This Article Full Text Full Text (PDF) All Versions of this Article: 39/4/1127    most recent STROKEAHA.107.497438v1 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 Holland, C. M. Articles by Greenberg, S. M. Search for Related Content PubMed PubMed Citation Articles by Holland, C. M. Articles by Greenberg, S. M. Pubmed/NCBI databases Medline Plus Health Information Alzheimer's Disease Amyloidosis MRI Scans Seniors' Health Related Collections Brain Circulation and Metabolism Computerized tomography and Magnetic Resonance Imaging PET and SPECT

(Stroke. 2008;39:1127.)
© 2008 American Heart Association, Inc.

Original Contributions

Spatial Distribution of White-Matter Hyperintensities in Alzheimer Disease, Cerebral Amyloid Angiopathy, and Healthy Aging

Christopher M. Holland, BS; Eric E. Smith, MD; Istvan Csapo, BS; Mahmut Edip Gurol, MD; Douglas A. Brylka, MD; Ronald J. Killiany, PhD; Deborah Blacker, MD, ScD; Marilyn S. Albert, PhD; Charles R.G. Guttmann, MD Steven M. Greenberg, MD, PhD

From the Center for Neurological Imaging (C.M.H., I.C., D.A.B., R.J.K., C.R.G.G.), Brigham and Women’s Hospital and Harvard Medical School; the Department of Anatomy and Neurobiology (C.M.H., R.J.K.), Boston University School of Medicine; the Neurology Clinical Trial Unit and Department of Neurology (E.E.S., M.E.G., S.M.G.), Massachusetts General Hospital and Harvard Medical School; and the Department of Psychiatry (R.J.K., D.B.), Massachusetts General Hospital and Harvard Medical School, Boston, Mass; and the Department of Neurology (M.S.A.), Johns Hopkins University School of Medicine, Baltimore, Md.

Correspondence to Charles R.G. Guttmann, MD, Center for Neurological Imaging, Brigham and Women’s Hospital, 221 Longwood Ave, RF 394, Boston, MA 02115. E-mail guttmann{at}bwh.harvard.edu

Background and Purpose— White-matter hyperintensities (WMHs) detected by magnetic resonance imaging are thought to represent the effects of cerebral small-vessel disease and neurodegenerative changes. We sought to determine whether the spatial distribution of WMHs discriminates between different disease groups and healthy aging individuals and whether these distributions are related to local cerebral perfusion patterns.

Methods— We examined the pattern of WMHs by T2/fluid-attenuated inversion recovery–weighted magnetic resonance imaging in 3 groups of subjects: cerebral amyloid angiopathy (n=32), Alzheimer disease or mild cognitive impairment (n=41), and healthy aging (n=29). WMH frequency maps were calculated for each group, and spatial distributions were compared by voxel-wise logistic regression. WMHs were also analyzed as a function of normal cerebral perfusion patterns by overlaying a single photon emission computed tomography atlas.

Results— Although WMH volume was greater in cerebral amyloid angiopathy and Alzheimer disease/mild cognitive impairment than in healthy aging, there was no consistent difference in the spatial distributions when controlling for total WMH volume. Hyperintensities were most frequent in the deep periventricular WM in all 3 groups. A strong inverse correlation between hyperintensity frequency and normal perfusion was demonstrated in all groups, demonstrating that WMHs were most common in regions of relatively lower normal cerebral perfusion.

Conclusions— WMHs show a common distribution pattern and predilection for cerebral WM regions with lower atlas-derived perfusion, regardless of the underlying diagnosis. These data suggest that across diverse disease processes, WM injury may occur in a pattern that reflects underlying tissue properties, such as relative perfusion.

Key Words: Alzheimer disease • cerebral amyloid angiopathy • magnetic resonance imaging • perfusion • white-matter hyperintensities

This article has been cited by other articles:

				E. E. Smith and S. M. Greenberg {beta}-Amyloid, Blood Vessels, and Brain Function Stroke, July 1, 2009; 40(7): 2601 - 2606. [Abstract] [Full Text] [PDF]

				G. J. Zipfel, H. Han, A. L. Ford, and J.-M. Lee Cerebral Amyloid Angiopathy: Progressive Disruption of the Neurovascular Unit Stroke, March 1, 2009; 40(3_suppl_1): S16 - S19. [Abstract] [Full Text] [PDF]

				Do White-Matter Hyperintensities Reflect Disease Process or Underlying Susceptibility? Journal Watch Neurology, September 9, 2008; 2008(909): 2 - 2. [Full Text]