Dilatation of the Virchow-Robin Space Is aSensitive Indicator of Cerebral MicrovascularDisease: Study in Elderly Patients withDementia

Tufail F. Patankar, Dipayan Mitra, Anoop Varma, Julie Snowden, David Neary, and Alan Jackson

BACKGROUND AND PURPOSE: Virchow-Robin spaces (VRSs) are CSF spaces that accompanyblood vessels as they perforate the brain substance. Dilatation of VRS is associated with microangiopathy. Microvascular disease has a major etiologic and pathogenetic role in dementias.To our knowledge, no investigators have looked at the relationship between dilated VRS onMR imaging and cerebral microvascular disease. The aim of our study was to test thehypothesis that dilatation of VRS is associated with subcortical vascular dementia.

METHODS: We recruited 75 patients with Alzheimer’s disease (n 35), ischemic vasculardementia (n 24), or frontotemporal dementia (n 16) and 35 healthy volunteers. Weassessed deep white matter and periventricular hyperintensities and the severity of VRSdilatation, as scored on MR images. Statistical group comparisons and multiple regressionanalyses were performed to quantify the relationship between imaging features and diagnoses.
RESULTS: White matter lesions were more common in patients with ischemic vasculardementia than in those with Alzheimer’s disease or healthy volunteers (P < .01). VRS scoreswere significantly higher in patients with vascular dementia than in patients with AD (P <.001), patients with FTD (P < .01), or healthy volunteers (P < .001). VRS scores accounted for29% of the variance in the regression model, and scores for periventricular hyperintensityaccounted for 2%.
CONCLUSION: VRS dilatation is common in diseases associated with microvascular abnormalityand can be used as a diagnostic tool to differentiate vascular dementias from degenerativedementias.