Objective To investigate the correlation between enlarged perivascular spaces(EPVS)in different regions and glymphatic system(GS)function with cognitive function in patients with recent subcortical small infarction(RSSI).Methods A retrospective study was conducted by consecutively enrolling patients with RSSI who were hospitalized in the Department of Neurology at the Third Affiliated Hospital of Nanjing Medical University(Changzhou Second People's Hospital)from December 2023 to December 2024.Baseline and clinical data were collected,including age,sex,body mass index(BMI),history of smoking and alcohol consumption,hypertension,diabetes mellitus,atrial fibrillation,coronary heart disease,and laboratory indicators(including homocysteine,total cholesterol,triglycerides,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,glycated hemoglobin,uric acid,and creatinine).Cognitive function was assessed within 7 d of onset using the mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)scale,which covers seven cognitive domains:visuospatial and executive functioning,naming,attention,language,abstraction,memory,and orientation.All patients underwent brain MRI within 3 d of admission,including diffusion tensor imaging(DTI)sequences.The DTI along the perivascular space(DTI-ALPS)post-processing tool was used to calculate the DTI-ALPS index on both sides,and the mean value was taken as an indicator to evaluate overall GS function.The volumes of EPVS in the basal ganglia(BG)and centrum semiovale(CSO)were measured.EPVS severity was visually rated based on Potter's method(on a scale range from 0 to 4)and categorized into a none-to-mild(grades 0-1)and a moderate-to-severe(grades 2-4)group.Patients were further classified by region into a BG-EPVS and a CSO-EPVS subgroups under each severity group.(1)Univariate analyses were performed to compare baseline characteristics,DTI-ALPS index,and cognitive assessment scores between groups.Variables with P＜0.05 in univariate analyses were tested for multicollinearity using variance inflation factor.Variables without multicollinearity were included in multivariate Logistic regression to identify independent factors associated with BG-EPVS.To assess the robustness of the predictive value of the DTI-ALPS index,outlier diagnostics and exclusion were performed,followed by re-estimation of the Logistic regression model.Spearman's correlation analysis was used to examine the associations of BG-EPVS volume with the DTI-ALPS index,MMSE scale score,MoCA scale score,and each cognitive domain score.Mediation analysis was conducted to evaluate whether the DTI-ALPS index mediated the relationship between BG-EPVS volume and MoCA scale score.Results A total of 65 RSSI patients were included in the study,comprising 34 males and 3 1 females,aged 37 to 78 years,with a mean age of(53±15)years.Among them,30 patients were classified into the none-to-mild EPVS group and 35 into the moderate-to-severe EPVS group.For regional classification,34 were in the none-to-mild BG-EPVS group and 31 in the moderate-to-severe BG-EPVS group;36 were in the none-to-mild CSO-EPVS group and 29 in the moderate-to-severe CSO-EPVS group.(1)Univariate analysis showed,in both overall EPVS and BG-EPVS subgroup,the none-to-mild groups had lower age,lower proportions of male and hypertensive patients,and higher DTI-ALPS indices,MMSE scale scores,and MoCA scale scores than the moderate-to-severe groups(all P＜0.05).No significant differences were found in other baseline or clinical characteristics(all P＞0.05).In the CSO-EPVS subgroup,age was the only variable differed significantly between the none-to-mild group(significantly younger)and the moderate-to-severe group(P＜0.05),no other variables showed significant differences between the groups(all P＞0.05).(2)No multicollinearity was found among age,sex,hypertension,and the DTI-ALPS index through the multicollinearity analysis.Multivariate Logistic regression identified older age(OR,4.410,95％CI 1.211-16.025,P=0.024),male(OR,1.076,95％CI 1.001-1.156,P=0.048),and hypertension(OR,6.287,95％CI 1.635-24.167,P=0.007)as independent risk factors for moderate-to-severe BG-EPVS in RSSI patients,while a higher DTI-ALPS index was an independent protective factor(OR,0.002,95％CI 0.000-0.904,P=0.046).To assess the robustness of this model,six outlier cases were identified and excluded.After reanalysis,the negative association between the DTI-ALPS index and BG-EPVS risk remained significant(OR,0.050,95％CI 0.003-0.974,P=0.048).(3)Spearman correlation analysis revealed that the BG-EPVS volume in RSSI patients was negatively correlated with the DTI-ALPS index(rs=-0.842,P=0.007),MMSE scale score(rs=-0.491,P=0.033),MoCA scale score(rs=-0.563,P=0.018),and visuospatial/executive function score(rs=-0.596,P=0.001).No significant correlations were found between BG-EPVS volume and other cognitive domains,including naming,attention,language,abstraction,memory,and orientation(all P＞0.05).(4)Mediation analysis showed that the total effect size of BG-EPVS volume on MoCA scale score was-0.673,with a direct effect size of-0.537(account for 79.79％of the total effect size)and an indirect effect size via the DTI-ALPS index of-0.136(account for 20.21％).Conclusions In RSSI patients,age,sex,hypertension,and the DTI-ALPS index were identified as independent factors associated with the severity of BG-EPVS.BG-EPVS volume was negatively correlated with the DTI-ALPS index and cognitive function scores in RSSI patients.Moreover,the DTI-ALPS index mediated the relationship between BG-EPVS volume and cognitive function in RSSI patients.

