TY - JOUR
T1 - Characterizing the white matter hyperintensity penumbra with cerebral blood flow measures
AU - Promjunyakul, N.
AU - Lahna, D.
AU - Kaye, J. A.
AU - Dodge, H. H.
AU - Erten-Lyons, D.
AU - Rooney, W. D.
AU - Silbert, L. C.
N1 - Funding Information:
Dr. Lisa Silbert receives research support from the NIH (1R01AG036772, P30 AG008017, P50 NS062684). She also receives reimbursement through Medicare or commercial insurance plans for providing clinical assessment and care for patients and for intraoperative neurophysiological monitoring, and is salaried to see patients at the Portland VA Medical Center.
Funding Information:
Dr. Kaye receives research support from the Department of Veterans Affairs [Merit Review grant] and the NIH (P30 AG008017, R01 AG024059, P30 AG024978, P01 AG043362, U01 AG010483); directs a center that receives research support from the NIH, CDC, Roche and Esai; receives reimbursement through Medicare or commercial insurance plans for providing clinical assessment and care for patients; is salaried to see patients at the Portland VA Medical Center; serves as an unpaid Chair of the International Society to Advance Alzheimer's Research and Treatment for the National Alzheimer's Association and as an unpaid Commissioner for the Center for Aging Services and Technologies; and serves on the editorial advisory board of the journal, Alzheimer's & Dementia and as Associate Editor, and Frontiers of Aging Neuroscience.
Funding Information:
Study funding: supported by NIH ( 1RO1AG036772 , P30 AG008017 , RO1 AG024059 ) and the Department of Veterans Affairs .
Publisher Copyright:
© 2015 The Authors. Published by Elsevier Inc.
PY - 2015/6/8
Y1 - 2015/6/8
N2 - Objective White matter hyperintensities (WMHs) are common with age, grow over time, and are associated with cognitive and motor impairments. Mechanisms underlying WMH growth are unclear. We aimed to determine the presence and extent of decreased normal appearing white matter (NAWM) cerebral blood flow (CBF) surrounding WMHs to identify 'WM at risk', or the WMH CBF penumbra. We aimed to further validate cross-sectional finding by determining whether the baseline WMH penumbra CBF predicts the development of new WMHs at follow-up. Methods Sixty-one cognitively intact elderly subjects received 3 T MPRAGE, FLAIR, and pulsed arterial spin labeling (PASL). Twenty-four subjects returned for follow-up MRI. The inter-scan interval was 18 months. A NAWM layer mask, comprised of fifteen layers, 1 mm thick each surrounding WMHs, was generated for periventricular (PVWMH) and deep (DWMH) WMHs. Mean CBF for each layer was computed. New WMH and persistent NAWM voxels for each penumbra layer were defined from follow-up MRI. Results CBF in the area surrounding WMHs was significantly lower than the total brain NAWM, extending approximately 12 mm from both the established PVWMH and DWMH. Voxels with new WMH at follow-up had significantly lower baseline CBF than voxels that maintained NAWM, suggesting that baseline CBF can predict the development of new WMHs over time. Conclusions A CBF penumbra exists surrounding WMHs, which is associated with future WMH expansion. ASL MRI can be used to monitor interventions to increase white matter blood flow for the prevention of further WM damage and its cognitive and motor consequences.
AB - Objective White matter hyperintensities (WMHs) are common with age, grow over time, and are associated with cognitive and motor impairments. Mechanisms underlying WMH growth are unclear. We aimed to determine the presence and extent of decreased normal appearing white matter (NAWM) cerebral blood flow (CBF) surrounding WMHs to identify 'WM at risk', or the WMH CBF penumbra. We aimed to further validate cross-sectional finding by determining whether the baseline WMH penumbra CBF predicts the development of new WMHs at follow-up. Methods Sixty-one cognitively intact elderly subjects received 3 T MPRAGE, FLAIR, and pulsed arterial spin labeling (PASL). Twenty-four subjects returned for follow-up MRI. The inter-scan interval was 18 months. A NAWM layer mask, comprised of fifteen layers, 1 mm thick each surrounding WMHs, was generated for periventricular (PVWMH) and deep (DWMH) WMHs. Mean CBF for each layer was computed. New WMH and persistent NAWM voxels for each penumbra layer were defined from follow-up MRI. Results CBF in the area surrounding WMHs was significantly lower than the total brain NAWM, extending approximately 12 mm from both the established PVWMH and DWMH. Voxels with new WMH at follow-up had significantly lower baseline CBF than voxels that maintained NAWM, suggesting that baseline CBF can predict the development of new WMHs over time. Conclusions A CBF penumbra exists surrounding WMHs, which is associated with future WMH expansion. ASL MRI can be used to monitor interventions to increase white matter blood flow for the prevention of further WM damage and its cognitive and motor consequences.
KW - Arterial spin labeling (ASL)
KW - Cerebral blood flow (CBF) penumbra
KW - Cognitive aging
KW - Vascular dementia
KW - White matter hyperintensity (WMH)
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U2 - 10.1016/j.nicl.2015.04.012
DO - 10.1016/j.nicl.2015.04.012
M3 - Article
C2 - 26106546
AN - SCOPUS:84930677050
SN - 2213-1582
VL - 8
SP - 224
EP - 229
JO - NeuroImage: Clinical
JF - NeuroImage: Clinical
ER -