• Esmée Verburgt, Esther Janssen, Mina A Jacob, Mengfei Cai, Annemieke Ter Telgte, Kim Wiegertjes, KesselsRoy P CRPCDonders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Gelderland, The Netherlands.Vincent Van Gogh Instituut, Venray, Limburg, The Netherlands., David G Norris, Jose Marques, Marco Duering, Anil M Tuladhar, and Frank-Erik De Leeuw.
• Department of Neurology, Radboudumc, Nijmegen, Gelderland, The Netherlands.
• J. Neurol. Neurosurg. Psychiatr. 2023 Feb 1; 94 (2): 144144.

BackgroundSmall hyperintense lesions are found on diffusion-weighted imaging (DWI) in patients with sporadic small vessel disease (SVD). Their exact role in SVD progression remains unclear due to their asymptomatic and transient nature. The main objective is to investigate the role of DWI+lesions in the radiological progression of SVD and their relationship with clinical outcomes.MethodsParticipants with SVD were included from the Radboud University Nijmegen Diffusion tensor MRI Cohort. DWI+lesions were assessed on four time points over 14 years. Outcome measures included neuroimaging markers of SVD, cognitive performance and clinical outcomes, including stroke, all-cause dementia and all-cause mortality. Linear mixed-effect models and Cox regression models were used to examine the outcome measures in participants with a DWI+lesion (DWI+) and those without a DWI+lesion (DWI-).ResultsDWI+lesions were present in 45 out of 503 (8.9%) participants (mean age: 66.7 years (SD=8.3)). Participants with DWI+lesions and at least one follow-up (n=33) had higher white matter hyperintensity progression rates (β=0.36, 95% CI=0.05 to 0.68, p=0.023), more incident lacunes (incidence rate ratio=2.88, 95% CI=1.80 to 4.67, p<0.001) and greater cognitive decline (β=-0.03, 95% CI=-0.05 to -0.01, p=0.006) during a median follow-up of 13.2 (IQR: 8.8-13.8) years compared with DWI- participants. No differences were found in risk of all-cause mortality, stroke or dementia.ConclusionPresence of a DWI+lesion in patients with SVD is associated with greater radiological progression of SVD and cognitive decline compared with patients without DWI+lesions.© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

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