Enlarged Perivascular Spaces on MRI Are a Feature of Cerebral Small Vessel Disease

TLDR

Enlarged perivascular spaces are common yet understudied, thought to reflect cerebral small vessel disease, and their precise mechanisms remain unclear. The study aimed to assess whether enlarged perivascular spaces are linked to lacunar stroke subtype and white matter hyperintensities. The authors prospectively recruited 350 patients (129 lacunar, 124 cortical) and 97 controls, rated basal ganglia and centrum semiovale perivascular spaces on T2 MRI, and compared them across stroke subtypes and controls while adjusting for vascular risk factors and white matter hyperintensities. Enlarged perivascular spaces, particularly in the basal ganglia, were significantly associated with lacunar stroke subtype and both deep and periventricular white matter hyperintensities, underscoring their relevance in small vessel disease.

Abstract

Enlarged perivascular spaces in the brain are common but generally overlooked and of uncertain pathophysiology. They may reflect underlying cerebral small vessel disease. We determined whether enlarged perivascular spaces were associated with lacunar stroke subtype and white matter hyperintensities, markers of established small vessel disease.We prospectively recruited patients with acute ischemic lacunar or cortical stroke. Age-matched nonstroke control subjects were also recruited. We rated basal ganglia and centrum semiovale enlarged perivascular spaces 0 to 4 (0=none, 4=>40) on T2-weighted MRI and white matter hyperintensities. We compared enlarged perivascular spaces between stroke subtypes and control subjects and assessed associations with vascular risk factors and white matter hyperintensities.We recruited 350 patients; 129 lacunar, 124 cortical stroke, and 97 age-matched control subjects. Adjusting for vascular risk factors and white matter hyperintensities, total enlarged perivascular spaces were associated with lacunar stroke subtype (P=0.04) in the acute stroke group (n=253); basal ganglia enlarged perivascular spaces were associated with lacunar stroke subtype (P=0.003), deep (P=0.02) and periventricular white matter hyperintensities (P=0.01); in all 350 subjects, total enlarged perivascular spaces were associated with deep (P<0.001) and periventricular (P<0.001) white matter hyperintensities.Although prevalent in patients with vascular risk factors and stroke, enlarged perivascular spaces are specifically associated with lacunar ischemic stroke and white matter hyperintensities. Further studies should determine the mechanism of this association while including adequate controls to account for stroke and vascular risk factors. Enlarged perivascular spaces should not be overlooked in studies of small vessel disease.