Arterial input function dispersal generated by brain computed tomography perfusion is associated with cerebral small vessel disease in stroke patients

Introduction Left atrial and ventricular dysfunction affect cerebral hemodynamics and are linked to white matter hyperintensities and other small vessel disease markers. Arterial input function dispersal from computed tomography perfusion reflects contrast passage through cerebral circulation and has been associated with cardiac dysfunction. We hypothesized that prolonged arterial input function dispersal is associated with higher small vessel disease burden. Patients and methods We retrospectively analyzed 369 patients with acute ischemic stroke or transient ischemic attack who underwent computed tomography perfusion and brain magnetic resonance imaging within 7 days of admission. Total small vessel disease score was assessed using a validated score incorporating white matter hyperintensities, lacunes, microbleeds, and enlarged perivascular spaces. Associations with high small vessel disease burden (score 3 or 4) were examined using logistic regression and receiver operating characteristic analysis. Results Among 369 patients, 115 (31%) had high small vessel disease burden. Each 1-second increase in arterial input function dispersal was independently associated with greater odds of high small vessel disease burden (odds ratio 1.12, 95% confidence interval 1.07–1.17, p<0.001). The prespecified cutoff of arterial input function >29 seconds was also associated with high small vessel disease burden (odds ratio 5.13, 95% confidence interval 2.78–9.45, p<0.001). Receiver operating characteristic analysis suggested an optimal cutoff of 30 seconds (area under the curve 0.71). Discussion and Conclusion Arterial input function dispersal was independently associated with total small vessel disease burden, suggesting it may be a useful risk marker for cumulative microvascular injury in addition to indicating cardiac dysfunction.