Assessment of white matter hyperintensity severity using multimodal MRI in Alzheimer’s Disease

White matter hyperintensities (WMHs) are clinically significant MRI abnormalities often detected in the elderly and early stages of Alzheimer’s Disease. They are indicative of vascular pathology but represent a mixture of microstructural tissue alterations that is highly variable between individuals. To better understand these alterations, we leveraged the signal of different MRI contrasts sampled within WMHs, which have differential sensitivity to microstructural properties. Subsequently, we sought to examine the asso of these WMH signal measures to clinically-relevant measures such as cortical and global brain atrophy, cognitive function, diagnostic and demographic differences, and Alzheimer’s Disease-relevant cardiovascular risk factors. Our sample of 118 subjects was composed of healthy controls (n=30), high-risk of Alzheimer’s Disease due to familial history (n=47), mild cognitive impairment (n=32), and clinical Alzheimer’s Disease (n=9) as a means of ascertaining a spectrum of impairment. We sampled the median signal within WMHs on weighted MRI images that are commonly acquired (T1-weighted [T1w], T2-weighted [T2w], T1w/T2w ratio, Fluid-Attenuated Inversion Recovery [FLAIR]), and the relaxation times from quantitative T1 (qT1) and T2* (qT2*) images. Main analyses were performed with a periventricular/deep/superficial white matter parcellation and were repeated with a lobar white matter parcellation. We demonstrated that the correlations between WMH signal measures were variable, suggesting that they are likely influenced by different microstructural properties. We observed that the WMH qT2* and FLAIR measures displayed different age- and disease-related trends compared to normal-appearing white matter, highlighting sensitivity to WMH-specific tissue deterioration. Further, WMH qT2* particularly in periventricular and occipital white matter regions was consistently associated with several of our clinical variables of interest using both parcellation schemes in univariate analyses, and further showed high contributions to a pattern of brain variables that was associated with age and cognitive variables in multivariate Partial Least Squares Correlation analyses. qT1 and FLAIR measures showed consistent clinical relationships in multivariate analyses only, while T1w, T2w, and T1w/T2w ratio measures were not consistently associated with clinical variables. We observed that the qT2* signal was sensitive to clinically-relevant microstructural tissue alterations specific to WMHs. Combining volumetric and signal measures of WMH, particularly qT2* and to a lesser extent qT1 and FLAIR, should be considered to more precisely characterize the severity of WMHs in vivo. These findings may have implications in determining the reversibility of WMHs and potential efficacy of cardio- and cerebrovascular treatments.