title: Intravoxel Incoherent Motion Imaging in Small Vessel Disease: Microstructural Integrity and Microvascular Perfusion Related to Cognition.
abstract: Cerebral small vessel disease (SVD) is associated with cognitive impairment. This may be because of decreased microstructural integrity and microvascular perfusion, but data on these relationships are scarce. We determined the relationship between cognition and microvascular perfusion and microstructural integrity in SVD patients, using intravoxel incoherent motion imaging-a diffusion-weighted magnetic resonance imaging technique designed to determine microvascular perfusion and microstructural integrity simultaneously.
  
  
  
  Seventy-three patients with SVD and 39 controls underwent intravoxel incoherent motion imaging and neuropsychological assessment. Parenchymal diffusivityD(a surrogate measure of microstructural integrity) and perfusion-related measurefD*were calculated for the normal appearing white matter, white matter hyperintensities, and cortical gray matter. The associations between cognitive performance andDandfD*were determined.
  
  
  
  In SVD patients, multivariable analysis showed that lowerfD*in the normal appearing white matter and cortical gray matter was associated with lower overall cognition (P=0.03 andP=0.002, respectively), lower executive function (P=0.04 andP=0.01, respectively), and lower information-processing speed (P=0.04 andP=0.01, respectively).Dwas not associated with cognitive function. In controls, no association was found betweenD,fD*, and cognition.
  
  
  
  In SVD patients, lower cognitive performance is associated with lower microvascular perfusion in the normal appearing white matter and cortical gray matter. Our results support recent findings that both cortical gray matter and normal appearing white matter perfusion may play a role in the pathophysiology of cognitive dysfunction in SVD.
  
  
  
  URL: http://www.trialregister.nl. Unique identifier: NTR3786.
authors.affiliation: From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.). eleana.zhang@mumc.nl.
authors.forename: C Eleana
authors.initials: CE
authors.lastname: Zhang
authors.affiliation: From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.).
authors.forename: Sau May
authors.initials: SM
authors.lastname: Wong
authors.affiliation: From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.).
authors.forename: Renske
authors.initials: R
authors.lastname: Uiterwijk
authors.affiliation: From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.).
authors.forename: Julie
authors.initials: J
authors.lastname: Staals
authors.affiliation: From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.).
authors.forename: Walter H
authors.initials: WH
authors.lastname: Backes
authors.affiliation: From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.).
authors.forename: Erik I
authors.initials: EI
authors.lastname: Hoff
authors.affiliation: From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.).
authors.forename: Tobien
authors.initials: T
authors.lastname: Schreuder
authors.affiliation: From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.).
authors.forename: Cécile R L P N
authors.initials: CR
authors.lastname: Jeukens
authors.affiliation: From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.).
authors.forename: Jacobus F A
authors.initials: JF
authors.lastname: Jansen
authors.affiliation: From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Oostenbrugge
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059345:Cerebral Small Vessel Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D066128:Gray Matter / Q000098:blood supply / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging*; D008875:Middle Aged; D066127:White Matter / Q000098:blood supply / Q000000981:diagnostic imaging*
keywords: cerebral blood flow; cerebral small vessel disease; cognition