Association between subcortical vascular disease on CT and neuropathological findings.
BACKGROUND
Small vessel cerebrovascular disease (svCVD) causes cognitive impairment and predicts poorer outcomes in elderly persons. The demonstration of svCVD by structural imaging such as computed tomography (CT) is central to the clinical diagnosis but its accuracy is uncertain.


OBJECTIVE
The aim of this study was to assess the validity of CT to detect pathologically verified svCVD.


METHODS
Leukoaraiosis, patchy lesions, and lacunes were assessed separately in different cerebral regions on CT scans of 87 elderly persons with Mini-Mental State Examination scores between 0 and 30 enrolled in the OPTIMA project. We rated small vessel disease on pathology separately in the white matter and basal ganglia as absent/mild, moderate, and severe. The presence of microinfarcts was also noted.


RESULTS
The severity of all types of CT lesions was associated with pathological findings. Subjects with absent/mild leukoaraiosis on CT decreased and those with severe leukoaraiosis increased with increasing severity of subcortical small vessel ratings on pathology (31, 18 and 0%; 17, 23 and 50%, respectively; p = 0.028). A similar association was present for patchy lesions (73, 59 and 17%; 7, 18 and 33%, respectively; p = 0.004) and lacune (83, 77 and 50%; 0, 4 and 17%, respectively; p = 0.023). Leukoaraiosis, patchy lesions, and lacunes on CT were associated also with microinfarcts on pathology (p < 0.05).


CONCLUSIONS
The standardized assessment of svCVD on CT films at the time of the diagnosis correlates with small vessel disease on pathology at death.
Rossi
Roberta
R
Laboratory of Epidemiology and Neuroimaging, IRCCS San Giovanni di Dio-FBF, Brescia, Italy.
Joachim
Catherine
C
Geroldi
Cristina
C
Combrinck
Marc
M
Esiri
Margaret M
MM
Smith
A David
AD
Frisoni
Giovanni B
GB
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D001921:Brain / Q000000981:diagnostic imaging* / Q000502:physiology; D020520:Brain Infarction / Q000000981:diagnostic imaging; D002196:Capillaries; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging*; D003072:Cognition Disorders / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed