MRI evidence of vascular brain injury is associated with an increased risk of stroke, dementia, and death, according to a systematic review and meta-analysis.
Earlier studies of the possible link between MRI markers of covert vascular brain injury and these outcomes have yielded inconsistent results, researchers note in JAMA Neurology, online October 22.
Dr. Stephanie Debette of the University of Bordeaux, France, and colleagues used data from 94 articles to investigate the association between four radiological features of vascular brain injury (brain infarcts [BIs]), white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), and perivascular spaces (PVSs) and the risk of incident stroke, dementia, and death.
The presence of BI was associated with a 2.38-fold increased risk of incident stroke (P < 0.001), a 29% increased risk of incident dementia (P=0.04), and a 64% increased risk of death (P < 0.001).
Extensive WMH burden was associated with a 2.45-fold increased risk of incident stroke (P < 0.001), an 84% increased risk of incident dementia (P < 0.001), and a 2.00-fold increased risk of mortality (P < 0.001).
CMB was associated with a 98% increased risk of incident stroke (P < 0.001) and a 53% increased risk of mortality (P < 0.001), but no significantly increased risk of incident dementia.
Most of these associations were seen both in the general population and in high-risk individuals, the researchers note.
There were insufficient eligible studies to conduct meta-analyses on the clinical significance of PVSs.
"From a practical perspective, the discovery of these MRI markers should prompt detailed assessment of a person's risk for stroke and dementia and careful evaluation of the benefit-risk ratio for available preventive strategies," the authors conclude. "Randomized clinical trials are required to determine whether specific therapies, particularly aspirin therapy and intensive blood pressure lowering, are beneficial when these MRI markers are noted as incidental findings."