Elsevier

Atherosclerosis

Volume 210, Issue 1, May 2010, Pages 130-136
Atherosclerosis

Brain volumes and cerebrovascular lesions on MRI in patients with atherosclerotic disease. The SMART-MR study

https://doi.org/10.1016/j.atherosclerosis.2009.10.039Get rights and content

Abstract

Objective

To estimate brain volumes, white matter lesion (WML) volume and asymptomatic infarcts on MRI in a large cohort of patients with atherosclerotic disease.

Methods

Within the SMART-MR (Second Manifestations of ARTerial disease-Magnetic Resonance) study, a prospective cohort study on determinants and course of brain changes on MRI, cross-sectional analyses were performed in 1044 patients (mean age 58 ± 10 years, 80% male) with coronary artery disease, cerebrovascular disease, peripheral arterial disease, or abdominal aortic aneurysm. Brain segmentation was used to quantify volumes of cortical gray matter, white matter, sulcal and ventricular cerebrospinal fluid, and WML. All volumes were expressed relative to intracranial volume. Brain infarcts were rated visually and distinctions were made between cortical infarcts, large subcortical infarcts, lacunar infarcts, and infarcts in the cerebellum and brainstem.

Results

With older age a nonlinear (quadratic) decrease in total brain volume was observed and a nonlinear increase in ventricular volume and WML. Cortical gray matter volume showed a linear decrease with age and was stronger in men than in women. WML volumes also increased more strongly in men than in women, while ventricular volume decrease showed no sex difference. Silent brain infarcts were present in 14% of men and women, and increased to 24% of subjects aged 65 years or older.

Conclusion

In a population with atherosclerotic diseases, decrease in brain volumes with increasing age is comparable with findings from the general population. However, vascular pathology on MRI, as indicated by white matter lesions and silent brain infarcts may be more common.

Introduction

Cardiovascular and cerebrovascular diseases are the top contributors of mortality worldwide. Also, because these patients will live longer as a result of improved treatment possibilities, cardiovascular and cerebrovascular diseases are expected to become a major cause of disability. Brain atrophy is a common finding on magnetic resonance imaging (MRI) in the elderly [1]. In healthy individuals, global and regional brain volume decline starts at a slow rate in early adulthood and accelerates in older age [2], [3]. The extent and rate of progression of global and regional brain atrophy are associated with cognitive decline and development of dementia [4], [5], [6]. In elderly people, white matter lesions (WML) and silent brain infarcts are also commonly found on MRI [7], [8], [9], [10]. They are also associated with future cognitive decline and dementia [11], [12], [13], [14]. Evidence has accumulated that vascular risk factors, including hypertension, hyperlipidemia, diabetes mellitus, obesity, large amounts of alcohol, and cigarette smoking, play an important role in the etiology of white matter lesions, silent brain infarcts and brain atrophy, and future cognitive decline and dementia [8], [11], [15], [16], [17], [18], [19], [20].

With recently developed methods for automated segmentation of brain structures, it is possible to make accurate estimations of brain volumes and volume of WML. Recent studies on basis of these techniques reported decreasing brain volumes and increasing WML volumes with older age in the general elderly population [21], [22], [23]. However, studies are also needed that examine brain volumes and cerebrovascular lesions on MRI in patients with atherosclerotic disease, since this group is, in particular, at high risk of developing brain atrophy, WML, silent brain infarcts, and subsequent cognitive decline.

In the present study, we estimated brain volumes, WML volume, and presence of silent brain infarcts on MRI in a large cohort of patients with atherosclerotic disease.

Section snippets

SMART-MR study

The present study is a cross-sectional study within the SMART-MR study, a cohort study within the Second Manifestations of ARTerial disease (SMART) study, with the objective to investigate brain changes on MRI in patients with symptomatic atherosclerotic disease. Between May 2001 and December 2005, 1309 patients newly referred to the University Medical Center Utrecht with manifest coronary artery disease, cerebrovascular disease, peripheral arterial disease or an abdominal aortic aneurysm

Results

As can be seen from Table 1, 824 men and 220 women were included in the study. The mean age in men and women was identical (58 ± 10 years). The majority of the study population had coronary artery disease. Men had larger ICV and larger uncorrected total brain volume, but smaller brain volumes and larger ventricles after correcting for ICV than women. Of the study sample 26.3% had one or more infarcts on MRI, the majority being lacunar infarcts. Table 2 shows the brain volumes and white matter

Discussion

To our knowledge, this is the first study reporting brain volumes and cerebrovascular lesions on MRI in a population of patients with atherosclerotic disease. The large number of patients included and the wide age range of the sample make this cohort unique. The size of this cohort and the segmentation technique used made precise estimates possible. The segmentation technique also allowed us to differentiate between total brain volume, ventricular volume, cortical gray matter volume and WML

Funding sources

Supported by a program grant from the Netherlands Organization for Scientific Research-Medical Sciences (NWO-MW: project no. 904-65-095) and a VIDI grant from the Netherlands Organization for Scientific Research (NWO: project no. 917-66-311).

Disclosure

The authors report no conflicts of interest.

Acknowledgments

We gratefully acknowledge the members of the SMART Study Group of University Medical Center Utrecht: A. Algra, MD, PhD, Julius Center for Health Sciences and Primary Care and Rudolf Magnus Institute for Neurosciences, Department of Neurology; P.A. Doevendans, MD, PhD, Department of Cardiology; Y. van der Graaf, MD, PhD, D.E. Grobbee, MD, PhD, and G.E.H.M. Rutten, MD, PhD, Julius Center for Health Sciences and Primary Care; L.J. Kappelle, MD, PhD, Department of Neurology; W.P.Th.M. Mali, MD,

References (29)

  • T. den Heijer et al.

    Use of hippocampal and amygdalar volumes on magnetic resonance imaging to predict dementia in cognitively intact elderly people

    Arch Gen Psychiatry

    (2006)
  • C.R. Jack et al.

    Brain atrophy rates predict subsequent clinical conversion in normal elderly and amnestic MCI

    Neurology

    (2005)
  • D. Mungas et al.

    Volumetric MRI predicts rate of cognitive decline related to AD and cerebrovascular disease

    Neurology

    (2002)
  • F.E. de Leeuw et al.

    Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam Scan Study

    J Neurol Neurosurg Psychiatry

    (2001)
  • Cited by (0)

    1

    Listed in the acknowledgements.

    View full text