High total cerebral blood flow is associated with a decrease of white matter lesions

Background Low cerebral blood flow (CBF) has been associated with the presence of white matter lesions (WMLs). However, the power of these studies was insufficient (n=20-35) to determine whether flow is associated with WMLs. Purpose The aim of this study was to investigate whether total cerebral blood flow (tCBF) is associated with the severity of white matter lesions (WMLs) in a large patient sample. Subjects and methods 228 patients with clinical symptoms of cardiovascular disease had MRI of the brain, consisting of a T2-w FLAIR and a 2D phase-contrast flow measurement of the internal carotid arteries and the basilar artery. WMLs were graded according to prevalence and size of deep and periventricular WMLs. To determine the relation between tCBF and WMLs we used linear and logistic regression analysis adjusted for age, gender, intima media thickness and hypertension. Results We observed an inverse association between the tCBF and the total number of WMLs adjusted for age, gender, intima media thickness and hypertension [B=-1, 0 WML 95% CI (-2.0 to 0.0, p=0.045) per 100 mL increase in tCBF]. The adjusted odds ratio for the presence of severe WMLs in patients with high tCBF (>675 mL/min) was 0.5 (95 % CI 0.2-1.0) compared with patients with normal tCBF. Conclusion In this study we found that high tCBF is associated with a decrease in presence and severity of WMLs.