White matter hyperintensity patterns in cerebral amyloid angiopathy and hypertensive arteriopathy

Objective: To identify different white matter hyperintensity (WMH) patterns between 2 hemorrhage-prone cerebral small vessel diseases (SVD): cerebral amyloid angiopathy (CAA) and hypertensive arteriopathy (HA). Methods: Consecutive patients with SVD-related intracerebral hemorrhage (ICH) from a single-center prospective cohort were analyzed. Four predefined subcortical WMH patterns were compared between the CAA and HA groups. These WMH patterns were (1) multiple subcortical spots; (2) peri–basal ganglia (BG); (3) large posterior subcortical patches; and (4) anterior subcortical patches. Their associations with other imaging (cerebral microbleeds [CMBs], enlarged perivascular spaces [EPVS]) and clinical markers of SVD were investigated using multivariable logistic regression. Results: The cohort included 319 patients with CAA and 137 patients with HA. Multiple subcortical spots prevalence was higher in the CAA compared to the HA group (29.8% vs 16.8%; p = 0.004). Peri-BG WMH pattern was more common in the HA- vs the CAA-ICH group (19% vs 7.8%; p = 0.001). In multivariable logistic regression, presence of multiple subcortical spots was associated with lobar CMBs (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.01–1.50, p = 0.039) and high degree of centrum semiovale EPVS (OR 2.43; 95% CI 1.56–3.80, p < 0.0001). By contrast, age (OR 1.05; 95% CI 1.02–1.09, p = 0.002), deep CMBs (OR 2.46; 95% CI 1.44–4.20, p = 0.001), total WMH volume (OR 1.02; 95% CI 1.01–1.04, p = 0.002), and high BG EPVS degree (OR 8.81; 95% CI 3.37–23.02, p < 0.0001) were predictors of peri-BG WMH pattern. Conclusion: Different patterns of subcortical leukoaraiosis visually identified on MRI might provide insights into the dominant underlying microangiopathy type as well as mechanisms of tissue injury in patients with ICH.