Brain morphometry and its relevance in cerebral small vessel disease

Abstract

Cerebral small vessel disease (CSVD) is a heterogeneous group of disorders which affect small perforating vessels of the brain. Clinically CSVD manifest with various constellations of symptoms, like cognitive, functional, affective as well as lacunar stroke or intracerebral hemorrhage. It is responsible for 25 % of all strokes and are the second contributor to dementia after Alzheimer's disease. The gold standard for CSVD diagnostic is neuroimaging. The main key features are white matter hyperintensity (WMH), lacunes, enlarged perivascular spaces (EPVS), brain atrophy. Brain atrophy have been recognized to play a synergistic role in both cerebrovascular and neurodegenerative disorders occurring in the aging brain. It reflects a final common pathway for pathological processes, which progress in time. CSVD progression results in gradual decrease of brain volume, which is seen as changes of ventricles size and cortical sulci span of the brain. But not much is known about its extent, correlates and consequences. The aim of the research is to investigate whether brain morphometric changes correlate with CSVD features. In this study, we included 129 CSVD patients and 165 non-CSVD controls, both with acute stroke. All participants underwent neuroimaging assessment with magnetic resonance imaging (MRI) and computed tomography (CT). We used both univariate and multivariate regression analysis, as well as correlation analysis to identify differences in brain morphometric parameters between groups. Multivariable regression analysis, adjusted for age and sex, revealed significant impact of Evans index (OR 1.09, 95 %; CI 1.01-1.16, p=0.018), the third ventricle index (OR 1.42, 95 %; CI 1.21-1.67, p<0.001), Schaltenbrand and N?rnberger index (OR 1.42, 95 %; CI 1.21-1.67, p<0.001), the fourth ventricle index (OR 1.31, 95 %; CI 1.13-1.51, p<0,001), bicaudate index (OR 1.19, 95 %; CI 1.10-1.30, p<0.001), cella media index (Schiersmann's index) (OR 0.55, 95 %; CI 0.42-0.72, p<0.001), Huckman number (OR 1.05, 95 %; CI 1.02- 1.08, p<0.001), width of the longitudinal cerebral fissure in the anterior part of the frontal lobes (OR 1.46, 95 %; CI 1.22-1.75, p<0.001), width of the left insular cistern (OR 1.24, 95 %; CI 1.11-1.39, p<0.001), width of the right insular cistern (OR 1.31, 95 %; CI 1.17-1.46, p<0.001), width of the right and left insular cisterns in sum (OR 1.17, 95 %; CI 1.10-1.25, p<0.001), width of the cerebral fissure in the area of the skull vault (OR 1.49, 95 %; CI 1.21- 1.84, p<0.001) on the CSVD presence. Width of the longitudinal cerebral fissure in the anterior part of the frontal lobes in CSVD was 6.13±1.56 mm vs 5.10±1.38 mm in non- CSVD, p<0.001 and width of the right and left insular cisterns in sum in CSVD was 16.98±4.60 mm vs 13.41±4.16 mm in non-CSVD, p<0.001. Width of the cerebral fissure in the area of the skull vault (parietal cortex) was also greater in CSVD patients: 5.04±1.85 mm vs 4.12±1.29 mm, p<0.001. Thus, all ventricular and cortical indices were increased in the group of patients with CSVD. Our results indicate that morphometric indicators of the brain are closely related to CSVD and can be useful for predicting the consequences of a stroke and ascertaining the decline of cognitive functions.