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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Jul;69(1):48–53. doi: 10.1136/jnnp.69.1.48

Reduced cerebral blood flow in white matter in ischaemic leukoaraiosis demonstrated using quantitative exogenous contrast based perfusion MRI

H Markus 1, D Lythgoe 1, L Ostegaard 1, M O'Sullivan 1, S Williams 1
PMCID: PMC1737001  PMID: 10864603

Abstract

OBJECTIVE—White matter hypoperfusion may play a part in the pathogenesis of ischaemic leukoaraiosis, but demonstration of this requires a high resolution quantitative method of cerebral blood flow (CBF) measurement. Initial exogenous contrast based MRI methods only allowed measurement of relative cerebral blood volume (CBV) values, but more recently a mathematical approach has been developed which enables absolute regional CBF and CBV to be determined. This technique was applied to patients with ischaemic leukoaraiosis to determine whether reduced white matter CBF in this patient group could be demonstrated.
METHODS—Eight patients with ischaemic leukoaraiosis (radiological leukoaraiosis and clinical lacunar stroke), and nine age matched controls were studied. A spin echo echoplanar image sequence was used on a 1.5 Tesla MR system. An arterial input function was obtained from voxels placed over the middle cerebral arteries. Cerebral blood flow, CBV, and mean transit (MTT) maps were derived. Regions of interest were placed at standard positions in the white and grey matter and mean values of CBF, CBV, and MTT were compared between the two groups.
RESULTS—Mean (SD) white matter CBF was significantly reduced in patients by 38% (13.40 (4.87) v 21.74 (3.53) ml/min/ 100 g, p=0.002). Significant reductions in CBF were seen in all white matter regions. By contrast there was no reduction in CBF in any grey matter region. There was no significant difference in white matter CBV between cases and controls; mean values were lower in all white matter regions for patients but this did not reach significance for any region. By contrast mean grey matter CBV was significantly higher in patients than in controls. Mean MTT values were higher in all regions of grey and white matter in the patient group, but this only achieved significance for the superior white matter.
CONCLUSION—A quantitative MR perfusion method showed reduced white matter CBF in patients with ischaemic leukoaraiosis, but normal grey matter CBF. This is consistent with hypoperfusion playing a part in the pathogenesis of ischaemic leukoaraiosis. The absolute values of white matter and grey matter CBF obtained in the patient groups were very similar to those in previous PET studies, providing further evidence for the validity of the regional CBF measurements obtained using this quantitative MR perfusion technique. The high spatial resolution and lack of radioactive administration makes such techniques ideal for longitudinal studies in this condition.



