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Abstract Details

White Matter and Watershed Ischemia in Cerebral Small Vessel Disease
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
147
In this study, we used MRI to characterize regional cerebral blood flow (CBF) and oxygen metabolism in cerebral small vessel disease (CSVD).

Chronic hypoxia-ischemia is a putative cause for CSVD, but direct human evidence is lacking. In a cohort of patients with CSVD, we hypothesized oxygen extraction fraction (OEF) would be elevated within the watershed—the region at highest risk for developing white matter hyperintensities (WMH).
Young healthy controls (n=22), older healthy controls (n=14), and patients with CSVD (n=29), underwent MRI using pseudocontinuous arterial spin labeling, asymmetric spin echo, and FLAIR to measure CBF, OEF, and WMH, respectively. The CBF map from young controls, thresholded at ≤ 10% of mean white matter (WM) CBF, was used to delineate the “physiologic watershed.” We compared group differences and conducted linear regression to evaluate the relationship between regional CBF and OEF with WMH. 
Whole brain and gray matter (GM) CBF were lowest in the CSVD cohort, while WM and watershed CBF did not differ between groups. WM and watershed OEF were highest in the CSVD cohort, and were associated with greater WMH. The physiologic watershed of young controls showed spatial overlap with regions of WMH lesion density in the CSVD cohort. Moreover, OEF progressively increased while CBF decreased, in concentric contours approaching WMH lesions. GM OEF was lowest in the CSVD cohort, and correlated with GM atrophy.
Elevated OEF in the physiologic watershed and at the leading edge of WMH growth suggests that chronic hypoxia-ischemia in WM contributes to CSVD pathogenesis. Decreased OEF in the GM suggests reduced oxygen utilization due to atrophy. 
Authors/Disclosures
Peter Kang, MD, MSCI (Washington University School of Medicine)
PRESENTER 		Dr. Kang has nothing to disclose.
No disclosure on file
No disclosure on file
Andria L. Ford, MD (Washington University) Dr. Ford has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bluebird Bio. The institution of Dr. Ford has received research support from NIH NHLBI and NIH NINDS.
No disclosure on file
No disclosure on file