Background: Small vessel disease (SVD)-related MRI abnormalities include cerebral microbleeds (CMB), intracerebral hemorrhage (ICH) and supratentorial dilated perivascular spaces (DPVS). In the cerebellum, deep CMB/ICH involving dentate nucleus (DN) is associated with hypertensive arteriopathy (HA), whereas superficial cerebellar CMB/ICH is associated with cerebral amyloid angiopathy (CAA). We studied DPVS inside DN (DN-DPVS) in patients with HA or CAA.
Methods: We retrospectively analyzed DN-DPVS presence and number on T2-weighted 3T MRI (performed on follow-up in the vast majority of cases) from 29 HA and 43 CAA patients with hemorrhage-related symptoms, consecutively recruited. Assessed characteristics were sex, age, cardiovascular risk factors, time between initial CAA/HA diagnosis and MRI, magnet, axial/coronal imaging, hemorrhagic lesions on T2*-weighted imaging, semi-quantitative supratentorial DPVS rating score for centrum semiovale and basal ganglia DPVS, and DN-DPVS presence and number.
Results: On univariate analysis, compared with CAA, HA patients were younger (median age 73 vs. 76, p=0.015), more frequently had diabetes (24% vs. 5%, p=0.014), showed fewer CMB (median 1 vs. 3, p=0.013), higher basal ganglia DPVS scores (p<0.001), lower centrum semiovale DPVS scores (p<0.001), more frequent DN-DPVS presence (97% vs. 63%, p<0.001), and higher DN-DPVS number (median 6.5 vs. 4, p=0.003). Multivariate analysis found significant associations with HA pathology for age (OR=0.93, 95% CI[0.87-0.98], p=0.005) and DN-DPVS presence (OR=19.15, 95% CI[3.01-396.09], p=0.001), while association with diabetes was borderline significant (OR=4.79, 95% CI[0.94-36.80], p=0.059).
Conclusions: Although frequently observed in both CAA and HA patients, DN-DPVS on MRI are more frequent in HA compared with CAA.
Keywords: Cerebral amyloid angiopathy; Dentate nucleus; Dilated perivascular spaces; Hypertensive arteriopathy; MRI; Small vessel disease.
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