Chronic kidney disease correlates with MRI findings of cerebral small vessel disease

Figures & data

Figure 1. Flow chart of the study design. Fifty two participants with CKD were separated into a progressive group and a stable group. CSVD (cerebral small vessel disease; enlarged VRS/WML/LI/CMB) comparisons were made between the two groups (progressive group at initial exam (group 1A), progressive group at follow-up (group 1B), stable group at initial exam (group 2A), stable group at follow-up (group 2B).

Table 1. Clinical data for participants (progressive group and stable group).

	Progressive group	Stable group	Comparisons between two groups p value
Number (N)	17	35
Age (years)	52.35 ± 6.99	54.46 ± 8.73
Gender（male/female）	11/6	19/16	0.476
Proportion who are smokers (%)	7 (41.2%)	12 (28.57%)	0.629
Hypertension (%)	4 (23.53%)	8 (22.86%)	0.956
Diabetes (type 2)	3 (17.65%)	9 (25.71%)	0.517
Total cholesterol (TC) (mmol/L)	5.10±1.01	5.30±0.95
TG (Triacylglycerol)	1.44±0.46	1.49±0.48
FBG (fasting blood glucose)	5.63±0.44	5.42±0.48
Urine erythrocytes	2.529 ± 1.463	1.686 ± 1.491
Urine protein
<0.2 g/L	n = 0	n = 2
0.2g∼1.0 g/L	n = 3	n = 7
1.0–2.0 g/L	n = 4	n = 8
2.0–4.0 g/L	n = 3	n = 12
>4.0 g/L	n = 7	n = 6
eGFR
Initial eGFR	35.975±11.645	36.765±12.040	0.82338
Follow-up eGFR	24.326±9.217	36.723±11.416	<0.001*
Initial CKD stage
Stage III	10	21
Stage IV	7	14
CKD stage at follow-up
Stage III	4	25
Stage IV	13	10

Note: *p < 0.05 was statistically significant.

Figure 2. MR images from a 53-year-old male patient in the stable group at follow-up. Enlarged VRS (Virchow-Robin spaces) and LI (lacunar infarcts) lesions are shown. VRS hypersignal in T2W imaging and hyposignal in T1W images in the basal ganglia and centrum semiovale, VRS score 2 (according to the scale 0 = none, 1 = 1–10, 2 = 11–20, 3 = 21–40, and 4 = >40 by summing the basal ganglia and centrum semiovale VRS scores). LI was evaluated by hypersignal in T2/FLAIR images and hyposignal in T1W images located beside the lateral ventricle (white arrow).

Figure 3. MR images from a 65-year-old patient from the progressive group at follow-up. WML (white matter lesions) and CMB (cerebral microbleeds) lesions are shown. WML surrounding the ventricle received Fazekas scale 2 points (fusion lesion) (T2W/FLAIR/T1W images) (black arrow). CMB lesions involved cortical, subcortical, and thalamic regions (white arrow) (magnitude image/phage image/SWI images).

Table 2. MR evaluation of CSVD VRS (Virchow-Robin spaces) results and comparisons between two groups [progressive group at initial exam (group 1A), progressive group at follow-up (group 1B), stable group at initial exam (group 2A), stable group at follow-up (group 2B)].

VRS score	Mean ±SD
Group 1A (patients number)	1.647±0.996
Group 1B (patients number)	1.8240.8±83
Group 2A (patients number)	1.371±1.06
Group 2B (patients number)	1.429±1.037
Comparison between groups	t Value	p Value
Group 1B vs. Group 1A	−1.852	0.083
Group2B vs. Group2A	−1	0.324

Table 3. MR evaluation of CSVD WML (white matter lesions) results and comparisons between two groups [progressive group at initial exam (group 1A), progressive group at follow-up (group 1B), stable group at initial exam (group 2 A), stable group at follow-up (group 2B)].

