Relationship between white matter hyperintensities and chronic kidney disease in patients with acute lacunar stroke.

BACKGROUND AND PURPOSE: Previous studies have revealed a relationship between chronic kidney disease (CKD) and white matter hyperintensities (WMH). However, studies on the WMH and CKD in acute stroke patients are rare, and the conclusion is consistent. Our study aimed to investigate the relationship between the severity of WMH and CKD in acute lacunar infarction patients. METHODS: Consecutive acute lacunar infarction patients were recruited in this cross-sectional study. All patients were divided into two groups according to the severity of periventricular WMH (PVWMH) and deep WMH (DWMH). We dichotomized the severity of WMH (PVWMH and DWMH, separately) into mild group (Fazekas scores 0-1) and moderate-severe group (Fazekas scores 2-3). Estimated glomerular filtration rate (eGFR), proteinuria, vascular risk factors, and clinical features were compared between these two groups. Multivariable logistic regression analysis was used to investigate the association between the severity of WMH and risk factors. RESULTS: A total of 993 acute lacunar infarction patients aged 25-95 years were enrolled. The proportions of participants presenting moderate-severe group PVWMH and DWMH were 46.6% and 38.6%, respectively. Patients with moderate-severe PVWMH had higher age (P < 0.001) and higher incidence of stroke history (P < 0.001) than those in mild group. The level of serum creatinine and the presence of CKD were significantly higher while the eGFR was significantly lower in patients with moderate-severe PVWMH than those with mild PVWMH. Patients with moderate-severe DWMH (n = 383) also had higher age (P < 0.001) and often had a history of stroke (P < 0.001). But the association between the severity of DWMH and eGFR was not found. Multivariable logistic regression analyses showed stage 2 CKD and stage 3 CKD were independently associated with moderate-severe PVWMH, but not DWMH. CONCLUSIONS: Our study demonstrates that CKD was independently associated with moderate-severe PVWMH in patients with acute lacunar infarction, but not DWMH. PVWMH and DWMH may have distinct pathophysiology.

Clinical Correlation of Magnetic Resonance Imaging Features of Cerebral Small Vessel Disease.

OBJECTIVE: We have discussed the clinical features and neuroimaging findings and investigated the correlations between the clinical characteristics and different neuroradiologic phenotypes of cerebral small vessel disease (CSVD). METHODS: A total of 1106 patients with a diagnosis of CSVD were enrolled. The demographic data, medical history, laboratory test results, and neuroimaging findings were retrieved for analysis. The differences in clinical parameters between patient groups were examined. The relationships between the clinical parameters and neuroradiologic phenotypes (i.e., white matter lesions [WMLs] and enlarged perivascular spaces) were assessed. The magnetic resonance imaging features were clustered using the fast clustering algorithm. RESULTS: Approximately one third of our patients presented with a lacune, which was associated with atrial fibrillation (P = 0.029), lacunar syndrome (P < 0.001), periventricular WMLs (P = 0.001), cerebral WMLs (P = 0.021), basal ganglia perivascular space grade (P < 0.001) and severity (P = 0.001), and semiovale perivascular space grade (P = 0.010) and severity (P = 0.002). Hypertension was associated with periventricular WMLs (P = 0.048), centrum semiovale WMLs (P = 0.026), and basal ganglia perivascular space grade (P < 0.001) and severity (P < 0.001). A novel clustering algorithm was derived to stratify our cohort into 3 different groups according to the differing severity of the cerebral WMLs and perivascular space enlargement. CONCLUSION: The present study has provided a comprehensive analysis of the clinical correlation of characteristics and neuroradiologic phenotypes in patients with CSVD. The insights from these findings could be used to refine the management strategy for patients with CSVD.