A METHOD FOR USING MR TO EVALUATE THE EFFECTS OF CARDIOVASCULAR-DISEASE ON THE BRAIN - THE CARDIOVASCULAR HEALTH STUDY

PURPOSE: To do a pilot study for the Cardiovascular Health Study (a po pulation-based, longitudinal study of coronary heart disease and strok e in adults 65 years of age and older designed to identify risk factor s related to cerebrovascular disease, particularly stroke): (a) to det ermine the feasibility of adding brain MR to the full-scale study; (b) to evaluate the reliability of standardized MR image interpretation i n a multicenter study; and (c) to compare the prevalence of stroke det ermined by MR with that by clinical history. METHODS: Protocol-defined MR studies were performed in 100 subjects with clinical histories of stroke and 203 subjects without reported histories of stroke. MR scans were independently evaluated by two trained neuroradiologists for the presence of small (less than or equal to 3 mm) and large (>3 mm) ''in farctlike'' lesions. The sizes of the cerebral sulci and lateral ventr icles and the extent of white matter disease were graded on a scale of 0 to 9. RESULTS: Eighty percent of the Cardiovascular Health Study pa rticipants who were invited to undergo MR studies agreed to do so; 95% of those agreeing to the procedure successfully completed the exams. Intrareader and interreader reliability of infarctlike lesion identifi cation was high for large lesions (kappa, 0.71 and 0.78, respectively) but not for small lesions (kappa, 0.71 and 0.32, respectively). Relax ed intrareader and interreader kappa scores for sulcal and ventricular sizes and extent of white matter disease were greater than 0.8. MR ev idence of infarctlike lesions was present in 77% of the participants w ith histories of stroke but was also present in 23% of the participant s without clinical histories of stroke. Seventy-nine percent of the in farctlike lesions were larger than 3 mm. CONCLUSIONS: This preliminary study indicates that a large, prospective, epidemiologic study of eld erly subjects using MR scans of the brain for identification of cerebr ovascular disease is feasible and that the interpretative results are reproducible, and suggests that MR evidence of stroke is more prevalen t than reported clinical history of stroke.