title: Clinical-MRI correlations in a multiethnic cohort with recent lacunar stroke: the SPS3 trial.
abstract: BACKGROUND
  Neuroimaging manifestations of small vessel disease are heterogeneous, and correlation with patient features has not been adequately characterized.
  
  
  OBJECTIVE
  Our goal was to correlate magnetic resonance imaging findings with clinical features in a large multiethnic cohort with recent lacunar stroke.
  
  
  METHODS
  Patient characteristics were correlated with neuroimaging results in the Secondary Prevention of Small Subcortical Stroke study participants.
  
  
  RESULTS
  Among 3005 patients, mean age was 63 years; 62% were men; and 51%, 30%, and 16% were non-Hispanic White, Hispanic, and Black, respectively. Recent lacunar infarcts were distributed between the subcortical hemisphere (31%), thalamus (26%), brainstem/cerebellum (26%), and basal ganglia/internal capsule (16%). Multiple lacunar infarcts (i.e., acute and remote) were present in 40% and associated with increased age (OR 1·3 per 20 years, 95% CI 1·1, 1·5), male gender (OR 1·5, CI 1·3, 1·7), hypertension (OR 1·5, CI 1·2, 1·8), increased systolic blood pressure (OR 1·2 per 20 mmHg, CI 1·1, 1·3), and prior stroke (OR 3·8, CI 2·9, 5·0). Moderate-severe white matter hyperintensities were present in 50% and associated with increased age (OR 4·3 per 20 years, CI 3·4, 5·4), hypertension (OR 1·8, CI 1·4, 2·3), increased systolic blood pressure (OR 1·3 per 20 mmHg, CI 1·1, 1·5), increased diastolic blood pressure (OR 1·2 per 10 mm, CI 1·0, 1·3), and prior stroke (OR 3·3, CI 2·3, 4·5). Infarct location varied significantly by race-ethnicity (P < 0·001), with Blacks and Hispanics having more infarcts in the brainstem/cerebellum than non-Hispanic Whites, and by gender with women more often having thalamic lacunes than men (P ≤ 0·001).
  
  
  CONCLUSIONS
  In patients with recent lacunar stroke, infarct location and number have distinctie associations with gender, vascular risk factors, and race-ethnicity, demonstrating the complex pathogenesis of lacunar stroke and cerebral small artery disease.
authors.affiliation: Department of Medicine, Division of Neurology, Brain Research Center, University of British Columbia, Vancouver, Canada.
authors.forename: Oscar R
authors.initials: OR
authors.lastname: Benavente
authors.forename: Lesly A
authors.initials: LA
authors.lastname: Pearce
authors.forename: Carlos
authors.initials: C
authors.lastname: Bazan
authors.forename: Ana M
authors.initials: AM
authors.lastname: Roldan
authors.forename: Luciana
authors.initials: L
authors.lastname: Catanese
authors.forename: Viveca M
authors.initials: VM
authors.lastname: Bhat Livezey
authors.forename: Gabriela
authors.initials: G
authors.lastname: Vidal-Pergola
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hart
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007391:International Cooperation; D020765:Intracranial Arterial Diseases / Q000209:etiology; D007843:Latin America; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D009656:North America; D013030:Spain; D059409:Stroke, Lacunar / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control*; D013997:Time Factors
keywords: African American; Hispanics; MRI; lacunar stroke; small vessel disease; white matter hyperintensity