Table 3_Deep medullary veins disruption in cerebral small vessel disease: links to AI-quantified lesions and cognitive decline.docx

BackgroundThe relationship between cerebral small vessel diseases (CSVD) and deep medullary veins (DMV) has been the subject of only a limited number of studies to date, with the majority of research focusing on the correlation between DMV and cognitive function in patients with CSVD. The present study aims to quantitatively evaluate the relationship between DMV and CSVD imaging markers, utilizing an artificial intelligence neuroimaging system to achieve this objective. Furthermore, an investigation was conducted into the correlation between DMV disruption and cognitive impairment.
MethodsThis cross-sectional study enrolled patients with CSVD imaging markers who were admitted to the Department of Neurology at our hospital. The quantitative assessment of CSVD imaging markers, encompassing white matter hyperintensities (WMH), lacunar infarction (LI), and cerebral microbleeds (CMB), was conducted employing the AccuBrain® neuroimaging system. The DMV was evaluated using susceptibility-weighted imaging (SWI) with a semi-quantitative scale. The Montreal Cognitive Assessment (MoCA) score was evaluated for each patient.
ResultsThe study’s sample population comprised 171 patients. Multivariate ordinal logistic regressions indicated that DMV score was significantly associated with WMH volume, LI count, and CMB count (p < 0.05). In the context of multivariate linear regression analysis, a significant negative correlation was observed between the DMV score and the MoCA score, with the latter being adjusted for confounding variables such as age, education, gender, and smoking history (p = 0.003). The application of path analysis revealed a significant correlation between the DMV score and the MoCA score, which indicates that WMH volume plays a mediating role in this relationship, thereby offering a novel perspective on cognitive function and neurodegenerative processes.
ConclusionDMV score is associated with the severity of WMH, CMB, and LI, as well as cognitive performance decline, implicating that cerebral venule damage may play a role in the development of CSVD and related cognitive impairment.

背景：迄今为止，关于脑小血管病（cerebral small vessel diseases, CSVD）与髓质深静脉（deep medullary veins, DMV）之间关联的研究尚为数不多，且多数研究均聚焦于脑小血管病患者中髓质深静脉与认知功能的相关性。本研究旨在借助人工智能神经影像系统，定量评估髓质深静脉与脑小血管病影像学标志物之间的关联，并探究髓质深静脉破坏与认知损害的相关性。
方法：本横断面研究纳入了我院神经内科收治的、具备脑小血管病影像学标志物的患者。采用AccuBrain®神经影像系统对脑小血管病影像学标志物，包括脑白质高信号（white matter hyperintensities, WMH）、腔隙性脑梗死（lacunar infarction, LI）及脑微出血（cerebral microbleeds, CMB），进行定量评估；采用半定量量表结合磁敏感加权成像（susceptibility-weighted imaging, SWI）对髓质深静脉进行评估；同时对所有患者开展蒙特利尔认知评估量表（Montreal Cognitive Assessment, MoCA）评分。
结果：本研究共纳入171例患者作为研究队列。多变量有序logistic回归分析结果显示，髓质深静脉评分与脑白质高信号体积、腔隙性脑梗死数量及脑微出血数量均存在显著相关性（p<0.05）。多变量线性回归分析显示，在校正年龄、受教育程度、性别及吸烟史等混杂变量后，髓质深静脉评分与蒙特利尔认知评估量表评分呈显著负相关（p=0.003）。路径分析结果显示，髓质深静脉评分与蒙特利尔认知评估量表评分存在显著相关性，提示脑白质高信号体积在二者关联中起中介作用，为认知功能与神经退行性病变的研究提供了全新视角。
结论：髓质深静脉评分与脑白质高信号、脑微出血、腔隙性脑梗死的严重程度及认知功能下降均存在相关性，提示脑静脉损伤可能参与脑小血管病及其相关认知损害的发生发展过程。