Regional Associations Between Ocular Vascular Parameters and Enlarged Perivascular Spaces in the Basal Ganglia and Centrum Semiovale.

Abstract

Background: Enlarged perivascular spaces (EPVS) represent a hallmark imaging feature of cerebral small vessel disease. The ocular vasculature is an anatomical extension of cerebral vessels, constituting part of the microvascular system; however, the relationship between ocular vascular characteristics and EPVS remains poorly understood. In this study, we examined the association between ocular vascular parameters and the regional distribution of EPVS in patients with minor stroke.

Methods: Patients diagnosed with minor stroke between 2021 and 2024 were prospectively enrolled. Ocular vascular characteristics were assessed using optical coherence tomography angiography (OCTA) and ophthalmic arterial ultrasound (OAU), while 3.0 T magnetic resonance imaging (MRI) was performed to evaluate EPVS in the centrum semiovale (CSO) and basal ganglia (BG). Demographic characteristics, clinical risk factors, neuroimaging findings, and laboratory data were recorded at admission.

Results: A total of 111 participants were enrolled, with a mean age of 65.23 ± 7.62 years; 43.24% were female. At baseline, 43 patients (38.74%) had high CSO-EPVS burden, and 61 (54.95%) had high BG-EPVS burden. In multivariate regression analysis, superficial retinal capillary plexus perifoveal density (odds ratio [OR] = 0.87, p = 0.020) measured by OCTA and diabetes mellitus were independently associated with BG-EPVS, whereas the resistive index of the ophthalmic artery (OR = 1.33, p < 0.001) measured by OAU was independently and positively associated with CSO-EPVS.

Conclusions: Ocular microvascular density was associated with BG-EPVS, whereas ocular vascular elasticity was associated with CSO-EPVS. These findings support the hypothesis that these EPVS subtypes arise from distinct vascular mechanisms - microvascular hypoperfusion versus reduced vascular elasticity.