Morphometry demonstrates loss of cortical thickness in cerebral microangiopathy

ObjectiveTo evaluate the role of MR morphometry in the characterization of cerebral microangiopathy (CMA) in relation to clinical and neuropsychological impairment.Subjects and Methods3D MR images of 27 patients and 27 age–matched controls were morphometrically analysed for regional thickness. The normalized values were related to the patients’ clinical and neuropsychological scores. The patients were categorised according to the amount of structural MR signal changes. A ventricle index reflecting internal atrophy was related to MR morphology and cortical thickness as an indicator for external atrophy.ResultsCortical thickness was significantly reduced in the patients group (3.03mm ± 0.26 vs. 3.22mm ± 0.13 in controls, p = 0.001). The severest loss of cortical thickness occurred in severe CMA. Internal and external atrophy evolved in parallel and both showed a significant relationship with structural MR–abnormalities (p < 0.05; r = –0.7; r = 0.67; r = –0.74, respectively). Neuropsychological performance correlated strongly with the loss of cortical thickness.ConclusionsCortical thickness was identified as the most sensitive parameter to characterize CMA. A strong correlation was found of morphometric parameters to the severity of CMA based on a score derived from T2–weighted MRI. The degree of cortical atrophy was directly related to the degree of neuropsychological impairment. Our findings suggest that the cortical thickness is a valid marker in the structural and clinical characterization of CMA.

[1]  D. W. Desmond.  Cognition and White Matter Lesions , 2002, Cerebrovascular Diseases.

[2]  E. Englund.  Neuropathology of White Matter Lesions in Vascular Cognitive Impairment , 2002, Cerebrovascular Diseases.

[3]  V. Hachinski,et al.  Rethinking Vascular Dementia (Part 1 of 2) , 1993 .

[4]  O Sabri,et al.  Neuropsychological impairment correlates with hypoperfusion and hypometabolism but not with severity of white matter lesions on MRI in patients with cerebral microangiopathy. , 1999, Stroke.

[5]  Nancy C. Andreasen,et al.  Manual and Automated Measurement of the Whole Thalamus and Mediodorsal Nucleus Using Magnetic Resonance Imaging , 2002, NeuroImage.

[6]  R. Kalaria.  Small Vessel Disease and Alzheimer’s Dementia: Pathological Considerations , 2002, Cerebrovascular Diseases.

[7]  H. Soininen,et al.  Hippocampal volumes in Alzheimer's disease, Parkinson's disease with and without dementia, and in vascular dementia , 1996, Neurology.

[8]  G. Román.  From UBOs to Binswanger's disease. Impact of magnetic resonance imaging on vascular dementia research. , 1996, Stroke.

[9]  V. Hachinski,et al.  Rethinking Vascular Dementia (Part 2 of 2) , 1993 .

[10]  Timo Erkinjuntti,et al.  Subcortical Vascular Dementia , 2002, Cerebrovascular Diseases.

[11]  Gabriele Lohmann,et al.  Automatic labelling of the human cortical surface using sulcal basins , 2000, Medical Image Anal..

[12]  C. Jack,et al.  Rates of hippocampal atrophy correlate with change in clinical status in aging and AD , 2000, Neurology.

[13]  O Sabri,et al.  Correlation of neuropsychological, morphological and functional (regional cerebral blood flow and glucose utilization) findings in cerebral microangiopathy. , 1998, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[14]  Alan C. Evans,et al.  Automated 3-D Extraction of Inner and Outer Surfaces of Cerebral Cortex from MRI , 2000, NeuroImage.

[15]  D G Norris,et al.  Reduced power multislice MDEFT imaging , 2000, Journal of magnetic resonance imaging : JMRI.

[16]  K. Double,et al.  Topography of brain atrophy during normal aging and alzheimer's disease , 1996, Neurobiology of Aging.

[17]  N. Schuff,et al.  Volumetric MRI predicts rate of cognitive decline related to AD and cerebrovascular disease , 2002, Neurology.

[18]  宮尾 眞一.  Leukoaraiosis in relation to prognosis for patients with lacunar infarction , 1992 .

[19]  G. Halliday,et al.  Patients with vascular dementia due to microvascular pathology have significant hippocampal neuronal loss , 2002, Journal of neurology, neurosurgery, and psychiatry.

[20]  C. Weiller,et al.  [A comparison of MRT and SPECT findings in patients with cerebral microangiopathy]. , 1991, Nuklearmedizin. Nuclear medicine.

[21]  R. Quester,et al.  The shrinkage of the human brain stem during formalin fixation and embedding in paraffin , 1997, Journal of Neuroscience Methods.

[22]  David G. Norris,et al.  Characterization of Cerebral Small Vessel Disease by Proton Spectroscopy and Morphological Magnetic Resonance , 2001, Cerebrovascular Diseases.

[23]  S. L. Free,et al.  Landmark-Based Morphometrics of the Normal Adult Brain Using MRI , 2001, NeuroImage.

[24]  Moo K. Chung,et al.  Deformation-based surface morphometry applied to gray matter deformation , 2003, NeuroImage.

[25]  H. Feys,et al.  The European Stroke Scale , 1994, Stroke.

[26]  F. Fazekas,et al.  Pathologic correlates of incidental MRI white matter signal hyperintensities , 1993, Neurology.

[27]  Alan C. Evans,et al.  Measurement of Cortical Thickness Using an Automated 3-D Algorithm: A Validation Study , 2001, NeuroImage.

[28]  Karl J. Friston,et al.  Voxel-Based Morphometry—The Methods , 2000, NeuroImage.

[29]  E. Ringelstein,et al.  [Effect of morphological changes on perfusion and metabolism in cerebral microangiopathy. A comparison of PET, SPECT, and magnetic resonance imaging findings]. , 1995, Nuklearmedizin. Nuclear medicine.

[30]  M. Weiner,et al.  Frontal lobe hypometabolism predicts cognitive decline in patients with lacunar infarcts. , 2001, Archives of neurology.

[31]  R. Kikinis,et al.  White matter changes with normal aging , 1998, Neurology.

[32]  R. Schneider,et al.  Einfluß morphologischer Veränderungen auf Durchblutung und Stoffwechsel bei zerebraler Mikroangiopathie , 1995, Nuklearmedizin.

[33]  L. Regeur,et al.  Increasing loss of brain tissue with increasing dementia: a stereological study of post‐mortem brains from elderly females , 2000, European journal of neurology.

[34]  B. Turetsky,et al.  Preservation of normal cognitive functioning in elderly subjects with extensive white-matter lesions of long duration. , 1990, Archives of General Psychiatry.

[35]  J. V. van Swieten,et al.  Hypertension in the elderly is associated with white matter lesions and cognitive decline , 1991, Annals of neurology.

[36]  Frederik Barkhof,et al.  Imaging of White Matter Lesions , 2002, Cerebrovascular Diseases.

[37]  F. Fazekas,et al.  Evolution of White Matter Lesions , 2002, Cerebrovascular Diseases.

[38]  S. Miyao,et al.  Leukoaraiosis in Relation to Prognosis for Patients with Lacunar Infarction , 1992, Stroke.

[39]  Leonardo Pantoni,et al.  Pathophysiology of Age-Related Cerebral White Matter Changes , 2002, Cerebrovascular Diseases.

[40]  R. D'Hooge,et al.  From Neuronal and Vascular Impairment to Dementia , 1999, Pharmacopsychiatry.

[41]  Gabriele Lohmann,et al.  Morphology-Based Cortical Thickness Estimation , 2003, IPMI.

[42]  Paul W. Burgess,et al.  Behavioural Assessment of the Dysexecutive Syndrome , 1997 .

[43]  D. Kennedy,et al.  Magnetic resonance imaging–based brain morphometry: Development and application to normal subjects , 1989, Annals of neurology.

[44]  N. Schuff,et al.  Effects of subcortical ischemic vascular dementia and AD on entorhinal cortex and hippocampus , 2002, Neurology.

[45]  J. Garcìa,et al.  Pathogenesis of leukoaraiosis: a review. , 1997, Stroke.

[46]  K Herholz,et al.  Severity of vascular dementia is related to volume of metabolically impaired tissue. , 1992, Archives of neurology.