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J Cereb Blood Flow Metab. 2020 Jan;40(1):85-99. doi: 10.1177/0271678X18803956. Epub 2018 Oct 8.

Small vessel disease is associated with altered cerebrovascular pulsatility but not resting cerebral blood flow.

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Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China.
Department of Neurology, Tiantan Hospital, Beijing, China.
Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
UK Dementia Research Institute at The University of Edinburgh, Edinburgh Medical School, Edinburgh, UK.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.


Cerebral small vessel disease (SVD) contributes to 25% of ischemic strokes and 45% of dementias. We aimed to investigate the role of cerebral blood flow (CBF) and intracranial pulsatility in SVD. We scanned 60 patients with minor ischemic stroke, representing a range of white matter hyperintensities (WMH). We rated WMH and perivascular spaces (PVS) using semi-quantitative scales and measured WMH volume. We measured flow and pulsatility in the main cerebral vessels and cerebrospinal fluid (CSF) using phase-contrast MRI. We investigated the association between flow, pulsatility and SVD features. In 56/60 patients (40 male, 67.8±8.3 years) with complete data, median WMH volume was 10.7 mL (range 1.4-75.0 mL), representing median 0.77% (0.11-5.17%) of intracranial volume. Greater pulsatility index (PI) in venous sinuses was associated with larger WMH volume (e.g. superior sagittal sinus, β = 1.29, P < 0.01) and more basal ganglia PVS (e.g. odds ratio = 1.38, 95% confidence interval 1.06, 1.79, per 0.1 increase in superior sagittal sinus PI) independently of age, sex and blood pressure. CSF pulsatility and CBF were not associated with SVD features. Our results support a close association of SVD features with increased intracranial pulsatility rather than with low global CBF, and provide potential targets for mechanistic research, treatment and prevention of SVD.


Cerebral blood flow; cerebral small vessel disease; cerebrovascular pulsatility; magnetic resonance imaging; perivascular spaces; stroke; white matter hyperintensities

[Available on 2021-01-01]

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