Topography and Determinants of Magnetic Resonance Imaging (MRI)-Visible Perivascular Spaces in a Large Memory Clinic Cohort

Background: magnetic resonance imaging-visible perivascular spaces (pvs) are related to interstitial fluid clearance pathways (including amyloid-β) in the brain and are suggested to be a marker of cerebral small vessel disease. we investigated the role,topography,and possible implications of pvs in cognitive impairment.methods and results: a total of 1504 patients undergoing memory clinic investigation and an associated brain magnetic resonance imaging scan were included in this cross-sectional study. magnetic resonance images were assessed for markers of small vessel disease. additionally,1039 patients had cerebrospinal fluid analysis of amyloid-β 42,total tau (t-tau),and phosphorylated tau (p-tau); 520 patients had apoe genotyping done. results were analyzed with generalized linear models. a total of 289 (19%; 95% confidence interval,17-21) had a high-grade pvs in the centrum semiovale (cso) and 65 (4%; 95% confidence interval: 3%-5%) in the basal ganglia (bg). centrum semiovale- and bg-pvs were both associated with high age (p<0.001),hypertension (p<0.001),probable cerebral amyloid angiopathy (p<0.05),moderate-to-severe white matter hyperintensities (p<0.001),cortical superficial siderosis (p<0.001),cerebral microbleeds (p<0.001),and pvs. centrum semiovale-pvs was separately associated with strictly lobar cerebral microbleeds (p=0.057). bg-pvs was associated with strictly deep cerebral microbleeds (p<0.001),lacunes (p<0.001),and vascular dementia (p=0.04). bg-pvs showed a tendency to be associated with high cerebrospinal fluid tau (b=0.002,p=0.04) in the whole cohort and in alzheimer's disease (b=0.005; p=0.02). no other associations with cerebrospinal fluid or the apoe e4 allele was observed.conclusions: centrum semiovale-pvs and bg-pvs have different underlying etiology,being associated with cerebral amyloid angiopathy and hypertensive vasculopathy,respectively,although a significant overlap between these pathologies is likely to exist. © 2017 the authors. published on behalf of the american heart association,inc.,by wiley.