title: Enlarged perivascular spaces as a marker of underlying arteriopathy in intracerebral haemorrhage: a multicentre MRI cohort study.
abstract: OBJECTIVE
  Small vessel disease (mainly hypertensive arteriopathy and cerebral amyloid angiopathy (CAA)) is an important cause of spontaneous intracerebral haemorrhage (ICH), a devastating and still poorly understood stroke type. Enlarged perivascular spaces (EPVS) are a promising neuroimaging marker of small vessel disease. Based on the underlying arteriopathy distributions, we hypothesised that severe centrum semiovale EPVS are more common in lobar ICH attributed to CAA than other ICH. We evaluated EPVS prevalence, severity and distribution, and their clinical-radiological associations.
  
  
  METHODS
  Retrospective multicentre cohort study of 121 ICH patients. Clinical information was obtained using standardised forms. Basal ganglia and centrum semiovale EPVS on T2-weighted MRI (graded 0-4 (>40 EPVS)), white-matter changes, cerebral microbleeds (CMBs) and lacunes were rated using validated scales.
  
  
  RESULTS
  Patients with probable or possible CAA (n=76) had a higher prevalence of severe (>40) centrum semiovale EPVS compared with other ICH patients (35.5% vs 17.8%; p=0.041). In logistic regression age (OR: 1.43; 95% CI 1.01 to 2.02; p=0.045), deep CMBs (OR: 3.27; 95% CI 1.27 to 8.45; p=0.014) and mean white-matter changes score (OR: 1.29; 95% CI 1.17 to 1.43; p<0.0001) were independently associated with increased basal ganglia EPVS severity; only age was associated with increased centrum semiovale EPVS severity (OR: 1.50; 95% CI 1.08 to 2.10; p=0.017).
  
  
  CONCLUSIONS
  EPVS are common in ICH. Different mechanisms may account for EPVS according to their anatomical distribution. Severe centrum semiovale EPVS may be secondary to, and indicative of, CAA with value as a new neuroimaging marker. By contrast, basal ganglia EPVS severity is associated with markers of hypertensive arteriopathy.
authors: Stroke Research Group, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
authors: Andreas
authors: A
authors: Charidimou
authors: Rukshan
authors: R
authors: Meegahage
authors: Zoe
authors: Z
authors: Fox
authors: Andre
authors: A
authors: Peeters
authors: Yves
authors: Y
authors: Vandermeeren
authors: Patrice
authors: P
authors: Laloux
authors: Jean-Claude
authors: JC
authors: Baron
authors: Hans Rolf
authors: HR
authors: Jäger
authors: David J
authors: DJ
authors: Werring
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers; D002539:Cerebral Arterial Diseases / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D002536:Cerebral Arteries / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers
keywords: Amyloid; Cerebrovascular Disease; Clinical Neurology; MRI