Extracellular free water (FW) has important roles in the occurrence and development of white matter hyperintensity (WMH).
Purpose
To explore the correlations between FW and WMH burden.
Material and Methods
A prospective analysis was conducted using magnetic resonance imaging (MRI) data from 126 individuals. WMH burden was determined based on WMH volumes and Fazekas scores from deep and periventricular white matter hyperintensity (DWMH and PWMH, respectively) in fluid-attenuated inversion recovery (FLAIR) images. FW values were taken from diffusion tensor imaging (DTI).
Results
Univariate analysis showed that FW values were correlated with WMH burden, including WMH volumes and DWMH and PWMH Fazekas scores (P < 0.05). After multivariate analysis, FW values were correlated with WMH volumes and DWMH and PWMH Fazekas scores when adjusted for age and hypertension (P < 0.05).
Conclusion
Using MRI, increasing extracellular FW was related to WMH burden.
WardlawJMSmithEEBiesselsGJ, et al.Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol2013;12:822–838.
2.
DengGXiaoJYuH, et al.Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a meta-analysis. J Neurointerv Surg2022;14:881–885.
3.
ZhangRYuWWuX, et al.Disentangling the pathologies linking white matter hyperintensity and geriatric depressive symptoms in subjects with different degrees of vascular impairment. J Affect Disord2021;282:1005–1010.
4.
DadarMMahmoudSZhernovaiaM, et al.White matter hyperintensity distribution differences in aging and neurodegenerative disease cohorts. Neuroimage Clin2022;36:103204.
5.
SuCYangXWeiS, et al.Periventricular white matter hyperintensities are associated with gait and balance in patients with minor stroke. Front Neurol2022;13:941668.
6.
SchumacherJRayNJHamiltonCA, et al.Free water imaging of the cholinergic system in dementia with Lewy bodies and Alzheimer’s disease. Alzheimers Dement2023;19:4549–4563.
7.
MaillardPFletcherESinghB, et al.Cerebral white matter free water: a sensitive biomarker of cognition and function. Neurology2019;92:e2221–e2231.
8.
ZhangCEWongSMUiterwijkR, et al.Blood-brain barrier leakage in relation to white matter hyperintensity volume and cognition in small vessel disease and normal aging. Brain Imaging Behav2019;13:389–395.
9.
ZhangRHuangPWangS, et al.Decreased cerebral blood flow and delayed arterial transit are independently associated with white matter hyperintensity. Front Aging Neurosci2022;14:762745.
10.
QiaoSLiHGuoF, et al.Research progress on cognitive impairment and the expression of serum inflammatory markers in patients with white matter hyperintensities: a narrative review. Ann Transl Med2022;10:421.
11.
BakkerENBacskaiBJArbel-OrnathM, et al.Lymphatic clearance of the brain: perivascular, paravascular and significance for neurodegenerative diseases. Cell Mol Neurobiol2016;36:181–194.
12.
DuyckaertsCDelatourBPotierMC. Classification and basic pathology of Alzheimer disease. Acta Neuropathol2009;118:5–36.
13.
YuXYinXHongH, et al.Increased extracellular fluid is associated with white matter fiber degeneration in CADASIL: in vivo evidence from diffusion magnetic resonance imaging. Fluids Barriers CNS2021;18:29.
14.
PasternakOSochenNGurY, et al.Free water elimination and mapping from diffusion MRI. Magn Reson Med2009;62:717–730.
15.
FazekasFKleinertROffenbacherH, et al.Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology1993;43:1683–1689.
16.
EggerCOpferRWangC, et al.MRI FLAIR lesion segmentation in multiple sclerosis: does automated segmentation hold up with manual annotation?Neuroimage Clin2017;13:264–270.
17.
HoyARKoayCGKecskemetiSR, et al.Optimization of a free water elimination two-compartment model for diffusion tensor imaging. Neuroimage2014;103:323–333.
18.
YanSWanJZhangX, et al.Increased visibility of deep medullary veins in leukoaraiosis: a 3-T MRI study. Front Aging Neurosci2014;6:144.
19.
MayerCNägeleFLPetersenM, et al.Free-water diffusion MRI detects structural alterations surrounding white matter hyperintensities in the early stage of cerebral small vessel disease. J Cereb Blood Flow Metab2022;42:1707–1718.
20.
MaillardPMitchellGFHimaliJJ, et al.Aortic stiffness, increased white matter free water, and altered microstructural integrity: a continuum of injury. Stroke2017;48:1567–1573.
21.
ZhangRZhouYYanS, et al.A brain region-based deep medullary veins visual score on susceptibility weighted imaging. Front Aging Neurosci2017;9:269.
22.
ZhangRHuangPJiaerkenY, et al.Venous disruption affects white matter integrity through increased interstitial fluid in cerebral small vessel disease. J Cereb Blood Flow Metab2021;41:157–165.
23.
WellerROHawkesCAKalariaRN, et al.White matter changes in dementia: role of impaired drainage of interstitial fluid. Brain Pathol2015;25:63–78.
24.
YuLHuXLiH, et al.Perivascular spaces, glymphatic system and MR. Front Neurol2022;13:844938.
25.
ThrippletonMJBackesWHSourbronS, et al.Quantifying blood-brain barrier leakage in small vessel disease: review and consensus recommendations. Alzheimers Dement2019;15:840–858.
26.
WongSMJansenJFAZhangCE, et al.Blood-brain barrier impairment and hypoperfusion are linked in cerebral small vessel disease. Neurology2019;92:e1669–e1677.
