Title:The Positional Relationship between Lacunae and White Matter Hyperintensity
in Patients with Cerebral Small Vessel Disease
Volume: 20
Issue: 3
Author(s): Lu An, Wenxin Yuan, Yunchao Wang, Shanshan Li, Ce Zong, Yuan Gao, Yusheng Li, Limei Wang, Ya Peng Li, Yan Ji*Yuming Xu*
Affiliation:
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
Keywords:
Lacunae, white matter hyperintensity, cerebral small vessel disease, positional relationship, risk factors, neuroimaging.
Abstract:
Background: Lacunae and white matter hyperintensity (WMH) are two crucial imaging
biomarkers of cerebral small vessel disease (CSVD). Multiple studies have revealed a close relationship
between WMH and lacunae and found that a double penumbra existed at the edge of
WMH that affects lacunae formation. The study aimed to explore the spatial distribution characteristics
and possible influencing factors of lacuna in relation to white matter hyperintensity in patients
with CSVD.
Methods: A total of 480 CSVD patients with WMH and with or without lacunae were included.
Data about blood biochemical indicators, cerebrovascular CT angiography, 24-hour ambulatory
blood pressure and ambulatory electrocardiogram, brain magnetic resonance imaging, and transcranial
Doppler ultrasound were gathered from all subjects. They were categorised into four
groups based on the spatial interaction between lacunae and WMH. Univariate analyses and multiple
logistic regression analyses were used to compare the differences in traditional vascular risk
factors, heart rate and blood pressure indicators, arterial pulsatility index (PI) values, and arterial
stenosis among different groups.
Results: The average age of 480 patients was (58.63 ± 11.91) years, with 347 males (72.3%). Univariate
analysis indicated that age, fasting blood glucose, triglycerides, total cholesterol, highdensity
lipoprotein, 24-hour and daytime and night systolic and diastolic blood pressure, nocturnal
heart rate, heart rate variability, PI values of ipsilateral and contralateral MCA (middle cerebral
artery) and ICA (Internal carotid artery) of the lacunae, Fazekas score of PWMH (periventricular
white matter hyperintensities), the proportion of MCA or ICA with stenosis rate over 50% on the
ipsilateral side of the lacunae were significantly different between different groups (p < 0.05). High
fasting blood glucose (OR=1.632, 95% CI= (1.128, 2.361), p =0.009), (OR=1.789, 95%CI=
(1.270, 2.520), p = 0.001), (OR=1.806, 95% CI= (1.292, 2.524), p =0.001) was identified as a risk
factor for lacunae formation by logistic regression analysis.
Conclusion: High fasting blood glucose can be considered a risk factor for lacunae formation in
patients with WMH. The more severe the PWMH and the higher the nocturnal heart rate, the more
likely the lacunae, as well as PWMH, overlap completely. Ipsilateral arteriosclerosis and stenosis
are independent risk factors for no contact between lacunae and PWMH.
