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RT Journal Article
SR Electronic
T1 Dilated Perivascular Spaces in the Basal Ganglia Are a Biomarker of Small-Vessel Disease in a Very Elderly Population with Dementia
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 893
OP 898
DO 10.3174/ajnr.A4237
VO 36
IS 5
A1 Hansen, T.P.
A1 Cain, J.
A1 Thomas, O.
A1 Jackson, A.
YR 2015
UL http://www.ajnr.org/content/36/5/893.abstract
AB BACKGROUND AND PURPOSE: Dilated perivascular spaces have been shown to be a specific biomarker of cerebral small-vessel disease in young patients with dementia. Our aim was to examine the discriminative power of dilated cerebral perivascular spaces as biomarkers of small-vessel disease in a very elderly population of patients with dementia. MATERIALS AND METHODS: We studied healthy volunteers (n = 65; mean age, 78 ± 5.6 years) and subjects with vascular dementia (n = 39; mean age, 76.9 ± 7.7 years) and Alzheimer disease (n = 47; mean age, 74.1 ± 8.5 years). We compared white matter hyperintensity and 2 semiquantitative perivascular space scoring systems (perivascular space-1 and perivascular space-2). Intra- and interobserver agreement was assessed by using a weighted Cohen κ statistic. Multinomial regression modeling was used to assess the discriminative power of imaging features to distinguish clinical groups. RESULTS: White matter hyperintensity scores were higher in vascular dementia than in Alzheimer disease (P &lt; .05) or healthy volunteers (P &lt; .01). The perivascular space-1 score was higher in vascular dementia and Alzheimer disease than in healthy volunteers (P &lt; .01). The perivascular space-2 score in the centrum semiovale showed no intergroup differences. However, perivascular space-2 in the basal ganglia was higher in vascular dementia than in Alzheimer disease (P &lt; .05) or healthy volunteers (P &lt; .001) and higher in Alzheimer disease than in healthy volunteers (P &lt; .001). Modeling of dementia versus healthy volunteers, Alzheimer disease versus healthy volunteers, and vascular dementia against Alzheimer disease demonstrated perivascular space-2basal ganglia as the only imaging parameter with independent significant discriminative power (P &lt; .01, P &lt; .01, and P &lt; .05) with areas under the receiver operating characteristic curve of 0.855, 0.774, and 0.71, respectively. Modeling of vascular dementia versus healthy volunteers showed that perivascular space-2basal ganglia (P &lt; .01) and the modified Scheltens score (P &lt; .05) contributed significant, independent discriminatory power, accounting for 34% and 13% of the variance in the model respectively. CONCLUSIONS: Dilated perivascular spaces remain a valuable biomarker of small-vessel disease in an elderly population. ADAlzheimer diseaseBGbasal gangliaCSOVcentrum semiovaleNormhealthy volunteersPVSdilated perivascular spacesROCreceiver operating characteristicSVDsmall-vessel diseaseVaDvascular dementia