White Matter Hyperintensity Volume and Cerebral Perfusion in Older Individuals with Hypertension Using Arterial Spin-Labeling.
OBJECTIVE
White matter hyperintensities of presumed vascular origin in elderly patients with hypertension may be part of a general cerebral perfusion deficit, involving not only the white matter hyperintensities but also the surrounding normal-appearing white matter and gray matter. We aimed to study the relation between white matter hyperintensity volume and CBF and assess whether white matter hyperintensities are related to a general perfusion deficit.


METHODS
In 185 participants of the Prevention of Dementia by Intensive Vascular Care trial between 72 and 80 years of age with systolic hypertension, white matter hyperintensity volume and CBF were derived from 3D FLAIR and arterial spin-labeling MR imaging, respectively. We compared white matter hyperintensity CBF, normal-appearing white matter CBF, and GM CBF across quartiles of white matter hyperintensity volume and assessed the continuous relation between these CBF estimates and white matter hyperintensity volume by using linear regression.


RESULTS
Mean white matter hyperintensity CBF was markedly lower in higher quartiles of white matter hyperintensity volume, and white matter hyperintensity volume and white matter hyperintensity CBF were negatively related (standardized β = -0.248,P= .001) in linear regression. We found no difference in normal-appearing white matter or GM CBF across quartiles of white matter hyperintensity volume or any relation between white matter hyperintensity volume and normal-appearing white matter CBF (standardized β = -0.065,P= .643) or GM CBF (standardized β = -0.035,P= .382) in linear regression.


CONCLUSIONS
Higher white matter hyperintensity volume in elderly individuals with hypertension was associated with lower perfusion within white matter hyperintensities, but not with lower perfusion in the surrounding normal-appearing white matter or GM. These findings suggest that white matter hyperintensities in elderly individuals with hypertension relate to local microvascular alterations rather than a general cerebral perfusion deficit.
From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.) j.vandalen@amc.nl.
J W
http://orcid.org/0000-0002-3439-8841
JW
van Dalen
Radiology (H.J.M.M.M., A.J.N., M.W.A.C., C.B.L.M.M.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
H J M M
http://orcid.org/0000-0003-0894-0307
HJMM
Mutsaerts
Radiology (H.J.M.M.M., A.J.N., M.W.A.C., C.B.L.M.M.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
A J
http://orcid.org/0000-0002-5477-973X
AJ
Nederveen
Departments of Radiology and Nuclear Medicine (H.V., M.D.S.).|Physics and Medical Technology (H.V.), Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, Amsterdam, the Netherlands.
H
http://orcid.org/0000-0001-9106-1172
H
Vrenken
Departments of Radiology and Nuclear Medicine (H.V., M.D.S.).
M D
http://orcid.org/0000-0002-8346-9044
MD
Steenwijk
Radiology (H.J.M.M.M., A.J.N., M.W.A.C., C.B.L.M.M.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
M W A
http://orcid.org/0000-0002-5162-8880
MWA
Caan
Radiology (H.J.M.M.M., A.J.N., M.W.A.C., C.B.L.M.M.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
C B L M
http://orcid.org/0000-0002-7600-9568
CBLM
Majoie
From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.).
W A
http://orcid.org/0000-0003-3174-8233
WA
van Gool
From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.).|Department of Neurology (E.R.), Radboud University Medical Center, Nijmegen, the Netherlands.
E
http://orcid.org/0000-0002-7250-3390
E
Richard