Neuroimaging patterns of chronic cerebrovascular insufficiency with evaluation of cerebral perfusion depending on the level of cognitive disorders

Aim. To evaluate the neuroimaging patterns of chronic cerebrovascular insufficiency with cerebral perfusion assessment depending on the level of cognitive impairment.

Materials and methods. The 58 patients aged 50–79 years were examined: 45 patients with a diagnosis of сhronic cerebrovascular insufficiency and 13 conditionally healthy volunteers. Patients with Chronic cerebrovascular insufficiency were ranked into three subgroups depending on the severity of cognitive impartment (CI). T1-, T2, T2*- VI, DWI, FLAIR and non-contrast MR perfusion (ASL) were included in the MR-protocol (Toshiba Vantage Titan, 1.5 T). The analysis of MRM patterns of Chronic cerebrovascular insufficiency was carried out according to STRIVE criteria. The total cerebral blood flow and regional in the frontal and parietal lobes were evaluated by the ASLperfusion.

Results. A relationship was found between the degree of leukoaraiosis, the type of expansion of the perivascular spaces of Virchow-Robin and the level of CI. According to ASL, total cerebral blood flow is higher in groups without CI and in patients with severe CI. There is a diffuse decrease of cerebral perfusion in patients with mild CI. This phenomenon is explained by initial impairment of the blood-brain barrier permeability, damage to the microvasculature. Relative hyperperfusion in the cortex of the frontal and parietal lobes of patients with dementia indicates the ineffectiveness of increased cortical blood flow and the resulting shunt blood flow due to the high resistance of the altered small cerebral vessels under high pulsating properties of the main arteries.

Conclusion. ASL perfusion is a complementary link to the STRIVE criteria in the diagnosis of chronic cerebrovascular insufficiency. The absence of changes in cerebral perfusion in patients with subjective manifestations of chronic cerebrovascular insufficiency makes it advisable to search for new methods for the diagnosis of preclinical stages of vascular cognitive impairment.

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