Deep medullary veins(DMVs)are critical components of the cerebral medullary venous system,responsible for venous drainage of the deep cerebral white matter.Recent research indicates that DMVs are closely related to cerebral small vessel disease(CSVD)and associated cognitive disorders.The morphological structure of DMVs can be clearly visualized on susceptibility weighted imaging and quantitative susceptibility mapping,which could potentially serve as markers for assessing the severity of CSVD.This article reviewed the anatomical characteristics and physiological functions of DMVs,as well as the mechanistic correlations between DMVs and various CSVD imaging markers,aiming to provide novel theoretical insights for early diagnosis and clinical management of CSVD.

Objective To investigate the correlation between enlarged perivascular spaces(EPVS)in different regions and glymphatic system(GS)function with cognitive function in patients with recent subcortical small infarction(RSSI).Methods A retrospective study was conducted by consecutively enrolling patients with RSSI who were hospitalized in the Department of Neurology at the Third Affiliated Hospital of Nanjing Medical University(Changzhou Second People's Hospital)from December 2023 to December 2024.Baseline and clinical data were collected,including age,sex,body mass index(BMI),history of smoking and alcohol consumption,hypertension,diabetes mellitus,atrial fibrillation,coronary heart disease,and laboratory indicators(including homocysteine,total cholesterol,triglycerides,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,glycated hemoglobin,uric acid,and creatinine).Cognitive function was assessed within 7 d of onset using the mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)scale,which covers seven cognitive domains:visuospatial and executive functioning,naming,attention,language,abstraction,memory,and orientation.All patients underwent brain MRI within 3 d of admission,including diffusion tensor imaging(DTI)sequences.The DTI along the perivascular space(DTI-ALPS)post-processing tool was used to calculate the DTI-ALPS index on both sides,and the mean value was taken as an indicator to evaluate overall GS function.The volumes of EPVS in the basal ganglia(BG)and centrum semiovale(CSO)were measured.EPVS severity was visually rated based on Potter's method(on a scale range from 0 to 4)and categorized into a none-to-mild(grades 0-1)and a moderate-to-severe(grades 2-4)group.Patients were further classified by region into a BG-EPVS and a CSO-EPVS subgroups under each severity group.(1)Univariate analyses were performed to compare baseline characteristics,DTI-ALPS index,and cognitive assessment scores between groups.Variables with P＜0.05 in univariate analyses were tested for multicollinearity using variance inflation factor.Variables without multicollinearity were included in multivariate Logistic regression to identify independent factors associated with BG-EPVS.To assess the robustness of the predictive value of the DTI-ALPS index,outlier diagnostics and exclusion were performed,followed by re-estimation of the Logistic regression model.Spearman's correlation analysis was used to examine the associations of BG-EPVS volume with the DTI-ALPS index,MMSE scale score,MoCA scale score,and each cognitive domain score.Mediation analysis was conducted to evaluate whether the DTI-ALPS index mediated the relationship between BG-EPVS volume and MoCA scale score.Results A total of 65 RSSI patients were included in the study,comprising 34 males and 3 1 females,aged 37 to 78 years,with a mean age of(53±15)years.Among them,30 patients were classified into the none-to-mild EPVS group and 35 into the moderate-to-severe EPVS group.For regional classification,34 were in the none-to-mild BG-EPVS group and 31 in the moderate-to-severe BG-EPVS group;36 were in the none-to-mild CSO-EPVS group and 29 in the moderate-to-severe CSO-EPVS group.