BACKGROUND: Dilated perivascular spaces (dPVS) seen on MRI are associated with small vessel disease in the aging population. We sought to investigate the incidence and dynamic evolution of MRI-detectable PVS progression in patients with cerebral amyloid angiopathy (CAA).
METHODS: Patients with symptomatic CAA who underwent baseline and follow-up MRI scans >2 years apart were included. The distribution and severity of both basal ganglia and centrum semiovale PVS were rated. Multivariable logistic regression was used to determine the risk factors for MRI-detectable PVS progression.
RESULTS: We included 90 patients with CAA, of which 53 (58.9%) had intracerebral hemorrhage (ICH) at baseline. During a median follow-up of 4.8 years (IQR: 3.6-6.6 years), MRI-detectable PVS progression was observed in 24 patients (26.7%) at follow-up MRI. After adjusting for age, hypertension and time interval between baseline and follow-up MRI, cerebral microbleed (CMB) progression (OR: 4.12, 95% CI: 1.31 to 12.95; p=0.015) and presence of ICH (OR: 8.61, 95% CI: 2.09 to 35.52; p=0.003) were independent predictors of PVS progression. In multivariable regression analysis, presence of ICH (OR: 9.22, 95% CI: 1.81 to 47.08; p=0.008) and hypertension (OR: 5.20, 95% CI 1.14 to 23.77; p=0.033) were associated with MRI-detectable BG-PVS progression. However, only CMB progression (OR: 10.15, 95% CI: 1.82 to 56.45; p=0.008) was associated with CSO-PVS progression.
CONCLUSIONS: MRI-detectable PVS progression occurs in a subset of CAA patients reimaged after a median of 4.8 years and is associated with CMB progression. PVS progression might be a useful neuroimaging marker for visualizing CAA-related vascular changes.