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Classification of white matter lesions and characteristics of small vessel disease markers

  • Neuro
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Abstract

Objectives

Radiological markers for cerebral small vessel disease (SVD) may have different biological underpinnings in their development. We attempted to categorize SVD burden by integrating white matter signal abnormalities (WMSA) features and secondary presence of lacunes, microbleeds, and enlarged perivascular spaces.

Methods

Data were acquired from 610 older adults (aged > 40 years) who underwent brain magnetic resonance imaging exam as part of a health checkup. The WMSA were classified individually by the number and size of non-contiguous lesions, distribution, and contrast. Age-detrended lacunes, microbleeds, and enlarged perivascular space were quantified to further categorize individuals. Clinical and laboratory values were compared across the individual classes.

Results

Class I was characterized by multiple, small, deep WMSA but a low burden of lacunes and microbleeds; class II had large periventricular WMSA and a high burden of lacunes and microbleeds; and class III had limited juxtaventricular WMSA and lacked lacunes and microbleeds. Class II was associated with older age, diabetes, and a relatively higher neutrophil-to-lymphocyte ratio. Smoking and higher uric acid levels were associated with an increased risk of class I.

Conclusion

The heterogeneity of SVD was categorized into three classes with distinct clinical correlates. This categorization will improve our understanding of SVD pathophysiology, risk stratification, and outcome prediction.

Key Points

• Classification of white matter signal abnormality (WMSA) features was associated with different characteristic of lacunes, microbleeds, and enlarged perivascular space and clinical variability.

• Class I was characterized by multiple, small, deep WMSA but a low burden of lacunes and microbleeds. Class II had large periventricular WMSA and a high burden of lacunes and microbleeds. Class III had limited juxtaventricular WMSA and lacked lacunes and microbleeds.

• Class II was associated with older age, diabetes, and higher neutrophil-to-lymphocyte ratio. Smoking and higher uric acid levels were associated with an increased risk of class I.

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Abbreviations

CMB:

Cerebral microbleeds

EPVS:

Enlarged perivascular spaces

NLR:

Neutrophil-to-lymphocyte ratio

SVD:

Small vessel disease

WMSA:

White matter signal abnormalities

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Funding

This work was supported by grants from the SNUH Research Fund (0520200010) and the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (2020R1A2C1100337).

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Authors and Affiliations

  1. Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Kyung-Il Park, Keun-Hwa Jung, Eung-Joon Lee, Woo-Jin Lee, Seol Ah Hwang & Sohyun Kim

  2. Department of Neurology, Seoul National University Healthcare System Gangnam Center, Seoul, South Korea

    Kyung-Il Park

  3. Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea

    Keun-Hwa Jung

  4. Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea

    Woo-Jin Lee

  5. Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    David H. Salat

  6. VA Boston Healthcare System, Neuroimaging Research for Veterans Center, Boston, MA, USA

    David H. Salat

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  1. Kyung-Il Park
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Corresponding author

Correspondence to Keun-Hwa Jung.

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Guarantor

The scientific guarantor of this publication is Keun-Hwa Jung, MD, PhD.

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

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

Ethical approval

This study was approved by the institutional review board of Seoul National University Hospital.

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• Retrospective

• Cross-sectional study

• Performed at one institution

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Park, KI., Jung, KH., Lee, EJ. et al. Classification of white matter lesions and characteristics of small vessel disease markers. Eur Radiol 33, 1143–1151 (2023). https://doi.org/10.1007/s00330-022-09070-1

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  • DOI: https://doi.org/10.1007/s00330-022-09070-1

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