(1)Univariate analysis showed,in both overall EPVS and BG-EPVS subgroup,the none-to-mild groups had lower age,lower proportions of male and hypertensive patients,and higher DTI-ALPS indices,MMSE scale scores,and MoCA scale scores than the moderate-to-severe groups(all P＜0.05).No significant differences were found in other baseline or clinical characteristics(all P＞0.05).In the CSO-EPVS subgroup,age was the only variable differed significantly between the none-to-mild group(significantly younger)and the moderate-to-severe group(P＜0.05),no other variables showed significant differences between the groups(all P＞0.05).(2)No multicollinearity was found among age,sex,hypertension,and the DTI-ALPS index through the multicollinearity analysis.Multivariate Logistic regression identified older age(OR,4.410,95％CI 1.211-16.025,P=0.024),male(OR,1.076,95％CI 1.001-1.156,P=0.048),and hypertension(OR,6.287,95％CI 1.635-24.167,P=0.007)as independent risk factors for moderate-to-severe BG-EPVS in RSSI patients,while a higher DTI-ALPS index was an independent protective factor(OR,0.002,95％CI 0.000-0.904,P=0.046).To assess the robustness of this model,six outlier cases were identified and excluded.After reanalysis,the negative association between the DTI-ALPS index and BG-EPVS risk remained significant(OR,0.050,95％CI 0.003-0.974,P=0.048).(3)Spearman correlation analysis revealed that the BG-EPVS volume in RSSI patients was negatively correlated with the DTI-ALPS index(rs=-0.842,P=0.007),MMSE scale score(rs=-0.491,P=0.033),MoCA scale score(rs=-0.563,P=0.018),and visuospatial/executive function score(rs=-0.596,P=0.001).No significant correlations were found between BG-EPVS volume and other cognitive domains,including naming,attention,language,abstraction,memory,and orientation(all P＞0.05).(4)Mediation analysis showed that the total effect size of BG-EPVS volume on MoCA scale score was-0.673,with a direct effect size of-0.537(account for 79.79％of the total effect size)and an indirect effect size via the DTI-ALPS index of-0.136(account for 20.21％).Conclusions In RSSI patients,age,sex,hypertension,and the DTI-ALPS index were identified as independent factors associated with the severity of BG-EPVS.BG-EPVS volume was negatively correlated with the DTI-ALPS index and cognitive function scores in RSSI patients.Moreover,the DTI-ALPS index mediated the relationship between BG-EPVS volume and cognitive function in RSSI patients.

Deep medullary veins(DMVs)are critical components of the cerebral medullary venous system,responsible for venous drainage of the deep cerebral white matter.Recent research indicates that DMVs are closely related to cerebral small vessel disease(CSVD)and associated cognitive disorders.The morphological structure of DMVs can be clearly visualized on susceptibility weighted imaging and quantitative susceptibility mapping,which could potentially serve as markers for assessing the severity of CSVD.This article reviewed the anatomical characteristics and physiological functions of DMVs,as well as the mechanistic correlations between DMVs and various CSVD imaging markers,aiming to provide novel theoretical insights for early diagnosis and clinical management of CSVD.

