Abstract T P363: Blood-Brain Barrier Damage in Vascular Risk Factor Associated White Matter Disease
Background: Vascular risk factor associated white matter disease (WMD), or leukoaraiosis, has been shown to demonstrate blood brain barrier damage (BBB) in patients with vascular dementia even when not detectable with standard clinical T1 post-contrast imaging.
Purpose: We sought to study the prevalence of white matter BBB damage in a population of patients admitted to an inpatient stroke service.
Methods: MRI scans of patients admitted for TIA or stroke were reviewed for evidence of confluent WMD in the centrum semiovale (CSO). To be included in the study patients must also have undergone a successful DSC image acquisition, also known as perfusion weighted image (PWI). The source images of the PWI were analyzed to generate blood-brain permeability images (BBPI) as described in a previous publication (Leigh et al, PLOS One 2012). The CSO in the first image above the lateral ventricles was used in each patient to generate BBPI measures. The pre-injection images of the PWI are T2* weighted and were therefore used to outline the area of confluent T2 signal change bilaterally. No acute strokes were present in any CSO analyzed as confirmed on DWI. The mean percent leakage (MPL) of contrast was calculated for each patient. A threshold of 2% of cerebral blood volume (CBV) was used to differentiate BBB damage from noise.
Results: 20 patients were included in the study, 8 were female, with a mean age of 65 years. The diagnosis was stroke in 15 patients and TIA in 5 patients. The location of the strokes were 5 pons, 3 basil ganglia, 3 periventricular, 1 thalamus, 1 cerebellar, 1 PCA, and 1 embolic shower. Of the 20 patients, 11 stroke patients and 3 TIA patients demonstrated BBB damage. The MPL ranged from 2.1% to 23.7% with an average value of 6.9% (of CBV). The MPL was even higher for the TIA group (12.2%) than for the for the stroke group (5.4%), although this difference failed to reach significance (p=0.056) .
Conclusions: In patients admitted for stroke evaluation, BBB damage in confluent WMD is common. The relevance of this finding remains unclear. However there appears to be a trend towards increased BBB damage in patients who present with events that do not localize to an acute stroke; further research should be directed at establishing the clinical implications of BBB damage in this population.
Author Disclosures: R. Leigh: None. P.B. Barker: None. A.E. Hillis: None.
- © 2014 by American Heart Association, Inc.