脑小血管病国际影像标准2更新要点解读

doi:10.3969/j.issn.1673-5765.2023.10.010

摘要/Abstract

摘要： 脑小血管病（cerebral small vessel disease,CSVD）是衰老过程中的常见疾病，可能会导致卒中、认知障碍、神经心理疾病或症状以及其他功能损害。CSVD常与神经退行性疾病并存，进一步加重认知损害及其他症状的发生，从而影响患者的日常生活能力。脑小血管病国际影像标准 1（standards for reporting vascular changes on neuroimaging-1，STRIVE-1）对结构MRI上所见的CSVD不同影像特征进行了分类和标准化。2023年发布的STRIVE-2进一步更新了CSVD血管变化的神经影像学指南。本文将对STRIVE-2更新要点进行解读。

关键词: 脑小血管病; 共识; 神经影像

Abstract: Cerebral small vessel disease (CSVD) is a common disease in the aging process that would result in stroke, cognitive disorder, neuropsychological disorders or symptoms, and other functional impairments. CSVD often co-exists with neurodegenerative diseases, further exacerbating cognitive impairment or other symptoms that affect the patient's ability to live independently. Standards for reporting vascular changes on neuroimaging 1 (STRIVE-1) classifies and standardizes the different features of CSVD seen on structural MRI. The STRIVE-2, published in 2023, further updates the neuroimaging guidelines for vascular changes in CSVD. This paper will explain the update points of STRIVE-2.

Key words: Cerebral small vessel disease; Consensus; Neuroimaging

叶瑾怡, 陈玮琪, 王伊龙. 脑小血管病国际影像标准2更新要点解读[J]. 中国卒中杂志, 2023, 18(10): 1175-1180.

YE Jinyi, CHEN Weiqi, WANG Yilong. Interpretation of the Updates on Standards for Reporting Vascular Changes on Neuroimaging 2[J]. Chinese Journal of Stroke, 2023, 18(10): 1175-1180.

