Perivascular Spaces in Old Age: Assessment, Distribution, and Correlation with White Matter Hyperintensities

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Fig 1.
Sample images of grades 0–3 for the number of perivascular spaces bilaterally in the basal ganglia medial to the external capsule. The images indicate grade 0 (A), grade 1 (B), grade 2 (C), and grade 3 (D) in the basal ganglia. Note that the perivascular spaces contributing to the score might be in another level and thus not visible in the sample images.
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Fig 2.
Sample images of PVS with different grades. A and B, Grade 3 in number and grade 1 in size of PVS in the subinsular, basal ganglia, frontal, and parietal regions. There are >10 PVS in each region, but none of the PVS are wider than 2 mm. In the basal ganglia, PVS are seen as dots (oval) because the image is acquired cross-sectional to the vessels (A, axial T1), while PVS are linear in the frontal and parietal lobe (arrows), where the vessels are in a plane with the image (B, axial T2). C, Grade 3 in number and grade 1 in size in the left hippocampus (oval, axial T2). PVS in the hippocampus are really hippocampal sulcus remnants, which can be clearly seen in D (arrow, coronal T1).
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Fig 3.
Age-specific distribution of global scores for the number, size, and a combination of both number and size of PVS. Note that there are 3 subjects with missing values in the global PVS score for size.

Table 1:

Demographic and clinical characteristics of study participants by sex

Characteristics	Total Sample	Men	Women	P Value^{^a}
No. of subjects	530	218	312
Age (yr) (No.) (%)
60	141 (26.6)	66 (30.3)	75 (24.0)
66	123 (23.2)	51 (23.4)	72 (23.1)
72	84 (15.8)	30 (13.8)	54 (17.3)
78	73 (13.8)	29 (13.3)	44 (14.1)
81	49 (9.2)	18 (8.3)	31 (9.9)
84	26 (4.9)	9 (4.1)	17 (5.4)
87	18 (3.4)	9 (4.1)	9 (2.9)
90 or older	16 (3.0)	6 (2.8)	10 (3.2)	.72
Age (yr), mean (SD)	70.7 (9.1)	70.1 (9.2)	71.1 (9.0)	.20
Education (No.) (%)
Primary school	67 (12.6)	26 (11.9)	41 (13.1)
Middle school	246 (46.4)	78 (35.8)	168 (53.8)
University	217 (40.9)	114 (52.3)	103 (33.0)	<.01
Hypertension (No.) (%)	383 (72.3)	165 (75.7)	218 (69.9)	.14
Diabetes (No.) (%)	41 (7.7)	25 (11.5)	16 (5.1)	<.01
High cholesterol (No.) (%)	295 (56.4)	118 (55.7)	177 (56.9)	.78
Obesity (No.) (%)	72 (13.6)	30 (13.8)	42 (13.5)	.93
Atrial fibrillation (No.) (%)	11 (2.1)	7 (3.2)	4 (1.3)	.13
Coronary heart disease (No.) (%)	53 (10.0)	30 (13.8)	23 (7.4)	.02
Heart failure (No.) (%)	12 (2.3)	5 (2.3)	7 (2.2)	.97
PVH (median) (IQR)	8 (6–9)	8 (6–10)	8 (6–9)	.56
WMH (median) (IQR)	16 (5–29)	16 (4–26)	16 (6–30)	.56

Table 2:

