Enlarged perivascular spaces and cerebral small vessel disease

Authors

  • Gillian M. Potter,

    1. Division of Clinical Neurosciences and SINAPSE Collaboration, University of Edinburgh, Western General Hospital, Edinburgh, UK
    Search for more papers by this author
  • Fergus N. Doubal,

    1. Division of Clinical Neurosciences and SINAPSE Collaboration, University of Edinburgh, Western General Hospital, Edinburgh, UK
    Search for more papers by this author
  • Caroline A. Jackson,

    1. Division of Clinical Neurosciences and SINAPSE Collaboration, University of Edinburgh, Western General Hospital, Edinburgh, UK
    Search for more papers by this author
  • Francesca M. Chappell,

    1. Division of Clinical Neurosciences and SINAPSE Collaboration, University of Edinburgh, Western General Hospital, Edinburgh, UK
    Search for more papers by this author
  • Cathie L. Sudlow,

    1. Division of Clinical Neurosciences and SINAPSE Collaboration, University of Edinburgh, Western General Hospital, Edinburgh, UK
    Search for more papers by this author
  • Martin S. Dennis,

    1. Division of Clinical Neurosciences and SINAPSE Collaboration, University of Edinburgh, Western General Hospital, Edinburgh, UK
    Search for more papers by this author
  • Joanna M. Wardlaw

    Corresponding author
    1. Division of Clinical Neurosciences and SINAPSE Collaboration, University of Edinburgh, Western General Hospital, Edinburgh, UK
    • Correspondence: Joanna M. Wardlaw, SFC Brain Imaging Research Centre, Division of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.

      E-mail: Joanna.Wardlaw@ed.ac.uk

    Search for more papers by this author

  • The copyright line for this article was changed on 03 June 2015 after original online publication.
  • Conflicts of interest: The authors declare no potential conflict of interest.
  • Funding: The Edinburgh Stroke Register, CLMS and CAJ were funded by the Wellcome Trust (grant number 063668, Clinician Scientist Award to CLMS) and the Binks Trust. The Lacunar Stroke Study was funded by the Chief Scientist Office of the Scottish Executive (grant number 217 NTU R37933) and the Wellcome Trust (grant number 075611). JMW was funded by the Scottish Funding Council SINAPSE Initiative (Scottish Imaging Network, A Platform for Scientific Excellence, http://www.sinapse.ac.uk). GMP was funded by NHS Lothian R&D and the Chief Scientist Office of the Scottish Executive. FND was funded by the Wellcome Trust (grant number 075611). Imaging was performed in the Scottish Funding Council Brain Imaging Research Centre at the University of Edinburgh and in the Neuroradiology Department, Western General Hospital, Edinburgh.

Abstract

Background and aims

Enlarged perivascular spaces (also known as Virchow–Robin spaces) on T2-weighted brain magnetic resonance imaging are common, but their etiology, and specificity to small vessel as opposed to general cerebrovascular disease or ageing, is unclear. We tested the association between enlarged perivascular spaces and ischemic stroke subtype, other markers of small vessel disease, and common vascular risk factors.

Methods

We prospectively recruited patients with acute stroke, diagnosed and subtyped by a stroke physician using clinical features and brain magnetic resonance imaging. A neuroradiologist rated basal ganglia and centrum semiovale enlarged perivascular spaces on a five-point scale, white matter lesions, recent and old infarcts, and cerebral atrophy. We assessed associations between basal ganglia-, centrum semiovale- and total (combined basal ganglia and centrum semiovale) enlarged perivascular spaces, stroke subtype, white matter lesions, atrophy, and vascular risk factors.

Results

Among 298 patients (mean age 68 years), after adjusting for vascular risk factors and white matter lesions, basal ganglia–enlarged perivascular spaces were associated with increasing age (P = 0·001), centrum semiovale–enlarged perivascular spaces (P < 0·001), cerebral atrophy (P = 0·03), and lacunar stroke subtype (P = 0·04). Centrum semiovale–enlarged perivascular spaces were associated mainly with basal ganglia–enlarged perivascular spaces. Total enlarged perivascular spaces were associated with increasing age (P = 0·01), deep white matter lesions (P = 0·005), and previous stroke (P = 0·006).

Conclusions

Enlarged perivascular spaces are associated with age, lacunar stroke subtype and white matter lesions and should be considered as another magnetic resonance imaging marker of cerebral small vessel disease. Further evaluation of enlarged perivascular spaces in studies of ageing, stroke, and dementia is needed to determine their pathophysiological importance.

Ancillary