title: MRI-visible perivascular spaces in cerebral amyloid angiopathy and hypertensive arteriopathy.
abstract: OBJECTIVE
  To assess MRI-visible enlarged perivascular spaces (EPVS) burden and different topographical patterns (in the centrum semiovale [CSO] and basal ganglia [BG]) in 2 common microangiopathies: cerebral amyloid angiopathy (CAA) and hypertensive arteriopathy (HA).
  
  
  METHODS
  Consecutive patients with spontaneous intracerebral hemorrhage (ICH) from a prospective MRI cohort were included. Small vessel disease MRI markers, including cerebral microbleeds (CMBs), cortical superficial siderosis (cSS), and white matter hyperintensities (WMH), were rated. CSO-EPVS/BG-EPVS were assessed on a validated 4-point visual rating scale (0 = no EPVS, 1 = <10, 2 = 11-20, 3 = 21-40, and 4 = >40 EPVS). We tested associations of predefined high-degree (score >2) CSO-EPVS and BG-EPVS with other MRI markers in multivariable logistic regression. We subsequently evaluated associations with CSO-EPVS predominance (i.e., CSO-EPVS > BG-EPVS) and BG-EPVS predominance pattern (i.e., BG-EPVS > CSO-EPVS) in adjusted multinomial logistic regression (reference group, BG-EPVS = CSO-EPVS).
  
  
  RESULTS
  We included 315 patients with CAA-ICH and 137 with HA-ICH. High-degree CSO-EPVS prevalence was greater in CAA-related ICH vs HA-related ICH (43.8% vs 17.5%,p< 0.001). In multivariable logistic regression, high-degree CSO-EPVS was associated with lobar CMB (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.10-1.61,p= 0.003) and cSS (OR 2.08, 95% CI 1.30-3.32,p= 0.002). Deep CMBs (OR 2.85, 95% CI 1.75-4.64,p< 0.0001) and higher WMH volume (OR 1.02, 95% CI 1.01-1.04,p= 0.010) were predictors of high-degree BG-EPVS. A CSO-EPVS-predominant pattern was more common in CAA-ICH than in HA-ICH (75.9% vs 39.4%, respectively,p< 0.0001). CSO-PVS predominance was associated with lobar CMB burden and cSS, while BG-EPVS predominance was associated with HA-ICH and WMH volumes.
  
  
  CONCLUSIONS
  Different patterns of MRI-visible EPVS provide insights into the dominant underlying microangiopathy type in patients with spontaneous ICH.
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston. andreas.charidimou.09@ucl.ac.uk.
authors.forename: Andreas
authors.initials: A
authors.lastname: Charidimou
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Gregoire
authors.initials: G
authors.lastname: Boulouis
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Marco
authors.initials: M
authors.lastname: Pasi
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Eitan
authors.initials: E
authors.lastname: Auriel
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Ellis S
authors.initials: ES
authors.lastname: van Etten
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Kellen
authors.initials: K
authors.lastname: Haley
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Alison
authors.initials: A
authors.lastname: Ayres
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Schwab
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Sergi
authors.initials: S
authors.lastname: Martinez-Ramirez
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Anand
authors.initials: A
authors.lastname: Viswanathan
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.affiliation: From the Hemorrhagic Stroke Research Program (A.C., G.B., M.P., E.A., E.S.v.E., K.H., A.A., K.M.S., S.M.-R., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: M Edip
authors.initials: ME
authors.lastname: Gurol
mesh_terms: D000368:Aged; D016657:Cerebral Amyloid Angiopathy / Q000000981:diagnostic imaging*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D012720:Severity of Illness Index; D012806:Siderosis / Q000150:complications; D013346:Subarachnoid Space / Q000000981:diagnostic imaging*