Distribution of regional perivascular spaces by number and size^{^a}

Hemispheres and Regions	No. of Perivascular Spaces				Size (mm in Diameter) of Perivascular Spaces^{^b}
Hemispheres and Regions	None	1–5	6–10	>10	None	1–2	3–4	>4
Left
Frontal	32 (6.0)	70 (13.2)	107 (20.2)	321 (60.6)	32 (6.0)	473 (89.3)	25 (4.7)	0
Parieto-occipital	25 (4.7)	68 (12.8)	116 (21.9)	321 (60.6)	25 (4.7)	486 (91.7)	16 (3.0)	3 (0.6)
Basal ganglia	0	85 (16.0)	240 (45.3)	205 (38.7)	0	443 (83.6)	80 (15.1)	7 (1.3)
Subinsular	128 (24.2)	277 (52.3)	107 (20.2)	18 (3.4)	128 (24.2)	370 (69.9)	30 (5.7)	1 (0.2)
Hippocampus	156 (29.4)	328 (61.9)	46 (8.7)	0	156 (29.4)	348 (65.7)	26 (4.9)	0
Mesencephalon	255 (48.1)	274 (51.9)	0	0	254 (47.9)	273 (51.5)	3 (0.6)	0
Cerebellum	456 (86.0)	74 (14.0)	0	0	456 (86.0)	74 (14.0)	0	0
Right
Frontal	28 (5.3)	64 (12.1)	94 (17.7)	344 (64.9)	28 (5.3)	474 (89.4)	27 (5.1)	1 (0.2)
Parieto-occipital	29 (5.5)	79 (14.9)	106 (20.0)	316 (59.6)	29 (5.5)	487 (91.9)	14 (2.6)	0
Basal ganglia	1 (0.2)	103 (19.4)	231 (43.6)	195 (36.8)	1 (0.2)	452 (85.3)	63 (11.9)	14 (2.6)
Subinsular	131 (24.7)	280 (52.8)	103 (19.4)	16 (3.0)	131 (24.7)	369 (69.6)	29 (5.5)	1 (0.2)
Hippocampus	210 (39.6)	284 (53.6)	35 (6.6)	1 (0.2)	209 (39.5)	292 (55.2)	26 (4.9)	2 (0.4)
Mesencephalon	263 (49.6)	265 (50.0)	2 (0.4)	0	262 (49.5)	263 (49.7)	4 (0.8)	0
Cerebellum	462 (87.2)	68 (12.8)	0	0	463 (87.4)	67 (12.6)	0	0

↵a Data are No. (%).
↵b There were missing values of perivascular space size in 1 subject in the mesencephalon (right hemisphere), 1 in the hippocampus (right hemisphere), and 1 in the basal ganglia (left hemisphere).

Table 3:

Partial correlation coefficients between PVS and WMH scores^{^a}

Global and Regional PVS Scores	WMH Scores
Global and Regional PVS Scores	Global	Lobar White Matter Areas^{^b}	Deep White Matter Areas^{^b}	Periventricular Regions^{^b}
PVS score, total
Global region	0.204^{^c}	0.182^{^c}	0.171^{^c}	0.066
Frontal region	0.040	0.048	0.011	0.007
Parieto-occipital region	0.028	0.017	0.028	0.031
Basal ganglia	0.318^{^c}	0.256^{^c}	0.292^{^c}	0.160^{^c}
Subinsular region	0.228^{^c}	0.206^{^c}	0.173^{^c}	0.101^{^d}
Hippocampus	0.127^{^c}	0.137^{^c}	0.072	0.021
Mesencephalon	0.044	0.044	0.073	−0.077
Cerebellum	0.071	0.034	0.110^{^d}	0.039
PVS score (No.)
Global region	0.206^{^c}	0.177^{^c}	0.183^{^c}	0.074
Frontal region	0.034	0.039	0.015	0.001
Parieto-occipital region	0.002	−0.013	0.018	0.022
Basal ganglia	0.355^{^c}	0.295^{^c}	0.303^{^c}	0.194^{^c}
Subinsular region	0.263^{^c}	0.223^{^c}	0.233^{^c}	0.111^{^d}
Hippocampus	0.101^{^d}	0.117^{^c}	0.051	−0.004
Mesencephalon	0.041	0.044	0.067	−0.081
Cerebellum	0.071	0.034	0.11^{^d}	0.037
PVS score (size)
Global region	0.184^{^c}	0.177^{^c}	0.140^{^c}	0.042
Frontal region	0.046	0.061	−0.004	0.023
Parieto-occipital region	0.109^{^d}	0.113^{^d}	0.052	0.053
Basal ganglia	0.070	0.042	0.107^{^d}	0.008
Subinsular region	0.143^{^d}	0.152^{^d}	0.059	0.073
Hippocampus	0.151^{^c}	0.154^{^c}	0.092^{^d}	0.043
Mesencephalon	0.002	0.012	0.029	−0.096^{^d}
Cerebellum	0.071	0.033	0.111	0.041

↵a The correlation coefficients were adjusted for age, sex, and education.
↵b Lobar white matter areas include the frontal, parieto-occipital, and temporal lobes in both hemispheres; deep white matter areas include the basal ganglia, capsular, thalami, pons, and mesencephalon; and periventricular areas include the frontal, lateral, and occipital periventricular areas.
↵c P < .01.
↵d P < .05.