ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neuroepidemiology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1647065
Exploration of Heterogeneity in Risk Factors Associated with Imaging Subtypes of White Matter Hyperintensities on Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging
Provisionally accepted
- Radiology, Jiangjin Central Hospital of Chongqing, Chongqing, China
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White matter hyperintensity (WMH), a critical early biomarker for cerebrovascular and neurodegenerative diseases, exhibits spatial heterogeneity that traditional global assessments overlook, leading to conflicting risk factor conclusions. This study aimed to evaluate WMH risk factor variability and construct a subtype-specific risk stratification model. A retrospective cohort of 540 participants (median age 70.0 years) with neurological symptoms underwent 3.0T FLAIR-MRI. WMH was stratified via Fazekas scoring (periventricular [PWMH] and deep [DWMH]) and anatomical segmentation (ventricular, periventricular, DWMH, juxtacortical regions). Statistical analyses included Mann-Whitney U tests, chi-square tests, binary logistic regression, and multiple linear regression. Results showed advanced age, hypertension, and abnormal renal function (creatinine, cystatin C, β2-microglobulin) were common risk factors for moderate-severe WMH (all P<0.0001). PWMH was associated with coronary heart disease (22.9% vs. 12.3%, P=0.001) and creatinine (OR=2.07), while DWMH correlated with smoking (40.3% vs. 30.2%), diabetes (47.0% vs. 34.8%), and β2-microglobulin (OR=1.79). Hyperlipidemia inversely associated with DWMH (42.95% vs. 52.43%, P=0.04). Linear regression revealed age and hypertension strongly drove periventricular WMH volume (β=0.236 and 3.618, P<0.0001), while diabetes exacerbated periventricular lesions (β=3.073, P=0.016). Conclusion: WMH subtypes demonstrate distinct risk factor profiles—PWMH links to cardiorenal factors, and DWMH to metabolic-microvascular insults. Spatial classification enhances risk stratification, supporting precision prevention strategies for cerebral small vessel disease.
Keywords: White matter hyperintensity (WMH), Risk factors, Deep white matter hyperintensity (DWMH), Periventricular white matter hyperintensity (PWMH),, FLAIR (Fluid attenuated inversion recovery)
Received: 16 Jun 2025; Accepted: 07 Aug 2025.
Copyright: © 2025 Yonglong, Xiufu, Haotian, Linrong, Zhaoyang, Jun and Ruipeng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zhou Jun, Radiology, Jiangjin Central Hospital of Chongqing, Chongqing, China
Liang Ruipeng, Radiology, Jiangjin Central Hospital of Chongqing, Chongqing, China
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