Enlarged perivascular spaces as vascular health indicators: correlations with clinical and imaging data in young and middle-age stroke patients

Purpose: To understand the role of enlarged Perivascular Spaces (PVSs) in a population with young middle age stroke and to identify predictors of PVSs enlargment using clinical and imaging data. Materials/Methods: Retrospective revision of demographics, clinical and MRI data, of 163 patients, with MRI confirmed stroke. Ischemic area and WMH were semi-automatically segmented on DWI images and FLAIR images. Severity of PVS was evaluated on T2-weighted images according to the Potter scale. To identify potential predictors of the extent of PVSs, an exploratory backward stepwise ordinal regression model was developed, including all measured variables. Results: With the extent of PVSs at Basal Ganglia as the dependent variable, the logarithm of WMH demonstrated a significant positive association with the outcome. ESUS exhibited a positive relationship, underscoring its potential role as a predictor of the outcome. In PVSs in Mid Brain, dyslipidemia displayed a significant negative effect, signifying a reduced likelihood of the outcome in its presence. Hypertension emerged as a statistically significant and notably positive predictor of PVSs. Conclusion: Significant associations between PVSs, WMH volume, and vascular features suggest their potential as vascular health indicators. These findings underscore the potentiality of PVSs as a biomarker for further investigation in stroke research. However, given the cross-sectional nature of our data, the relationship between PVS alterations and stroke requires further longitudinal studies to clarify their role and temporal association and eventually refining diagnostic and therapeutic approaches and mitigating stroke risks for younger stroke populations.