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MRI contrast accumulation in features of cerebral small vessel disease: blood-brain barrier dysfunction or elevated vascular density?
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MRI contrast accumulation in features of cerebral small vessel disease: blood-brain barrier dysfunction or elevated vascular density?
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Journal Article
MRI contrast accumulation in features of cerebral small vessel disease: blood-brain barrier dysfunction or elevated vascular density?
2025
Overview
Background
White matter lesions (WML) and dilated perivascular spaces (PVS) are features of small vessel disease (SVD), commonly observed in aging and dementia, with unknown pathophysiology. Human studies have documented contrast accumulation within and in proximity of SVD-lesions. However, whether such observations mainly reflect excessive blood-brain barrier (BBB) leakage, or altered microvascular density in the investigated regions, remains unclear.
Methods
To evaluate the roles of BBB leakage and vascular density in aging and SVD, dynamic contrast enhanced (DCE) MRI was used to estimate the permeability-surface area product (PS) and fractional plasma volume (
) in normal-appearing brain tissue and in proximity of and within WML and PVS in a population-based cohort (
N
= 56; 34/22 m/f; age 64 to 84 years). Analysis of variance (ANOVA) was used to assess regional differences in PS and
and analysis of covariance (ANCOVA) was used to assess regional differences in PS with
and vascular risk as covariates.
Results
Pronounced increases in PS and
were observed from normal-appearing white matter (NAWM) to WML peripheries to WMLs. Similar PS and
increases were observed from basal ganglia (BG) to BG-PVS. Further, PS in NAWM and white matter (WM) PVS were found to increase with cortex-to-ventricular depth. However, ANCOVA models with
as a covariate showed that variance in PS was mainly explained by v
p
(η
2
=0.17 to η
2
=0.35; all
p
< 10
− 3
), whereas the effect of region was only borderline-significant when comparing NAWM, WML peripheries and WML (
p
= 0.03) and non-significant for the other comparisons (
p
> 0.29).
Conclusions
Our findings support the notion that contrast leakage across the BBB accumulates within and in proximity of SVD-related lesions. However, high contrast accumulation may mainly reflect high vascularization, and to a lesser degree than previously recognized BBB dysfunction.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
Subject
/ Aging
/ Biomedical and Life Sciences
/ Blood-Brain Barrier - diagnostic imaging
/ Blood-Brain Barrier - metabolism
/ Blood-Brain Barrier - pathology
/ Blood-Brain Barrier - physiopathology
/ Cerebral Small Vessel Diseases - diagnostic imaging
/ Cerebral Small Vessel Diseases - metabolism
/ Cerebral Small Vessel Diseases - pathology
/ Dementia
/ Diseases
/ Female
/ Glymphatic System - diagnostic imaging
/ Humans
/ Lesions
/ Magnetic Resonance Imaging - methods
/ Male
/ MRI
