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Karger_ESC London_2013

London, United Kingdom 2013 TABLE 1. Mean (±SD) post-contrast signal enhancement in each tissue for different white matter hyperintensity severity. Tissue PVH0 PVH1 PVH2 PVH3 GM 81 ± Cerebrovasc Dis 2013; 35 (suppl 3)1-854 47 15 91 ± 22 97 ± 22 99 ± 20 82 ± 17 92 ± 22 97 ± 20 100 ± 23 NAWM 24 ± 11 27 ± 9 30 ± 8 29 ± 8 25 ± 10 27 ± 9 30 ± 8 30 ± 9 CSF 302 ± 52 315 ± 59 308 ± 46 294 ± 55 317 ± 59 311 ± 52 304 ± 57 295 ± 56 WMH 48 ± 17 52 ± 20 47 ± 11 39 ± 10 58 ± 18 51 ± 19 43 ± 11 40 ± 11 7 Brain imaging A 15:30 - 15:40 Blood-brain barrier impairment in stroke patients differs with white matter hyperintensi-ty severity in diseased and normal appearing tissues. P.A. Armitage1, M. Valdes Hernandez2, S. Makin3, K. Shuler4, F.N. Doubal5, A. Del Bene6, X. Wang7, M.S. Dennis8, J.M. University of Sheffield, Sheffield, UNITED KINGDOM1,University of Edinburgh, Edin-burgh, UNITED KINGDOM2, University of Edinburgh, Edinburgh, UNITED KINGDOM3, University of Edinburgh, Edinburgh, UNITED KINGDOM4, University of Edinburgh, Edin-burgh, UNITED KINGDOM5, University of Edinburgh, Edinburgh, UNITED KINGDOM6, University of Edinburgh, Edinburgh, UNITED KINGDOM7, University of Edinburgh, Edin-burgh, UNITED KINGDOM8, University of Edinburgh, Edinburgh, UNITED KINGDOM9 BACKGROUND: Blood-brain barrier (BBB) impairment may be a contributory factor in the development of small vessel disease. We investigated whether subtle BBB abnormalities iden-tified by MRI differed with severity of white matter hyperintensities (WMH) in patients with minor stroke. METHODS: T1-weighted Dynamic Contrast-Enhanced MRI was performed for 25 minutes fol-lowing gadoterate administration in 206 patients with non-disabling ischaemic stroke, classified according to their Periventricular (PVH) and Deep (DWMH) WMH Fazekas scores (range 0-3). Post-contrast signal enhancement curves were measured in Grey Matter (GM), Normal Appear-ing White Matter (NAWM), CSF and WMH, carefully segmented blind to all other data with a validated method (MCMxxxVI). Recent and old stroke lesions were masked out from the sig-nal analysis. RESULTS: Signal enhancement curves differed between PVH/DWMH scores in GM (p=0.016/0.019), NAWM (p=0.023/0.035), WMH (p<0.001/<0.001), but not in CSF (p=0.18/0.40) (Table 1). In general, mean signal enhancement was greater in GM and NAWM for patients with more severe WMH (Fazekas 2-3), consistent with increased BBB impairment in patients with more severe white matter damage. Conversely, WMH showed reduced mean signal enhancement with more severe WMH, but there was a tendency for patients with more severe WMH to exhibit rising signal enhancement during the later post-contrast phase, while patients with less severe WMH (Fazekas 0-1) exhibited a falling profile in the same phase (Fig-ure 1). CONCLUSION: Signal enhancement profiles appear to vary with severity of white matter dis-ease in both normal and diseased tissues in stroke patients. These suggest that increased BBB permeability may contribute to the development of white matter disease, although further anal-ysis that accounts for key variables (e.g. age) is required to model the complex relationship be-tween signal enhancement properties and the BBB.


Karger_ESC London_2013
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