WML score	Mean±SD
Group 1A (patients number)	0.647±0.702
Group 1B (patients number)	1.059±0.659
Group 2A (patients number)	0.657±0.765
Group 2B (patients number)	0.743±0.78
Comparison between groups	t Value	p Value
Group 1B vs. Group 1A	−3.347	0.004*
Group 2B vs. Group 2A	−1.785	0.083

*p < 0.05 was statistically significant.

Table 4. MR evaluation of CSVD LI (lacunar infarcts) results and comparisons between two groups [Progressive group at initial exam (group 1 A), Progressive group at follow-up (group 1B), Stable group at initial exam (group 2 A), Stable group at follow-up (group 2B)].

LI	Positive	Negative	Positive ratio (%)
Group 1A (patients number)	3	14	17.6
Group 1B (patients number)	4	13	23.5
Group 2A (patients number)	6	29	17.1
Group 2B (patients number)	7	28	20
Comparison between groups	t Value	p Value
Group 1B vs. Group 1A	−1	0.332
Group 2B vs. Group 2A	−1	0.324

Table 5. MR evaluation of CSVD CMB (cerebral microbleeds) results and comparisons between two groups [progressive group at initial exam (group 1A), progressive group at follow-up (group 1B), stable group at initial exam (group 2A), stable group at follow-up (group 2B)].

CMB	Positive	Negative	Positive ratio (%)
Group 1A (patients number)	0	17	0
Group 1B (patients number)	5	12	29.4
Group 2A (patients number)	0	35	0
Group 2B (patients number)	1	34	2.8
Comparison between groups	t Value	p Value
Group 1B vs. Group 1A	−2.582	0.020*
Group 2B vs. Group 2A	−1	0.324

*p < 0.05 was statistically significant.

Figure 4. The mean CSVD scores of VRS (Virchow-Robin spaces)/WML (white matter lesions)/LI (lacunar infarcts)/CMB (cerebral microbleeds) and comparison between the two patient groups [progressive group at initial exam (group1A), progressive group at follow-up (group 1B), stable group at initial exam (group 2A), stable group at follow-up (group 2B)].

Table 6. eGFR value and VRS/LI/WML/CMB comparisons between progressive group and stable group [progressive group at initial exam (group 1A), progressive group at follow-up (group 1B), stabilized group at initial exam (group 2A), stable group at follow-up (group 2B)].

	Number	eGFR	VRS	LI	WML	CMB
		Mean + SD	Mean + SD	Mean + SD	Mean + SD	Mean + SD
Group 1A	17	35.975 ± 11.645	1.647 ± 0.996	0.177 ± 0.393	0.647 ± 0.702	0
Group 2A	35	36.765 ± 12.04	1.371 ± 1.06	0.171 ± 0.382	0.657 ± 0.765	0
	t Value	−0.224	0.897	0.044	−0.046	–
	p Value	0.823	0.374	0.965	0.964	–
Group 1B	17	24.326 ± 9.217	1.824 ± 0.883	0.235 ± 0.437	1.059 ± 0.659	0.294	0.47
Group 2B	35	36.723 ± 11.416	1.429 ± 1.037	0.2 ± 0.406	0.722 ± 0.779	0.029	0.169
	t Value	−3.897	1.349	0.287	1.539	2.994
	p Value	<0.001	0.183	0.775	0.13	0.004*

*p < 0.05 was statistically significant.

Table 7. Pearson’s Correlation for eGFR with VRS, WML, LI, and CMB.

Correlation Coefficients	Initial eGFR	Follow-up eGFR	Initial VRS	Follow-up VRS	Initial WML	Follow-up WML	Initial LI	Follow-up LI	Initial CMB	Follow-up CMB
Initial eGFR	1	–	−0.234 (p = 0.095)	–	−0.196 (p = 0.164)	–	−0.144 (p = 0.307)	–	--
Follow-up eGFR	–	1	–	−0.296* (p = 0.037)	–	−0.284 (p = 0.041)*	–	−0.181 (p = 0.2)		−0.358* (p = 0.009)

Two-tailed test of significance was used.

*Correlation is significant at the 0.05 level.