Simultaneous investigation of microvasculature and parenchyma in cerebral small vessel disease using intravoxel incoherent motion imaging.
Cerebral small vessel disease (cSVD) is associated with microvascular and parenchymal alterations. Intravoxel incoherent motion (IVIM) MRI has been proposed to simultaneously measure both the microvascular perfusion and parenchymal diffusivity. This study aimed to evaluate the application of IVIM in cSVD to assess the microvasculature and parenchymal microstructure.



Seventy-three patients with cSVD (age 70 ± 11 y) and thirty-nine controls (age 69 ± 12 y) underwent IVIM imaging (3T). Group differences of the perfusion volume fractionfand the parenchymal diffusivityDwere investigated using multivariable linear regression accounted for age, sex and cardiovascular factors. To examine the relation between the IVIM measures and the disease severity on structural MRI, white matter hyperintensity (WMH) load served as surrogate measure of the disease severity.



Patients had a largerf(p< 0.024) in the normal appearing white matter (NAWM) than controls. HigherD(p< 0.031) was also observed for patients compared with controls in the NAWM and grey matter. Bothf(p< 0.024) andD(p< 0.001) in the NAWM and grey matter increased with WMH load.



The increased diffusivity reflects the predicted microstructural tissue impairment in cSVD. Unexpectedly, an increased perfusion volume fraction was observed in patients. Future studies are needed to reveal the precise nature of the increased perfusion volume fraction. IVIM imaging showed that the increases offandDin cSVD were both related to disease severity, which suggests the potential of IVIM imaging to provide a surrogate marker for the progression of cSVD.
Dept. of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands.
Sau May
SM
Wong
Dept. of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands; Dept. of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.
C Eleana
CE
Zhang
Dept. of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands.
Frank C G
FC
van Bussel
Dept. of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands; Dept. of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.
Julie
J
Staals
Dept. of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
Cécile R L P N
CR
Jeukens
Dept. of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands.
Paul A M
PA
Hofman
Dept. of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands; Dept. of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.
Robert J
RJ
van Oostenbrugge
Dept. of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands.
Walter H
WH
Backes
Dept. of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands.
Jacobus F A
JF
Jansen
D000368:Aged; D000369:Aged, 80 and over; D059345:Cerebral Small Vessel Diseases / Q000000981:diagnostic imaging*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009038:Motion; D000072356:Parenchymal Tissue / Q000000981:diagnostic imaging*; D010477:Perfusion; D012189:Retrospective Studies; D066127:White Matter / Q000000981:diagnostic imaging
BMI, body mass index; Brain parenchyma; Cerebral small vessel disease; DGM, deep grey matter; DW, diffusion weighted; Diffusion weighted imaging; FLAIR, fluid attenuated inversion recovery; FOV, field of view; IVIM, intravoxel incoherent motion imaging; Intravoxel incoherent motion imaging; LS, lacunar stroke; Microvasculature; NAWM, normal appearing white matter; PVS, perivascular spaces; Perfusion MR imaging; ROI, region of interest; SNR, signal-to-noise ratio; WMH, white matter hyperintensity; cSVD, cerebral small vessel disease; mVCI, mild vascular cognitive impairment