Research Paper Volume 14, Issue 17 pp 6844—6858

Aging, prevalence and risk factors of MRI-visible enlarged perivascular spaces

Frances Rodriguez Lara1, *, , Ashlea Lynn Scruton2, *, , Adlin Pinheiro2,3, , Serkalem Demissie2,3, , Pedram Parva4, , Andreas Charidimou5, , Michael Francis1, , Jayandra J. Himali2,3,5,6, , Charles DeCarli7, , Alexa Beiser2,3,5, , Sudha Seshadri2,5,6, , Jose R. Romero2,5, ,

  • 1 Boston University School of Medicine, Boston, MA 02118, USA
  • 2 NHLBI’s Framingham Heart Study, Framingham, MA 01702, USA
  • 3 Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
  • 4 Department of Radiology, Veterans Affairs Boston Health System, Boston, MA 02130, USA
  • 5 Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA
  • 6 The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX 78229, USA
  • 7 Department of Neurology, University of California at Davis, Davis, CA 95817, USA
* Equal contribution

Received: January 30, 2022       Accepted: May 30, 2022       Published: July 15, 2022
How to Cite

Copyright: © 2022 Rodriguez Lara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background and purpose: Cerebral small vessel disease (CSVD) increases with age and is associated with stroke and cognitive decline. Enlarged Perivascular Spaces (ePVS) is an emerging marker of CSVD, but its prevalence over the life span remain unclear. We characterized the age and sex-specific prevalence of ePVS and relation to age-specific risk factors, in a large community-based sample.

Methods: We included 3,710 Framingham Heart Study participants with available brain MRI (average age 61.4±14.6, 46% men). ePVS burden was rated in the centrum semiovale (CSO) and basal ganglia (BG) regions. Individual vascular risk factors were related to ePVS burden in the CSO, BG, and mixed CSO-BG regions using multivariable adjusted ordinal logistic regression analysis.

Results: Severe ePVS prevalence increased with age in men and women, and paralleled increase in vascular risk factors, and prevention treatment use. Older age, hypertension (and resulting higher treatment use), higher systolic and diastolic blood pressure, and smoking were associated with higher burden of ePVS in the CSO, BG and mixed regions.

Conclusions: Our observations reinforce the hypothesis that ePVS may be a marker of aging-driven brain vascular pathologies, and its association with vascular risk factors support their role as CSVD imaging biomarker.


ePVS: enlarged perivascular spaces; PVS: perivascular spaces; BG: basal ganglia; CSO: centrum semiovale; CAA: cerebral amyloid angiopathy; FHS: Framingham Heart Study; JRR: Jose Rafael Romero; PP: Pedram Parva; AS: Ashlea Scruton.