Brain volumes and cerebrovascular lesions on MRI in patients with atherosclerotic disease. The SMART-MR study.
OBJECTIVE
To estimate brain volumes, white matter lesion (WML) volume and asymptomatic infarcts on MRI in a large cohort of patients with atherosclerotic disease.


METHODS
Within the SMART-MR (Second Manifestations of ARTerial disease-Magnetic Resonance) study, a prospective cohort study on determinants and course of brain changes on MRI, cross-sectional analyses were performed in 1044 patients (mean age 58+/-10 years, 80% male) with coronary artery disease, cerebrovascular disease, peripheral arterial disease, or abdominal aortic aneurysm. Brain segmentation was used to quantify volumes of cortical gray matter, white matter, sulcal and ventricular cerebrospinal fluid, and WML. All volumes were expressed relative to intracranial volume. Brain infarcts were rated visually and distinctions were made between cortical infarcts, large subcortical infarcts, lacunar infarcts, and infarcts in the cerebellum and brainstem.


RESULTS
With older age a nonlinear (quadratic) decrease in total brain volume was observed and a nonlinear increase in ventricular volume and WML. Cortical gray matter volume showed a linear decrease with age and was stronger in men than in women. WML volumes also increased more strongly in men than in women, while ventricular volume decrease showed no sex difference. Silent brain infarcts were present in 14% of men and women, and increased to 24% of subjects aged 65 years or older.


CONCLUSIONS
In a population with atherosclerotic diseases, decrease in brain volumes with increasing age is comparable with findings from the general population. However, vascular pathology on MRI, as indicated by white matter lesions and silent brain infarcts may be more common.
Geerlings
Mirjam I
MI
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands. m.geerlings@umcutrecht.nl
Appelman
Auke P A
AP
Vincken
Koen L
KL
Algra
Ale
A
Witkamp
Theo D
TD
Mali
Willem P T M
WP
van der Graaf
Yolanda
Y
D000367:Age Factors; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology; D050197:Atherosclerosis / Q000473:pathology*; D001921:Brain / Q000473:pathology*; D002544:Cerebral Infarction / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000473:pathology; D015331:Cohort Studies; D003327:Coronary Disease / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D016491:Peripheral Vascular Diseases / Q000473:pathology; D011446:Prospective Studies; D012307:Risk Factors