Cerebral blood flow and metabolism associated with cerebral microbleeds in small vessel disease
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ORIGINAL ARTICLE
Cerebral blood flow and metabolism associated with cerebral microbleeds in small vessel disease Tetsuya Hashimoto1 • Chiaki Yokota1 • Kazuhiro Koshino2 • Ryo Shimomura1 Tenyu Hino1 • Tetsuaki Moriguchi2 • Yuki Hori2 • Toshiyuki Uehara1 • Kazuo Minematsu1 • Hidehiro Iida2 • Kazunori Toyoda1
•
Received: 4 March 2016 / Accepted: 12 May 2016 Ó The Japanese Society of Nuclear Medicine 2016
Abstract Objective Cerebral microbleeds (CMBs), probably reflecting microangiopathy, have not yet sufficiently been examined in association with cerebral blood flow (CBF) and metabolism. We investigated the relationships between CMBs, and CBF and metabolism in symptomatic small vessel disease. Methods We enrolled 22 patients with symptomatic small vessel disease without severe stenosis ([50 %) in major cerebral arteries. Volumes of white matter lesions (WMLs) and number of CMBs were assessed on images of fluidattenuated inversion recovery and gradient-echo T2*weighted magnetic resonance imaging, respectively. Patients were divided into two groups according to the median number of CMBs (group I \5, n = 10; group II C5, n = 12). Parametric images of CBF, cerebral metabolic rate of oxygen (CMRO2), oxygen extraction fraction and cerebral blood volume were estimated using positron emission tomography and 15O-labeled gases. The functional values in the cortex–subcortex, basal ganglia, and centrum semiovale were compared between the two groups. Results Volumes of WMLs of group II were larger than those of group I (median: 38.4; range: 25.1–91.5 mL vs. median: 11.3; range: 4.2–73.4 mL, p = 0.01). In the centrum semiovale, the mean CBF of group II was
& Chiaki Yokota [email protected] 1
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
2
Department of Investigative Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
significantly lower than that of group I (12.6 ± 2.6 vs. 15.6 ± 3.3 mL/100 g/min, p = 0.04). In the other regions, there were no significant differences in either CBF or CMRO2 between the two groups. Conclusions Our study indicated that increases in the number of CMBs with larger volumes of WMLs were associated with cerebral ischemia in the deep white matter in patients with symptomatic small vessel disease. Keywords Centrum semiovale Cerebral blood flow Cerebral microbleeds Small vessel disease White matter lesions
Introduction Cerebral microbleeds (CMBs) are not only common in the elderly population [1, 2], but also frequent in patients with chronic hypertension [1, 3, 4], diabetes mellitus [4], and white matter lesions (WMLs) [1, 5, 6]. Although the underlying vascular pathology related to CMBs has not been clarified, accumulated evidence has revealed their significance as a marker of small vessel disease, such as lacunar infarction and WMLs [1, 4–6], both of which contribute to cognitive impairment [7, 8]. In the general elderly population, subjects with five or more CMBs, especially in a str
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