Objective To investigate the relationship between choroidal thickness and white matter hyperintensity(WMH)in patients with recent subcortical small infarct(RSSI).Methods A total of 83 RSSI patients hospitalized in our hospital from November 2021 to May 2023 were enrolled,and according to paraventricular WMH,they were divided into no to mild lesion group 1(46 cases)and moderate to severe lesion group 1(37 cases),and based on deep WMH,40 of them were assigned into no to mild lesion group 2 and 43 cases into moderate to severe lesion group 2.All patients underwent cranial MRI for paraventricular WMH and deep WMH,and optical coher-ence tomography to measure choroid thickness by semi-automatic segmentation.The relationship between choroidal thickness and WMH at paraventricular and deep parts was analyzed.Results Significant advanced age,higher proportions of smoking and hypertension,and larger volume of deep WMH,while obviously thinner choroid thickness were observed in the moderate to severe lesion group 2 than the no to mild lesion group 2(P＜0.05,P＜0.01).While the moder-ate to severe lesion group 1 had older age,higher smoking and hypertension ratios,and higher volume of paraventricular WMH when compared with the no to mild group 1(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that age(OR=1.170,95％CI:1.064-1.287,P=0.001),hypertension(OR=4.533,95％CI:1.215-16.914,P=0.024),and choroidal thickness(OR=0.953,95％CI:0.931-0.975,P=0.001)were independent risk factors for deep WMH grade.Conclusion Changes in choroidal thickness in RSSI patients are independent influ-encing factors for severity of deep WMH lesions.The more severe the deep WMH lesion is,the thinner the choroidal thickness.

Quantitative susceptibility mapping (QSM) is a noninvasive MR post-processing technique that can quantitatively analyze tissue magnetic susceptibility, which has important value in early diagnosis and assessment of cerebral small vessel disease (CSVD). In recent years, QSM has gradually been applied in clinical neuroimaging both domestically and internationally, becoming a new hotspot. This review focuses on the principle and classification of QSM, application of QSM in the gray matter microstructure, white matter microstructure, venous oxygen saturation assessment, cerebral microhemorrhage and cognitive function assessment of CSVD, so as to provide new perspective for its neuroimaging evaluation.

Objective:To evaluate the visibility of deep medullary veins (DMVs) in patients with recent subcortical small infarction (RSSI), and explore the influence of DMVs visibility in RSSI with cognitive impairment.Methods:One hundred and sixty-four first-onset RSSI patients admitted to Department of Neurology, Third Affiliated Hospital of Nanjing Medical University from February 2023 to May 2024 were selected. According to Montreal cognitive assessment (MoCA), they were divided into normal cognitive function group (MoCA scores≥26, n=78) and cognitive impairment group (MoCA scores<26, n=86); DMVs visibility on amplitude map or minimum intensity projection map in susceptibility weighted imaging was evaluated by visual scoring method. Univariate analysis was used to compare the differences in general clinical data and DMVs visibility scores between two groups; multivariate Logistic regression analysis was used to identify the independent influencing factors for RSSI combined with cognitive impairment. Spearman rank correlation was used to analyze the correlations of DMVs visibility score with MoCA score and cognitive scores in various cognitive domains, while mediation analysis was used to explore the correlations of MoCA score with total white matter hyperintensity (WMH) volume and DMVs visibility score. Results:The DMVs visibility score, age, hypertension proportion, periventricular white matter hyperintensity (PWMH) volume, and total WMH volume in RSSI patients with cognitive impairment were significantly higher, while body mass index (BMI) was statistically lower than those in patients with normal cognitive function ( P<0.05). Multivariate Logistic regression analysis showed that age ( OR=1.069, 95% CI: 1.017-1.123, P=0.008), total WMH volume ( OR=1.845, 95% CI: 1.050-3.241, P=0.033), and DMVs visibility score ( OR=1.239, 95% CI: 1.057-1.454, P=0.008) were independent influencing factors for cognitive impairment in RSSI patients. Spearman rank correlation showed negative correlations between DMVs visibility score and MoCA score ( rs=-0.472, P<0.001), between DMVs visibility score and score of executive function and visual-spatial skills ( rs=-0.329, P<0.001), between DMVs visibility score and attention score ( rs=-0.491, P<0.001), between DMVs visibility score and delayed recall score ( rs=-0.516, P<0.001), and between DMVs visibility score and directional ability score ( rs=-0.162, P=0.039) in RSSI patients. Mediation analysis results showed that DMVs visibility score not only had a direct effect of 87.5% on MoCA score, but also had an indirect effect of 12.5% on MoCA score through total WMH volume. Conclusion:Cognitive impairment trend to appear in RSSI patients with high DMVs visibility score, and WMH volume plays a mediating role in the effect of DMVs visibility on RSSI with cognitive impairment.

