title: Total cerebral blood flow, white matter lesions and brain atrophy: the SMART-MR study.
abstract: We investigated whether total cerebral blood flow (CBF) was associated with brain atrophy, and whether this relation was modified by white matter lesions (WML). Within the Second Manifestations of ARTerial disease-magnetic resonance (SMART-MR) study, a prospective cohort study among patients with arterial disease, cross-sectional analyses were performed in 828 patients (mean age 58+/-10 years, 81% male) with quantitative flow, atrophy, and WML measurements on magnetic resonance imaging (MRI). Total CBF was measured with MR angiography and was expressed per 100 mL brain volume. Total brain volume and ventricular volume were divided by intracranial volume to obtain brain parenchymal fraction (BPF) and ventricular fraction (VF). Lower BPF indicates more global brain atrophy, whereas higher VF indicates more subcortical brain atrophy. Mean CBF was 52.0+/-10.2 mL/min per 100 mL, mean BPF was 79.2+/-2.9%, and mean VF was 2.03+/-0.96%. Linear regression analyses showed that lower CBF was associated with more subcortical brain atrophy, after adjusting for age, sex, vascular risk factors, intima-media thickness, and lacunar infarcts, but only in patients with moderate to severe WML (upper quartile of WML): Change in VF per s.d. decrease in CBF 0.18%, 95% CI: 0.02 to 0.34%. Our findings suggest that cerebral hypoperfusion in the presence of WML may be associated with subcortical brain atrophy.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Auke P A
authors.initials: AP
authors.lastname: Appelman
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: Koen L
authors.initials: KL
authors.lastname: Vincken
authors.forename: Audrey M
authors.initials: AM
authors.lastname: Tiehuis
authors.forename: Theo D
authors.initials: TD
authors.lastname: Witkamp
authors.forename: Willem P T M
authors.initials: WP
authors.lastname: Mali
authors.forename: Mirjam I
authors.initials: MI
authors.lastname: Geerlings
mesh_terms: D000368:Aged; D001284:Atrophy / Q000473:pathology*; D001927:Brain Diseases / Q000473:pathology*; D002560:Cerebrovascular Circulation; D054022:Cerebrum / Q000473:pathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D011446:Prospective Studies; D012039:Regional Blood Flow