参考文献

[1] WARDLAW J M，SMITH E E，BIESSELS G J，et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration[J]. Lancet Neurol，2013，12（8）：822-838.
[2] SAINI M，SUMINISTRADO M S，HILAL S，et al. Prevalence and risk factors of acute incidental infarcts[J]. Stroke，2015，46（10）：2722-2727.
[3] BATOOL S，O'DONNELL M，SHARMA M，et al. Incidental magnetic resonance diffusion-weighted imaging-positive lesions are rare in neurologically asymptomatic community-dwelling adults[J]. Stroke，2014，45（7）：2115-2117.
[4] KIMBERLY W T，GILSON A，ROST N S，et al. Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy[J]. Neurology，2009，72（14）：1230-1235.
[5] AURIEL E，GUROL M E，AYRES A，et al. Characteristic distributions of intracerebral hemorrhage-associated diffusion-weighted lesions[J]. Neurology，2012，79（24）：2335-2341.
[6] GREGOIRE S M，CHARIDIMOU A，GADAPA N，et al. Acute ischaemic brain lesions in intracerebral haemorrhage：multicentre cross-sectional magnetic resonance imaging study[J]. Brain，2011，134（Pt8）：2376-2386.
[7] O'SULLIVAN M，RICH P M，BARRICK T R，et al. Frequency of subclinical lacunar infarcts in ischemic leukoaraiosis and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy[J]. AJNR Am J Neuroradiol，2003，24（7）：1348-1354.
[8] Van VELUW S J，SHIH A Y，SMITH E E，et al. Detection，risk factors，and functional consequences of cerebral microinfarcts[J]. Lancet Neurol，2017，16（9）：730-740.
[9] CHO A H，KWON H S，LEE M H，et al. Hemorrhagic focus within the recent small subcortical infarcts on long-term follow-up magnetic resonance imaging[J/OL]. Stroke，2022，53（4）：e139-e140[2023-07-01]. https://doi.org/10.1161/STROKEAHA.121.037939.
[10] PINTER D，GATTRINGER T，ENZINGER C，et al. Longitudinal MRI dynamics of recent small subcortical infarcts and possible predictors[J]. J Cereb Blood Flow Metab，2019，39（9）：1669-1677.
[11] DUERING M，ADAM R，WOLLENWEBER F A，et al. Within-lesion heterogeneity of subcortical DWI lesion evolution，and stroke outcome：a voxel-based analysis[J]. J Cereb Blood Flow Metab，2020，40（7）：1482-1491.
[12] BOUVY W H，GEURTS L J，KUIJF H J，et al. Assessment of blood flow velocity and pulsatility in cerebral perforating arteries with 7-T quantitative flow MRI[J]. NMR Biomed，2016，29（9）：1295-1304.
[13] DEBETTE S，SCHILLING S，DUPERRON M G，et al. Clinical significance of magnetic resonance imaging markers of vascular brain injury：a systematic review and meta-analysis[J]. JAMA Neurol，2019，76（1）：81-94.
[14] IST-3 Collaborative Group. Association between brain imaging signs，early and late outcomes，and response to intravenous alteplase after acute ischaemic stroke in the third International Stroke Trial（IST-3）：secondary analysis of a randomised controlled trial[J]. Lancet Neurol，2015，14（5）：485-496.
[15] APPLETON J P，WOODHOUSE L J，ADAMI A，et al. Imaging markers of small vessel disease and brain frailty，and outcomes in acute stroke[J/OL]. Neurology，2020，94（5）：e439-e452[2023-07-01]. https://doi.org/10.1212/WNL.0000000000008881.
[16] LING Y F，CHABRIAT H. Incident cerebral lacunes：a review[J]. J Cereb Blood Flow Metab，2020，40（5）：909-921.
[17] HUISA B N，CAPRIHAN A，THOMPSON J，et al. Long-term blood-brain barrier permeability changes in Binswanger disease[J]. Stroke，2015，46（9）：2413-2418.
[18] BLAIR G W，THRIPPLETON M J，SHI Y L，et al. Intracranial hemodynamic relationships in patients with cerebral small vessel disease[J/OL]. Neurology，2020，94（21）：e2258-e2269[2023-07-01]. https://doi.org/10.1212/WNL.0000000000009483.
[19] WARDLAW J M，SMITH C，DICHGANS M. Small vessel disease：mechanisms and clinical implications[J]. Lancet Neurol，2019，18（7）：684-696.
[20] KEITH J，GAO F Q，NOOR R，et al. Collagenosis of the deep medullary veins：an underrecognized pathologic correlate of white matter hyperintensities and periventricular infarction?[J]. J Neuropathol Exp Neurol，2017，76（4）：299-312.
[21] FAZEKAS F，CHAWLUK J B，ALAVI A，et al. MR signal abnormalities at 1. 5 T in Alzheimer's dementia and normal aging[J]. AJR Am J Roentgenol，1987，149（2）：351-356.
[22] SMITH E E，BIESSELS G J，DE GUIO F，et al. Harmonizing brain magnetic resonance imaging methods for vascular contributions to neurodegeneration[J/OL]. Alzheimers Dement（Amst），2019，11：191-204[2023-07-01]. https://doi.org/10.1016/j.dadm.2019.01.002.
[23] CHARIDIMOU A，BOULOUIS G，FROSCH M P，et al. The Boston criteria version 2.0 for cerebral amyloid angiopathy：a multicentre，retrospective，MRI-neuropathology diagnostic accuracy study[J]. Lancet Neurol，2022，21（8）：714-725.
[24] BEST J G，AMBLER G，WILSON D，et al. Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack：a pooled analysis of individual patient data from cohort studies[J]. Lancet Neurol，2021，20（4）：294-303.
[25] MARTÍ-FÀBREGAS J，CAMPS-RENOM P，BEST J G，et al. Stroke risk and antithrombotic treatment during follow-up of patients with ischemic stroke and cortical superficial siderosis[J/OL]. Neurology，2023，100（12）：e1267-e1281[2023-07-01]. https://doi.org/10.1212/WNL.0000000000201723.
[26] DUERING M，RIGHART R，WOLLENWEBER F A，et al. Acute infarcts cause focal thinning in remote cortex via degeneration of connecting fiber tracts[J]. Neurology，2015，84（16）：1685-1692.
[27] DE GUIO F，DUERING M，FAZEKAS F，et al. Brain atrophy in cerebral small vessel diseases：extent，consequences，technical limitations and perspectives：the HARNESS initiative[J]. J Cereb Blood Flow Metab，2020，40（2）：231-245.
[28] SUBOTIC A，MCCREARY C R，SAAD F，et al. Cortical thickness and its association with clinical cognitive and neuroimaging markers in cerebral amyloid angiopathy[J]. J Alzheimers Dis，2021，81（4）：1663-1671.
[29] 中国研究型医院学会脑小血管病专业委员会《中国脑小血管病诊治专家共识》编写组. 中国脑小血管病诊治专家共识2021[J]. 中国卒中杂志，2021，16（7）：716-726.
Cerebral Small Vessel Disease Professional Committee Consensus Writing Group，Chinese Research Hospital Association. Chinese consensus on diagnosis and therapy of cerebral small vessel disease 2021[J]. Chin J Stroke，2021，16（7）：716-726.