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European Radiology
Published in: European Radiology 11/2023

07-06-2023 | CADASIL | Neuro

Presumed periventricular venous infarction on magnetic resonance imaging and its association with increased white matter edema in CADASIL

Authors: Xinfeng Yu, Xinzhen Yin, Hui Hong, Shuyue Wang, Yeerfan Jiaerken, Duo Xu, Fan Zhang, Ruiting Zhang, Linglin Yang, Baorong Zhang, Minming Zhang, Peiyu Huang

Published in: European Radiology | Issue 11/2023

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Abstract

Objectives

Venous pathology could contribute to the development of parenchymal lesions in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We aim to identify presumed periventricular venous infarction (PPVI) in CADASIL and analyze the associations between PPVI, white matter edema, and microstructural integrity within white matter hyperintensities (WMHs) regions.

Methods

We included forty-nine patients with CADASIL from a prospectively enrolled cohort. PPVI was identified according to previously established MRI criteria. White matter edema was evaluated using the free water (FW) index derived from diffusion tensor imaging (DTI), and microstructural integrity was evaluated using FW-corrected DTI parameters. We compared the mean FW values and regional volumes with different levels of FW (ranging from 0.3 to 0.8) in WMHs regions between the PPVI and non-PPVI groups. We used intracranial volume to normalize each volume. We also analyzed the association between FW and microstructural integrity in fiber tracts connected with PPVI.

Results

We found 16 PPVIs in 10 of 49 CADASIL patients (20.4%). The PPVI group had larger WMHs volume (0.068 versus 0.046, p = 0.036) and higher FW in WMHs (0.55 versus 0.52, p = 0.032) than the non-PPVI group. Larger areas with high FW content were also found in the PPVI group (threshold: 0.7, 0.47 versus 0.37, p = 0.015; threshold: 0.8, 0.33 versus 0.25, p = 0.003). Furthermore, higher FW correlated with decreased microstructural integrity (p = 0.009) in fiber tracts connected with PPVI.

Conclusions

PPVI was associated with increased FW content and white matter degeneration in CADASIL patients.

Clinical relevance statement

PPVI is an important factor related with WMHs, and therefore, preventing the occurrence of PPVI would be beneficial for patients with CADASIL.

Key Points

•Presumed periventricular venous infarction is important and occurs in about 20% of patients with CADASIL.
•Presumed periventricular venous infarction was associated with increased free water content in the regions of white matter hyperintensities.
•Free water correlated with microstructural degenerations in white matter tracts connected with the presumed periventricular venous infarction.
Appendix
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Metadata
Title
Presumed periventricular venous infarction on magnetic resonance imaging and its association with increased white matter edema in CADASIL
Authors
Xinfeng Yu
Xinzhen Yin
Hui Hong
Shuyue Wang
Yeerfan Jiaerken
Duo Xu
Fan Zhang
Ruiting Zhang
Linglin Yang
Baorong Zhang
Minming Zhang
Peiyu Huang
Publication date
07-06-2023
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2023
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-023-09744-4

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