Atherosclerotic risk is associated with cerebral perfusion – a cross-sectional study using arterial spin labelling MRI

Non-invasive measurement of cerebral perfusion is promising for identifying individuals at high risk of cerebrovascular disease for prevention strategies. We tested whether the new and easily calculated arterial spin labelling (ASL) MRI parameter for vascular and tissue signal distribution - ‘spatial coefficient of variation’ (ASL-sCoV) - correlates better as a radiological marker with atherosclerotic risk than the more courant markers white matter hyperintensity volume (WMHV) and cerebral blood flow (CBF).
Methods
195 participants of the preDIVA trial, aged 72-80 years with systolic hypertension (>140 mmHg) were invited for 2 MRI-scans 2-3 years apart. WMHV was derived from 3D FLAIR; grey matter CBF and ASL-sCoV from ASL. The ASL-sCoV was defined as the standard deviation of CBF divided by the mean CBF in the entire region of interest. Atherosclerotic risk was operationalized as 10-year cardiovascular risk by the Systematic COronary Risk Evaluation Older Persons (SCORE O.P.) and calculated at baseline and follow-up. Data were analysed using linear regression.
Results
CBF was associated with atherosclerotic risk scores at baseline (standardized-beta=-0.26, 95%CI=-0.40,-0.13, p<0.001) but not on follow-up (standardized-beta=-0.14, 95%CI=-0.33,0.04, p=0.12). ASL-sCoV was associated with atherosclerotic risk scores at both time points (baseline standardized-beta=0.23, 95%CI=0.10,0.36, p<0.0001, follow-up standardized beta= 0.20, 95%CI=0.03,0.36, p=0.02). WMHV was not significantly associated with atherosclerotic risk scores at either time-points (p>0.25). There were no longitudinal associations between changes in MRI parameters and baseline atherosclerotic risk scores. Imputation of missing values, exclusion of outliers, and repeating analyses using the Framingham- and ASCVD risk scores instead of the SCORE O.P. gave similar results.
Conclusions
Our findings suggest that ASL-sCoV correlates better with atherosclerotic risk than the more conventional markers CBF and WMHV. Our data reaffirm that non-invasive imaging with MRI is highly informative and could provide additional information about the (cerebro)vascular status, especially in participants in whom early prevention of atherosclerosis and cardiovascular disease might still be attainable.