Response to Letter by Park and Yasuda
We thank Drs Park and Yasuda for their interesting comments. They pointed out the importance of using MRI FLAIR images to diagnose leukoaraiosis (LA). In fact, we also used FLAIR images to evaluate periventricular hyperintensities (PVH) and subcortical white matter lesions (SWML).1 It is important to note that the LA in the study of Park et al2 included both PVH and SWML. Moreover, we evaluated PVH and SWML separately because of differences in their locations and underlying pathology, depending on their severity.3
We re-examined the association between metabolic syndrome (MetS) and PVH and SWML, including minimal LA. The logistic analysis adjusted for age, gender, and smoking revealed that MetS was not associated with minimal PVH (OR=0.80, 95% CI: 0.48 to 1.29 for PVH grade 1; OR=1.14, 95% CI: 0.65 to 2.00 for PVH grade 2). Furthermore, MetS was not associated with minimal SWML (OR=0.94, 95% CI: 0.58 to 1.52 for SWML grade 1). Therefore, our study disagreed with theirs. More data and longitudinal studies are required to determine whether minimal LA is related to MetS.
Bokura H, Yamaguchi S, Iijima K, Iijima K, Nagai A, Oguro H. Metabolic syndrome is associated with silent ischemic brain lesions. Stroke. 2008; 39: 1607–1609.
Park K, Yasuda N, Toyonaga S, Yamada SM, Nakabayashi H, Nakasato M, Nakagomi T, Tsubosaki E, Shimizu K. Significant association between leukoaraiosis and metabolic syndrome in healthy subjects. Neurology. 2007; 69: 974–978.
Fazekas F, Kleinert R, Offenbacher H, Schmidt R, Kleinert G, Payer F, Radner H, Lechner H. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology. 1993; 43: 1683–1689.