Glymphatic system (GS), also known as glial-lymphatic system, plays a vital role in maintaining brain homeostasis. Previous research has established a link between cerebral small vessel disease (CSVD) and GS dysfunction. Diffusion tensor image analysis along the perivascular space (DTI-ALPS), an emerging non-invasive neuroimaging technique, has made significant strides in assessing GS function in central nervous system diseases. This review examines the DTI-ALPS principles, and relations of DTI-ALPS index with glymphatic circulation, various imaging markers of CSVD, and CSVD-related cognitive impairment, aiming to facilitate the early diagnosis, progression, and prognoses of CSVD.

Objective To investigate the relationship between APCV sign on SWI and END in pa-tients with acute anterior circulation cerebral infarction.Methods A retrospective study was con-ducted on 146 patients with acute anterior circulation cerebral infarction who were consecutively admitted in our hospital from May 2023 to March 2024.According to the results of SWI,they were divided into a negative APCV sign group(93 cases)and a positive APCV sign group(53 cases),and based on the progression of END or not within 3 d after admission,they were also assigned into a non-END group(97 cases)and an END group(49 cases).The general clinical data were compared between the negative and positive APCV sign groups and between the non-END and END groups.Multivariate logistic regression analysis was used to identify the risk factors for END and analyze the relationship between the occurrence of END and APCV sign in cerebral infarction.Results The positive APCV sign group had significantly larger proportions of hypertension and diabetes,higher glycosylated hemoglobin level and NIHSS score at admission,and elevated infarct volume than the negative APCV sign group(P＜0.01).Advanced age,higher ratios of hyperten-sion and diabetes,elevated NIHSS score,larger infarct volume and more APCV sign were ob-served in the END group than the non-END group(P＜0.05,P＜0.01).Multivariate logistic re-gression analysis showed that APCV sign was an independent risk factor for the occurrence of END in acute anterior circulation cerebral infarction after adjusting the variables,including age,hypertension,diabetes,N1HSS score,and infarct volume(OR=6.629,95％CI:1.799-24.428).Conclusion APCV sign is an independent risk factor for the occurrence of END in cerebral infarc-tion,and its appearance on the SWI sequence is an early marker in predicting the prognosis of cer-ebral infarction.

The Xuming Decoction, which is recorded in the "Gu Jin Lu Yan" section of Zhang Zhongjing's Synopsis of the Golden Chamber, is a traditional Chinese medicine formula. Recent literature review and summary of the clinical application research progress have found that this formula is primarily used to treat diseases such as acute cerebral infarction, facial neuritis, multiple sclerosis, Guillain-Barre syndrome, and pulmonary distension. However, different medical practitioners and scholars hold diverse understandings of Xuming Decoction.