Résumé
The common cerebral small vessel disease (CSVD) neuroimaging features visible on conventional structural magnetic resonance imaging include recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain atrophy. The CSVD neuroimaging features have shared and distinct clinical consequences, and the automatic quantification methods for these features are increasingly used in research and clinical settings. This review article explores the recent progress in CSVD neuroimaging feature quantification and provides an overview of the clinical consequences of these CSVD features as well as the possibilities of using these features as endpoints in clinical trials. The added value of CSVD neuroimaging quantification is also discussed for researches focused on the mechanism of CSVD and the prognosis in subjects with CSVD.
Sujets)
Humains , Maladies des petits vaisseaux cérébraux/imagerie diagnostique , Imagerie par résonance magnétique , Neuroimagerie , PronosticRésumé
ABSTRACT Objective: To investigate the predictive value of transcranial Doppler (TCD) ultrasound for cerebral small vessel disease in elderly patients. Methods: Transcranial Doppler ultrasound and magnetic resonance imaging (MRI) were performed on 184 elderly patients with cerebral small vessel disease. The relationship of clinical characteristics and TCD ultrasound parameters with severe white matter lesions (WMLs) in MRI were investigated by univariate analysis and multivariate analysis. Results: The univariate analysis showed that age, left middle cerebral artery (MCA) mean flow velocity, right MCA mean flow velocity and mean MCA pulsatility index were significantly correlated with severe WMLs (p < 0.05). The multivariate logistic regression analysis showed that only age (odds ratio: 1.21; 95%CI: 1.10-1.36; p < 0.01) and MCA pulsatility index (dominance ratio: 1.13; 95%CI: 1.06-1.80; p = 0.02) were significantly correlated with severe WMLs. The analysis of TCD ultrasound parameters showed that when the cut-off for MCA pulsatility index was 1.04, it could identify severe WMLs. The area under the curve was 0.70 (95%CI: 0.60-0.80). The sensitivity and specificity were 63.0% and 72.0%, respectively. The positive and negative predictive values were 35.4% and 86.6%, respectively. Conclusion: The MCA pulsatility index in TCD ultrasound is significantly correlated with severe WMLs; and TCD ultrasound can guide selective MRI for the detection of WMLs.
RESUMO Objetivo: Investigar o valor preditivo do ultrassom de Doppler transcraniano (TCD) para doença de pequenos vasos (SVD) em pacientes idosos. Métodos: ultrassonografia de TCD e ressonância magnética (RM) foram realizadas em 184 idosos portadores de SVD cerebral. As relações das características clínicas e os parâmetros ultrassonográficos do TCD com lesão grave de substância branca (WML) no desempenho da RM foram investigados por análise univariada e análise multivariada. Resultados: A análise univariada mostrou que, a idade, a velocidade média de fluxo (MFV) da artéria média cerebral (MCA) esquerda, a MFV da MCA direita e o índice de pulsatilidade (PI) médio estiveram significativamente relacionados à WML grave (P <0,05). A análise de regressão logística multivariada mostrou que apenas a idade (razão de chances: 1,21; IC95%: 1,10-1,36; P <0,01) e o PI da MCA (razão de dominância: 1,13; IC 95%: 1,06-1,80; P = 0,02) estiveram significativamente relacionados a WML grave. A análise dos parâmetros ultrassonográficos do TCD mostrou que, quando o ponto de corte do IP do MCA foi 1,04, ele pôde identificar à WML grave. A área sob a curva foi de 0,70 (IC 95%: 0,60-0,80). A sensibilidade e especificidade foram de 63,0% e 72,0%, respectivamente. Os valores preditivos positivos e negativos foram de 35,4% e 86,6%, respectivamente. Conclusão: O PI da MCA na ultrassonografia do TCD está significativamente relacionado à WML grave. A ultrassonografia TCD pode orientar a ressonância magnética seletiva para detecção da WML.