TY - JOUR
T1 - Clinical Associations and Prognostic Value of MRI-Visible Perivascular Spaces in Patients With Ischemic Stroke or TIA
T2 - A Pooled Analysis
AU - Best, Jonathan G
AU - Ambler, Gareth
AU - Wilson, Duncan
AU - Du, Houwei
AU - Lee, Keon-Joo
AU - Lim, Jae-Sung
AU - Teo, Kay Cheong
AU - Mak, Henry
AU - Kim, Young Dae
AU - Song, Tae-Jin
AU - Selcuk Demirelli, Derya
AU - Nishihara, Masashi
AU - Yoshikawa, Masaaki
AU - Kubacka, Marta
AU - Zietz, Annaelle
AU - Al-Shahi Salman, Rustam
AU - Jäger, Hans Rolf
AU - Lip, Gregory Y H
AU - Panos, Leonidas
AU - Goeldlin, Martina B
AU - Slater, Lee-Anne
AU - Karayiannis, Christopher Charles
AU - Phan, Thanh G
AU - Bellut, Maximilian
AU - Abrigo, Jill
AU - Cheng, Cyrus
AU - Leung, Thomas W
AU - Chu, Winnie
AU - Chappell, Francesca
AU - Makin, Stephen D J
AU - van Dam-Nolen, Dianne H K
AU - Kooi, M Eline
AU - Köhler, Sebastian
AU - Staals, Julie
AU - Kuchcinski, Grégory
AU - Bordet, Régis
AU - Dubost, Florian
AU - Wardlaw, Joanna M
AU - Soo, Yannie O Y
AU - Fluri, Felix
AU - Srikanth, Velandai K
AU - Jung, Simon
AU - Peters, Nils
AU - Hara, Hideo
AU - Yakushiji, Yusuke
AU - Necioglu Orken, Dilek
AU - Heo, Ji-Hoe
AU - Lau, Gary Kui Kai
AU - Bae, Hee-Joon
AU - Werring, David J
PY - 2024/1/9
Y1 - 2024/1/9
N2 - Background and Objectives: Visible perivascular spaces are an MRI marker of cerebral small vessel disease and might predict future stroke. However, results from existing studies vary. We aimed to clarify this through a large collaborative multicenter analysis. Methods: We pooled individual patient data from a consortium of prospective cohort studies. Participants had recent ischemic stroke or transient ischemic attack (TIA), underwent baseline MRI, and were followed up for ischemic stroke and symptomatic intracranial hemorrhage (ICH). Perivascular spaces in the basal ganglia (BGPVS) and perivascular spaces in the centrum semiovale (CSOPVS) were rated locally using a validated visual scale. We investigated clinical and radiologic associations cross-sectionally using multinomial logistic regression and prospective associations with ischemic stroke and ICH using Cox regression. Results: We included 7,778 participants (mean age 70.6 years; 42.7% female) from 16 studies, followed up for a median of 1.44 years. Eighty ICH and 424 ischemic strokes occurred. BGPVS were associated with increasing age, hypertension, previous ischemic stroke, previous ICH, lacunes, cerebral microbleeds, and white matter hyperintensities. CSOPVS showed consistently weaker associations. Prospectively, after adjusting for potential confounders including cerebral microbleeds, increasing BGPVS burden was independently associated with future ischemic stroke (versus 0-10 BGPVS, 11-20 BGPVS: HR 1.19, 95% CI 0.93-1.53; 21+ BGPVS: HR 1.50, 95% CI 1.10-2.06; p = 0.040). Higher BGPVS burden was associated with increased ICH risk in univariable analysis, but not in adjusted analyses. CSOPVS were not significantly associated with either outcome. Discussion: In patients with ischemic stroke or TIA, increasing BGPVS burden is associated with more severe cerebral small vessel disease and higher ischemic stroke risk. Neither BGPVS nor CSOPVS were independently associated with future ICH.
AB - Background and Objectives: Visible perivascular spaces are an MRI marker of cerebral small vessel disease and might predict future stroke. However, results from existing studies vary. We aimed to clarify this through a large collaborative multicenter analysis. Methods: We pooled individual patient data from a consortium of prospective cohort studies. Participants had recent ischemic stroke or transient ischemic attack (TIA), underwent baseline MRI, and were followed up for ischemic stroke and symptomatic intracranial hemorrhage (ICH). Perivascular spaces in the basal ganglia (BGPVS) and perivascular spaces in the centrum semiovale (CSOPVS) were rated locally using a validated visual scale. We investigated clinical and radiologic associations cross-sectionally using multinomial logistic regression and prospective associations with ischemic stroke and ICH using Cox regression. Results: We included 7,778 participants (mean age 70.6 years; 42.7% female) from 16 studies, followed up for a median of 1.44 years. Eighty ICH and 424 ischemic strokes occurred. BGPVS were associated with increasing age, hypertension, previous ischemic stroke, previous ICH, lacunes, cerebral microbleeds, and white matter hyperintensities. CSOPVS showed consistently weaker associations. Prospectively, after adjusting for potential confounders including cerebral microbleeds, increasing BGPVS burden was independently associated with future ischemic stroke (versus 0-10 BGPVS, 11-20 BGPVS: HR 1.19, 95% CI 0.93-1.53; 21+ BGPVS: HR 1.50, 95% CI 1.10-2.06; p = 0.040). Higher BGPVS burden was associated with increased ICH risk in univariable analysis, but not in adjusted analyses. CSOPVS were not significantly associated with either outcome. Discussion: In patients with ischemic stroke or TIA, increasing BGPVS burden is associated with more severe cerebral small vessel disease and higher ischemic stroke risk. Neither BGPVS nor CSOPVS were independently associated with future ICH.
KW - Humans
KW - Female
KW - Aged
KW - Male
KW - Ischemic Stroke
KW - Prognosis
KW - Ischemic Attack, Transient/complications diagnostic imaging
KW - Prospective Studies
KW - Intracranial Hemorrhages
KW - Stroke/diagnostic imaging
KW - Cerebral Small Vessel Diseases/complications diagnostic imaging
KW - Magnetic Resonance Imaging
KW - Cerebral Hemorrhage
U2 - 10.1212/WNL.0000000000207795
DO - 10.1212/WNL.0000000000207795
M3 - Article
SN - 0028-3878
VL - 102
JO - Neurology
JF - Neurology
IS - 1
M1 - e207795
ER -