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Clinical Significance of Magnetic Resonance Imaging Markers of Vascular Brain Injury: A Systematic Review and Meta-analysis
Debette S, Schilling S, Duperron MG, Larsson SC, Markus HS.. JAMA neurology, 2019-01-01
Topic: Risk, prevention and care in population studies
Importance Covert vascular brain injury (VBI) is highly prevalent in community-dwelling older persons, but its clinical and therapeutic implications are debated. Objective To better understand the clinical significance of VBI to optimize prevention strategies for the most common age-related neurological diseases, stroke and dementia. Data source We searched for articles in PubMed between 1966 and December 22, 2017, studying the association of 4 magnetic resonance imaging (MRI) markers of covert VBI (white matter hyperintensities [WMHs] of presumed vascular origin, MRI-defined covert brain infarcts [BIs], cerebral microbleeds [CMBs], and perivascular spaces [PVSs]) with incident stroke, dementia, or death. Study selection Data were taken from prospective, longitudinal cohort studies including 50 or more adults. Data extraction and synthesis We performed inverse variance-weighted meta-analyses with random effects and z score-based meta-analyses for WMH burden. The significance threshold was P Main outcomes and measures Stroke (hemorrhagic and ischemic), dementia (all and Alzheimer disease), and death. Results Of 2846 articles identified, 94 studies were eligible, with up to 14 529 participants for WMH, 16 012 participants for BI, 15 693 participants for CMB, and 4587 participants for PVS. Extensive WMH burden was associated with higher risk of incident stroke (hazard ratio [HR], 2.45; 95% CI, 1.93-3.12; P Conclusions and relevance We report evidence that MRI markers of VBI have major clinical significance. This research prompts careful evaluation of the benefit-risk ratio for available prevention strategies in individuals with covert VBI.
Key findings
- Results Of 2846 articles identified, 94 studies were eligible, with up to 14 529 participants for WMH, 16 012 participants for BI, 15 693 participants for CMB, and 4587 participants for PVS.
- Extensive WMH burden was associated with higher risk of incident stroke (hazard ratio [HR], 2.45; 95% CI, 1.93-3.12; P Conclusions and relevance We report evidence that MRI markers of VBI have major clinical significance.
Why it matters
This 2019 systematic review and meta-analysis pooled 94 prospective cohort studies to ask whether four MRI signs of "covert" vascular brain injury (white matter hyperintensities, covert brain infarcts, microbleeds and perivascular spaces) predict later stroke, dementia or death. The one result kept in alzhub's copy is that extensive white matter hyperintensity burden went with a higher rate of stroke (hazard ratio 2.45; 95% CI 1.93–3.12), and the authors conclude the markers "have major clinical significance". The studies were observational and no treatment was tested, so it does not show that preventing these scan changes prevents stroke or dementia.
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Study details
- Study designmeta-analysis
- Participants529
- Evidence strengthHigh
How this study scored 79/100
Published in a leading specialty journal, and it is a meta-analysis pooling many studies. Scored zero for effect reported because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (JAMA neurology) |
| Journal's citation record | 2 / 4 | JAMA Neurology: journal h-index 235 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A meta-analysis pooling many studies |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2019 — within 10 year(s) of the newest study here |
| Sample size | 2 / 4 | 529 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 6 / 7 | Cited 725 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 80.6 citations a year over 9 year(s) since 2019 |
| Impact for its field and year | 5 / 6 | Cited 25.3× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 38 other studies in this library |
| Still being cited | 4 / 4 | Cited 334 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Hugh Stephen Markus: h-index 137 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Inserm: institution h-index 1,988 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 3 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 30422209) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 79 / 100 | — |
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Read the original
- DOI: 10.1001/jamaneurol.2018.3122
- PubMed: 30422209
- Original source →
- Free full text: PubMed Central →
Full text: free to read — PubMed Central lists this copy as free to read: the link above (checked 10 Oct 2026).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Debette, S., Schilling, S., Duperron, M. G., Larsson, S. C., & Markus, H. S. (2019). Clinical Significance of Magnetic Resonance Imaging Markers of Vascular Brain Injury: A Systematic Review and Meta-analysis. JAMA neurology. https://doi.org/10.1001/jamaneurol.2018.3122
Vancouver
Debette S, Schilling S, Duperron MG, Larsson SC, Markus HS. Clinical Significance of Magnetic Resonance Imaging Markers of Vascular Brain Injury: A Systematic Review and Meta-analysis. JAMA neurology. 2019. doi:10.1001/jamaneurol.2018.3122. PMID: 30422209.
BibTeX
@article{debette2019-30422209,
author = {Debette, S. and Schilling, S. and Duperron, M. G. and Larsson, S. C. and Markus, H. S.},
title = {{Clinical Significance of Magnetic Resonance Imaging Markers of Vascular Brain Injury: A Systematic Review and Meta-analysis}},
journal = {JAMA neurology},
year = {2019},
doi = {10.1001/jamaneurol.2018.3122},
pmid = {30422209},
url = {https://doi.org/10.1001/jamaneurol.2018.3122}
}
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