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Selected References

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  1. Boxerman J. L., Hamberg L. M., Rosen B. R., Weisskoff R. M. MR contrast due to intravascular magnetic susceptibility perturbations. Magn Reson Med. 1995 Oct;34(4):555–566. doi: 10.1002/mrm.1910340412. [DOI] [PubMed] [Google Scholar]
  2. De Cristofaro M. T., Mascalchi M., Pupi A., Nencini P., Formiconi A. R., Inzitari D., Dal Pozzo G., Meldolesi U. Subcortical arteriosclerotic encephalopathy: single photon emission computed tomography-magnetic resonance imaging correlation. Am J Physiol Imaging. 1990;5(2):68–74. [PubMed] [Google Scholar]
  3. De Reuck J., Decoo D., Marchau M., Santens P., Lemahieu I., Strijckmans K. Positron emission tomography in vascular dementia. J Neurol Sci. 1998 Jan 21;154(1):55–61. doi: 10.1016/s0022-510x(97)00213-x. [DOI] [PubMed] [Google Scholar]
  4. Hachinski V. C., Potter P., Merskey H. Leuko-araiosis. Arch Neurol. 1987 Jan;44(1):21–23. doi: 10.1001/archneur.1987.00520130013009. [DOI] [PubMed] [Google Scholar]
  5. Hatazawa J., Shimosegawa E., Satoh T., Toyoshima H., Okudera T. Subcortical hypoperfusion associated with asymptomatic white matter lesions on magnetic resonance imaging. Stroke. 1997 Oct;28(10):1944–1947. doi: 10.1161/01.str.28.10.1944. [DOI] [PubMed] [Google Scholar]
  6. Miyazawa N., Satoh T., Hashizume K., Fukamachi A. Xenon contrast CT-CBF measurements in high-intensity foci on T2-weighted MR images in centrum semiovale of asymptomatic individuals. Stroke. 1997 May;28(5):984–987. doi: 10.1161/01.str.28.5.984. [DOI] [PubMed] [Google Scholar]
  7. Ostergaard L., Johannsen P., Høst-Poulsen P., Vestergaard-Poulsen P., Asboe H., Gee A. D., Hansen S. B., Cold G. E., Gjedde A., Gyldensted C. Cerebral blood flow measurements by magnetic resonance imaging bolus tracking: comparison with [(15)O]H2O positron emission tomography in humans. J Cereb Blood Flow Metab. 1998 Sep;18(9):935–940. doi: 10.1097/00004647-199809000-00002. [DOI] [PubMed] [Google Scholar]
  8. Ostergaard L., Smith D. F., Vestergaard-Poulsen P., Hansen S. B., Gee A. D., Gjedde A., Gyldensted C. Absolute cerebral blood flow and blood volume measured by magnetic resonance imaging bolus tracking: comparison with positron emission tomography values. J Cereb Blood Flow Metab. 1998 Apr;18(4):425–432. doi: 10.1097/00004647-199804000-00011. [DOI] [PubMed] [Google Scholar]
  9. Ostergaard L., Weisskoff R. M., Chesler D. A., Gyldensted C., Rosen B. R. High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part I: Mathematical approach and statistical analysis. Magn Reson Med. 1996 Nov;36(5):715–725. doi: 10.1002/mrm.1910360510. [DOI] [PubMed] [Google Scholar]
  10. Ostrow P. T., Miller L. L. Pathology of small artery disease. Adv Neurol. 1993;62:93–123. [PubMed] [Google Scholar]
  11. Pantoni L., Garcia J. H. Pathogenesis of leukoaraiosis: a review. Stroke. 1997 Mar;28(3):652–659. doi: 10.1161/01.str.28.3.652. [DOI] [PubMed] [Google Scholar]
  12. Pantoni L., Inzitari D., Pracucci G., Lolli F., Giordano G., Bracco L., Amaducci L. Cerebrospinal fluid proteins in patients with leucoaraiosis: possible abnormalities in blood-brain barrier function. J Neurol Sci. 1993 Apr;115(2):125–131. doi: 10.1016/0022-510x(93)90214-j. [DOI] [PubMed] [Google Scholar]
  13. Schumann P., Touzani O., Young A. R., Morello R., Baron J. C., MacKenzie E. T. Evaluation of the ratio of cerebral blood flow to cerebral blood volume as an index of local cerebral perfusion pressure. Brain. 1998 Jul;121(Pt 7):1369–1379. doi: 10.1093/brain/121.7.1369. [DOI] [PubMed] [Google Scholar]
  14. Weisskoff R. M., Zuo C. S., Boxerman J. L., Rosen B. R. Microscopic susceptibility variation and transverse relaxation: theory and experiment. Magn Reson Med. 1994 Jun;31(6):601–610. doi: 10.1002/mrm.1910310605. [DOI] [PubMed] [Google Scholar]
  15. Yao H., Sadoshima S., Ibayashi S., Kuwabara Y., Ichiya Y., Fujishima M. Leukoaraiosis and dementia in hypertensive patients. Stroke. 1992 Nov;23(11):1673–1677. doi: 10.1161/01.str.23.11.1673. [DOI] [PubMed] [Google Scholar]
  16. Yao H., Sadoshima S., Kuwabara Y., Ichiya Y., Fujishima M. Cerebral blood flow and oxygen metabolism in patients with vascular dementia of the Binswanger type. Stroke. 1990 Dec;21(12):1694–1699. doi: 10.1161/01.str.21.12.1694. [DOI] [PubMed] [Google Scholar]

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