Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Arteriolosclerosis


KEY FACTS

Terminology

  • Sclerosis of small-sized arteries (arterioles)

    • Common with chronic hypertension (HTN) &/or diabetes

    • May lead to vascular dementia (VaD)

Imaging

  • Multifocal white matter (WM) hypodensity on CT

  • Patchy/confluent ↑ T2/FLAIR hyperintensities

    • Broad or confluent base with ventricles

    • Periventricular > deep > juxtacortical involvement

  • Findings nonspecific

    • Large number of causes other than arteriopathy

    • Demyelination, infection, inflammatory, drug related, metabolic, age related

  • Caused by several types of arteriopathy

    • Arteriolosclerosis

    • Chronic hypertension (more basal ganglia, periventricular WM involvement)

    • Diabetes mellitus (more peripheral involvement)

Top Differential Diagnoses

  • Age-related WM changes

  • Perivascular (Virchow-Robin) spaces

  • Demyelinating disease

  • VaD

  • Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)

  • Cerebral amyloid angiopathy (CAA)

Clinical Issues

  • Clinical and radiographic picture overlaps

    • Multi-infarct (vascular) dementia: Caused by arteriolosclerosis &/or multiple infarcts

    • Subcortical arteriosclerotic encephalopathy (Binswanger disease)

Diagnostic Checklist

  • Use FLAIR, T2* (GRE, SWI) sequences in all elderly patients

    • Look for microbleeds (HTN, CAA)

Axial FLAIR MR shows mild atrophy and confluent periventricular
and punctate subcortical
white matter hyperintensity typical for arteriolosclerosis (chronic small vessel disease) in this elderly patient with mild cognitive impairment.

Axial DTI trace shows no areas of diffusion restriction to suggest acute ischemia in this elderly patient. Arteriolosclerosis may mask an acute ischemic event, so DWI or DTI sequences are helpful to exclude acute ischemia in this patient population.

Axial T2 MR in a patient with chronic hypertension shows confluent regions of periventricular hyperintensity
related to arteriolosclerosis. There are chronic lacunar infarcts
and a chronic hypertensive basal ganglia hemorrhage
.

GRE in the same case shows blooming hypointensity
around the chronic hypertensive hemorrhage. Multiple foci of susceptibility artifact or “blooming” are seen in the deep gray nuclei
and white matter
related to microhemorrhages from chronic hypertension.

TERMINOLOGY

Synonyms

  • Small vessel disease, microvascular disease, microangiopathy

  • Imaging correlate = leukoaraiosis or periventricular leukoencephalopathy

Definitions

  • Sclerosis of small-sized arteries (arterioles)

    • Commonly from chronic HTN, hypercholesterolemia &/or diabetes mellitus (DM)

    • May lead to vascular dementia

IMAGING

General Features

  • Best diagnostic clue

    • White matter (WM) hypodensity (rarefaction) on CT

    • Patchy/confluent hyperintensity on T2WI/FLAIR

  • Location

    • Periventricular white matter (PVWM) and deep WM

      • –

        Broad or confluent base with ventricle

      • –

        Periventricular (particularly along atria of lateral ventricles) > deep > subcortical involvement

    • Basal ganglia (BG)

      • –

        More BG involvement with chronic HTN

      • –

        More peripheral WM involvement

        • □

          Diabetes mellitus, cerebral amyloid angiopathy

  • Size

    • Varies, progresses with age

    • Range: Punctate to large confluent

  • Morphology

    • Bilateral patchy or confluent

CT Findings

  • NECT

    • Multifocal/confluent ill-defined hypodense areas that spare cortex

    • Broad or confluent base with ventricles

      • –

        Periventricular > deep > juxtacortical involvement

  • CECT

    • No enhancement

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts