Leukoaraiosis (ILA) is believed to be ischaemic in origin due its association with cerebrovascular risk factors and similar location as lacunar infarctions. Its pathophysiology is not well understood and its diagnosis is still based on magnetic resonance imaging (MRI) as well as exclusion of other causes of white matter hyperintensities (WMH). So far there are no known confirming or screening diagnostic tests of ILA. Ultrasound studies have recently shown increased large artery stiffness, increased cerebrovascular resistance and lower cerebral blood flow in ILA patients. Increased arterial stiffness and decreased blood flow could have a synergistic effect and their ratio could be a useful diagnostic index of ILA.Design and method:
We used Trans Cerebral Doppler sonography (TCD) and carotid duplex ultrasound to compeare cerebral blood flow and carotid stiffness in 53 ILA patients to 40 risk factor matched controls. The ILA diagnosis was based on head MRI and exclusion of other causes of WMH. Middle cerebral artery (MCA) systolic, diastolic and mean blood flow velocities (v-MCAs, v-MCAd, v-MCAm) and resistance indices (RI, PI) were determined. Carotid stiffness was accessed by pulse wave velocityβ (PWVβ, m/s), pressure–strain elasticity modulus (Ep, kPa) and β index. In addition we introduced new ILA indices (ILAi) that are rations of carotid stiffness parameters and MCA mean blood flow velocity. The diagnostic significance of ILAi for the prediction of ILA was analysed.Results:
We found significantly lower diastolic, systolic and mean MCA blood flow velocities and increased carotid stiffness in the ILA group (p < 0,05). Higher pulsatility and resistivity indices of MCA were found in the ILA group, but they did not reached statistical significance. All the ILAi were significantly higher in the ILA group, the most significant was PWVβ/v-ACMm (p = 0.003). All ILAi were allso significantly associated with ILA and were sensitive and specific for predicting ILA (p < 0.05).Conclusions:
MCA blood flow velocities are lower and carotid stiffness increased in ILA patients compared to risk factors matched controls. The combination of lower velocities and increased carotid stiffness represented as ILA indices could have a potential diagnostic value for ILA.