title: Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease.
abstract: OBJECTIVE
  Enlarged perivascular spaces in the brain are common but generally overlooked and of uncertain pathophysiology. They may reflect underlying cerebral small vessel disease. We determined whether enlarged perivascular spaces were associated with lacunar stroke subtype and white matter hyperintensities, markers of established small vessel disease.
  
  
  METHODS
  We prospectively recruited patients with acute ischemic lacunar or cortical stroke. Age-matched nonstroke control subjects were also recruited. We rated basal ganglia and centrum semiovale enlarged perivascular spaces 0 to 4 (0=none, 4=>40) on T2-weighted MRI and white matter hyperintensities. We compared enlarged perivascular spaces between stroke subtypes and control subjects and assessed associations with vascular risk factors and white matter hyperintensities.
  
  
  RESULTS
  We recruited 350 patients; 129 lacunar, 124 cortical stroke, and 97 age-matched control subjects. Adjusting for vascular risk factors and white matter hyperintensities, total enlarged perivascular spaces were associated with lacunar stroke subtype (P=0.04) in the acute stroke group (n=253); basal ganglia enlarged perivascular spaces were associated with lacunar stroke subtype (P=0.003), deep (P=0.02) and periventricular white matter hyperintensities (P=0.01); in all 350 subjects, total enlarged perivascular spaces were associated with deep (P<0.001) and periventricular (P<0.001) white matter hyperintensities.
  
  
  CONCLUSIONS
  Although prevalent in patients with vascular risk factors and stroke, enlarged perivascular spaces are specifically associated with lacunar ischemic stroke and white matter hyperintensities. Further studies should determine the mechanism of this association while including adequate controls to account for stroke and vascular risk factors. Enlarged perivascular spaces should not be overlooked in studies of small vessel disease.
authors.affiliation: MRCP, Division of Clinical Neurosciences, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK. fergus.doubal@ed.ac.uk
authors.forename: Fergus N
authors.initials: FN
authors.lastname: Doubal
authors.forename: Alasdair M J
authors.initials: AM
authors.lastname: MacLullich
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Ferguson
authors.forename: Martin S
authors.initials: MS
authors.lastname: Dennis
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Wardlaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001160:Arterioles / Q000473:pathology* / Q000503:physiopathology; D020520:Brain Infarction / Q000473:pathology / Q000503:physiopathology; D002552:Cerebral Ventricles / Q000098:blood supply* / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies