Sensitivity of diffusion tensor imaging to regional mixed cerebrovascular pathology

Diffusion tensor imaging is a candidate biomarker in cerebrovascular disease. Yet, little is known about the sensitivity of diffusion tensor imaging to mixed forms of cerebrovascular pathology: stroke and white matter hyperintensities. We evaluated the sensitivity of diffusion tensor imaging to regional lesion load, considering both stroke and white matter hyperintensity lesions. 65 older adults and 39 individuals with chronic stroke underwent diffusion tensor imaging and comprehensive cerebrovascular lesion segmentation. We tested relationships between fractional anisotropy or mean diffusivity and cerebrovascular lesions with linear mixed effects regression. In older adults, tract microstructure related to white matter hyperintensity lesion load (fractional anisotropy: <i>b</i> = -0.003, <i>P</i> = 0.003; mean diffusivity: <i>b</i> = 0.071 × 10^-4, <i>P</i> < 0.001). In individuals with chronic stroke, tract microstructure related to stroke lesion load (fractional anisotropy: <i>b</i> = -0.041, <i>P</i> < 0.001; mean diffusivity: <i>b</i> = 1.460 × 10^-4, <i>P</i> < 0.001), with a significant interaction between stroke and white matter hyperintensity lesion load (fractional anisotropy: <i>b</i> = 0.019, <i>P</i> < 0.001; mean diffusivity: <i>b</i> = -0.727 × 10^-4, <i>P</i> < 0.001). Among both groups, whole-brain normal appearing white matter microstructure did not relate to whole-brain lesion volumes. Our findings provide foundational evidence for the use and interpretation of diffusion tensor imaging as a biomarker in cerebrovascular disease.