A comparison of Gadolinium- and water-based blood-brain barrier dysfunction measures in patients with small vessel disease

Clinically relevant non-invasive blood-brain barrier (BBB) function imaging techniques are needed to monitor the role of neuroinflammation and endothelial cell dysfunction, particularly in small vessel disease (SVD). Diffusion-weighted ASL measures water exchange rate (kw), a promising endogenous BBB function metric, but has not been assessed in sporadic SVD. We measured kw in SVD patients to explore associations with established Gadolinium-based contrast agent (GBCA) BBB permeability measures and SVD severity. We found only limited associations between kw and GBCA metrics, although patients with more severe SVD tended to have higher kw, reflecting that the methods may probe different mechanisms.