title: Longitudinal relationship between cerebral small-vessel disease and cerebral blood flow: the second manifestations of arterial disease-magnetic resonance study.
abstract: OBJECTIVE
  Cerebral small-vessel disease and cerebral blood flow (CBF) are interrelated. However, the direction of the relationship is unknown, and longitudinal studies are scarce. We investigated the longitudinal relationship between CBF and white matter hyperintensities (WMHs) and lacunes, as representatives of cerebral small-vessel disease, in patients with manifest arterial disease.
  
  
  METHODS
  Within the Second Manifestations of Arterial Disease-Magnetic Resonance (SMART-MR) study, 1.5T brain magnetic resonance imaging, including an MR angiography, was obtained at baseline and after on ≈3.9 years of follow-up in 575 patients with manifest arterial disease (mean age, 57±10 years). Longitudinal associations of WMHs and lacunes with parenchymal CBF (pCBF; per 100-mL brain volume) were estimated using regression analyses, adjusted for age, sex, follow-up time, and baseline brain measures.
  
  
  RESULTS
  Baseline pCBF was not associated with progression of WMHs and lacunes over time. However, periventricular and deep WMHs at baseline were associated with decline in pCBF; mean (95% confidence interval) decline in pCBF per % intracranial volume increase in periventricular and deep WMH volume was -0.70 (-1.40 to -0.00) and -1.01 (-1.64 to -0.38) mL/min per 100-mL brain volume, respectively. These associations were partly explained by cardiovascular risk factors but remained significant for deep WMHs (mean decline [95% confidence interval] in pCBF per % intracranial volume increase in deep WMH volume was -0.92 [-1.56 to -0.28] mL/min per 100-mL brain volume). Lacunes were not associated with change in pCBF.
  
  
  CONCLUSIONS
  In patients with manifest arterial disease, baseline periventricular and deep WMH volumes were associated with decline in pCBF over time, but baseline pCBF was not associated with progression of WMHs and lacunes over time.
authors: From the Department of Radiology (P.H.v.d.V., J.H., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.M., Y.v.d.G., M.I.G.), and Image Sciences Institute (K.L.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.).
authors: Pieternella H
authors: PH
authors: van der Veen
authors: From the Department of Radiology (P.H.v.d.V., J.H., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.M., Y.v.d.G., M.I.G.), and Image Sciences Institute (K.L.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.).
authors: Majon
authors: M
authors: Muller
authors: From the Department of Radiology (P.H.v.d.V., J.H., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.M., Y.v.d.G., M.I.G.), and Image Sciences Institute (K.L.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.).
authors: Koen L
authors: KL
authors: Vincken
authors: From the Department of Radiology (P.H.v.d.V., J.H., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.M., Y.v.d.G., M.I.G.), and Image Sciences Institute (K.L.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.).
authors: Jeroen
authors: J
authors: Hendrikse
authors: From the Department of Radiology (P.H.v.d.V., J.H., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.M., Y.v.d.G., M.I.G.), and Image Sciences Institute (K.L.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.).
authors: Willem P T M
authors: WP
authors: Mali
authors: From the Department of Radiology (P.H.v.d.V., J.H., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.M., Y.v.d.G., M.I.G.), and Image Sciences Institute (K.L.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.).
authors: Yolanda
authors: Y
authors: van der Graaf
authors: From the Department of Radiology (P.H.v.d.V., J.H., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.M., Y.v.d.G., M.I.G.), and Image Sciences Institute (K.L.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.). m.geerlings@umcutrecht.nl.
authors: Mirjam I
authors: MI
authors: Geerlings
mesh_terms: D000367:Age Factors; D000368:Aged; D002539:Cerebral Arterial Diseases / Q000503:physiopathology*; D059345:Cerebral Small Vessel Diseases / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D059409:Stroke, Lacunar / Q000473:pathology; D066127:White Matter / Q000473:pathology
keywords: atherosclerosis; cerebral small vessel disease; magnetic resonance imaging