This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Marstrand, J.R. Articles by Larsson, H.B.W. Search for Related Content PubMed PubMed Citation Articles by Marstrand, J.R. Articles by Larsson, H.B.W. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETAZOLAMIDE Medline Plus Health Information MRI Scans Related Collections Pathophysiology Other arteriosclerosis Imaging Ischemic biology - basic studies Computerized tomography and Magnetic Resonance Imaging Other Vascular biology

(Stroke. 2002;33:972.)
© 2002 American Heart Association, Inc.

Original Contributions

Cerebral Perfusion and Cerebrovascular Reactivity Are Reduced in White Matter Hyperintensities

J.R. Marstrand, MD; E. Garde, MD, PhD; E. Rostrup, MD, MSc; P. Ring, MSc; S. Rosenbaum, MD, PhD; E.L. Mortensen, PhD H.B.W. Larsson, MD, PhD

From the Danish Research Centre for Magnetic Resonance (J.R.M., E.G., E.R., P.R., S.R.), Hvidovre Hospital, Hvidovre, and Department of Health Psychology (E.L.M.), Institute of Public Health, University of Copenhagen, Copenhagen, Denmark; and MR-Centre, University Hospital Trondheim (H.B.W.L.), Trondheim, Norway.

Correspondence to Jacob R. Marstrand, MD, Danish Research Centre for Magnetic Resonance, Hvidovre Hospital, Kettegård Alle 30, DK-2650 Hvidovre, Denmark. E-mail marstrand{at}dadlnet.dk

Background and Purpose— There is growing evidence that white matter hyperintensities (WMH) should not be considered as benign age-dependent changes on MR images but indicate pathological changes with clinical consequences. Previous studies comparing subjects with WMH to normal controls have reported global reductions in cerebral blood flow (CBF) and cerebral vascular reactivity. In this study, we examined localized hemodynamic status to compare WMH to normal appearing white matter (NAWM).

Methods— A group of 21 normal 85-year-old subjects were studied using dynamic contrast-enhanced MRI together with administration of acetazolamide. From a combination of anatomic images with different signal weighting, regions of interest were generated corresponding to gray and white matter and WMH. Localized measurements of CBF and cerebral blood volume (CBV) and mean transit time were obtained directly within WMH and NAWM.

Results— When comparing WMH to NAWM, measurements showed significantly lower CBF (P=0.004) and longer mean transit time (P< 0.001) in WMH but no significant difference in CBV (P=0.846). The increases in CBF and CBV induced by acetazolamide were significantly smaller in WMH than in NAWM (P=0.026, P<0.001).

Conclusion— These results show that a change in the hemodynamic status is present within the WMH, making these areas more likely to be exposed to transient ischemia inducing myelin rarefaction. In the future, MRI may be used to examine the effect of therapeutic strategies designed to prevent or normalize vascular changes.

Key Words: hemodynamics • magnetic resonance imaging, perfusion-weighted • white matter

This article has been cited by other articles:

				G. F. Mitchell Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage J Appl Physiol, November 1, 2008; 105(5): 1652 - 1660. [Abstract] [Full Text] [PDF]

				T.J. Huynh, B. Murphy, J.A. Pettersen, H. Tu, D.J. Sahlas, L. Zhang, S.P. Symons, S. Black, T.-Y. Lee, and R.I. Aviv CT Perfusion Quantification of Small-Vessel Ischemic Severity AJNR Am. J. Neuroradiol., November 1, 2008; 29(10): 1831 - 1836. [Abstract] [Full Text] [PDF]

				N. Altaf, P. S. Morgan, A. Moody, S. T. MacSweeney, J. R. Gladman, and D. P. Auer Brain White Matter Hyperintensities Are Associated with Carotid Intraplaque Hemorrhage Radiology, July 1, 2008; 248(1): 202 - 209. [Abstract] [Full Text] [PDF]

				C. M. Holland, E. E. Smith, I. Csapo, M. E. Gurol, D. A. Brylka, R. J. Killiany, D. Blacker, M. S. Albert, C. R.G. Guttmann, and S. M. Greenberg Spatial Distribution of White-Matter Hyperintensities in Alzheimer Disease, Cerebral Amyloid Angiopathy, and Healthy Aging Stroke, April 1, 2008; 39(4): 1127 - 1133. [Abstract] [Full Text] [PDF]

				V. H. ten Dam, D. M. J. van den Heuvel, A. J. M. de Craen, E. L. E. M. Bollen, H. M. Murray, R. G. J. Westendorp, G. J. Blauw, and M. A. van Buchem Decline in Total Cerebral Blood Flow Is Linked with Increase in Periventricular but Not Deep White Matter Hyperintensities Radiology, April 1, 2007; 243(1): 198 - 203. [Abstract] [Full Text] [PDF]

				D. G. Munoz Leukoaraiosis and Ischemia: Beyond the Myth Stroke, June 1, 2006; 37(6): 1348 - 1349. [Full Text] [PDF]

				R Peters Ageing and the brain Postgrad. Med. J., February 1, 2006; 82(964): 84 - 88. [Abstract] [Full Text] [PDF]

				S. M. Greenberg, M. E. Gurol, J. Rosand, and E. E. Smith Amyloid Angiopathy-Related Vascular Cognitive Impairment Stroke, November 1, 2004; 35(11_suppl_1): 2616 - 2619. [Abstract] [Full Text] [PDF]

				J. van der Grond, A. F. van Raamt, Y. van der Graaf, W. P.T.M. Mali, and R. H.C. Bisschops A fetal circle of Willis is associated with a decreased deep white matter lesion load Neurology, October 26, 2004; 63(8): 1452 - 1456. [Abstract] [Full Text] [PDF]

				H.-K. Kuo and L. A. Lipsitz Cerebral White Matter Changes and Geriatric Syndromes: Is There a Link? J. Gerontol. A Biol. Sci. Med. Sci., August 1, 2004; 59(8): M818 - M826. [Abstract] [Full Text] [PDF]

				G. J. del Zoppo TIAs and the pathology of cerebral ischemia Neurology, April 27, 2004; 62(8_suppl_6): S15 - S19. [Full Text]