH and D-WMH and anterior-versus-posterior WMH predominance were also evaluated. Statistical analysis was performed with SPSS software.

Results

We included 618 patients, with a mean age of 72 years (standard deviation [SD] 11 years). The most frequent WMH pattern was D-WMH (73%). In a multivariable analysis, hypertension was associated with PV-WMH (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.29–2.50, p = 0.001) and BG-WMH (OR 2.13, 95% CI 1.19–3.83, p = 0.012). Diabetes mellitus was significantly related to PV-WMH (OR 1.69, 95% CI 1.24–2.30, p = 0.001), D-WMH (OR 1.46, 95% CI 1.07–1.49, p = 0.017), and confluence patterns of D-WMH and PV-WMH (OR 1.62, 95% CI 1.07–2.47, p = 0.024). Hyperlipidemia was found to be independently related to brainstem distribution (OR 1.70, 95% CI 1.08–2.69, p = 0.022).

Conclusions

Different CVRF profiles were significantly related to specific WMH spatial distribution patterns in a large IS cohort.

Key Points

• An observational study of WMH in a large IS cohort was assessed by a modified visual evaluation.

• Different CVRF profiles were significantly related to specific WMH spatial distribution patterns.

• Distinct WMH anatomical patterns could be related to different pathophysiological mechanisms.

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Abbreviations

AF:

Atrial fibrillation

BG-WMH:

Basal ganglia white matter hyperintensities

BMI:

Body mass index

B-WMH:

Brainstem white matter hyperintensities

CAD:

Coronary artery disease

CI:

Confidence interval

CVRF:

Cerebrovascular risk factors

D-WMH:

Deep white matter hyperintensities

FLAIR:

Fluid attenuated inversion recovery

IQR:

Interquartile range

IS:

Ischemic stroke

OR:

Odds ratio

PV-WMH:

Periventricular white matter hyperintensities

SVD:

Small vessel disease

TIA:

Transient ischemic attack

WMH:

White matter hyperintensities

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Acknowledgements

U Can Have It Translations provided English language assistance.

Funding

This study was supported in part by Spain’s Ministry of Health (Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III FEDER, RD12/0042/0020 INVICTUS-PLUS). HERO multicenter study was supported by Fondo de Investigaciones Sanitarias Instituto de Salud Carlos III (FI12/00296; RETICS INVICTUS PLUS RD16/0019/ 0010; FEDER) and an unrestricted grant from Bristol-Myers Squibb/Pfizer. The study is part of the Stroke Project, Cerebrovascular Diseases Study Group of the Spanish Neurological Society. Eva Giralt-Steinhauer received funding from Instituto de Salud Carlos III, with a Grant (JR18/00004). Carla Avellaneda received funding from Instituto de Salud Carlos III, with a Grant (CM18/00040). Isabel Fernandez received funding from Instituto de Salud Carlos III, with a Grant (CM/00003). Neither the funders nor the sponsor had any input into our study design; data collection, data analyses, and data interpretation; writing of the report; or the decision to submit the manuscript for publication. The corresponding author had full access to all data and had final responsibility for the decision to submit for publication.

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Authors and Affiliations

  1. Department of Neuroradiology, Hospital Clínic i Provincial, Villarroel, 170, Barcelona, Spain

    Santiago Medrano-Martorell & Sofía González-Ortiz

  2. Department of Neuroradiology, Hospital del Mar, Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

    Santiago Medrano-Martorell, Jaume Capellades, Sofía González-Ortiz & Marta Vilas-González

  3. Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d’Investigacions Mèdiques), Universitat Autònoma de Barcelona (UAB)/DCEXS-Universitat Pompeu Fabra (UPF), Barcelona, Spain

    Jordi Jiménez-Conde, Ana Rodríguez-Campello, Ángel Ois, Elisa Cuadrado-Godia, Carla Avellaneda, Isabel Fernández, Jaume Roquer & Eva Giralt-Steinhauer

  4. Department of Neuroradiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

    Elisa Merino-Peña

  5. Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

    Joan Martí-Fàbregas

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  1. Santiago Medrano-Martorell
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  2. Jaume Capellades
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  3. Jordi Jiménez-Conde
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  13. Joan Martí-Fàbregas
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  14. Eva Giralt-Steinhauer
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Corresponding author

Correspondence to Santiago Medrano-Martorell.

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Guarantor

The scientific guarantor of this publication is Eva Giralt-Steinhauer.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Eva Giralt-Steinhauer kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported; the MRI of a total of 274 patients from the HERO study cohort were included. The results of this study were previously published: Martí-Fàbregas J, Medrano-Martorell S, Merino E, et al MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation. Neurology. 2019;92(21):e2432-e2443.

Methodology

• retrospective

• cross-sectional study

• multicenter study

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Medrano-Martorell, S., Capellades, J., Jiménez-Conde, J. et al. Risk factors analysis according to regional distribution of white matter hyperintensities in a stroke cohort. Eur Radiol 32, 272–280 (2022). https://doi.org/10.1007/s00330-021-08106-2

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