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September 10, 2025

An exploratory study of the diffusion tensor imaging analysis along perivascular spaces (DTI-ALPS) index combined with quantitative analysis of choroid plexus volume and perivascular spaces in different cognitive stages of cerebral small vessel disease

WLWen‐Min LuChinese Culture University YLYang LiKarlsruhe Institute of Technology RCRan ChenChinese Academy of Medical Sciences & Peking Union Medical College

Key Points

Progressive reduction in the DTI-ALPS index correlates with cognitive decline in patients with CSVD.
The combination of DTI-ALPS, BG-EPVS numbers, and CPV achieved high diagnostic accuracy for cognitive impairment.
Increased BG-EPVS numbers effectively distinguished between CSVD and normal controls with a high ROC curve area.
CPV was identified as an optimal standalone biomarker for vascular dementia, enhancing diagnostic precision.

Abstract

Cerebral small vessel disease (CSVD) is a major contributor to cognitive impairment and dementia. Growing evidence suggests that impaired perivascular clearance plays a pivotal role in CSVD pathogenesis, yet non-invasive biomarkers for early cognitive decline remain limited. This study aimed to explore the diagnostic value of the diffusion tensor imaging analysis along perivascular spaces (DTI-ALPS) index, enlarged perivascular spaces (EPVS) numbers/volume, and choroid plexus volume (CPV) across different cognitive stages of CSVD. We retrospectively analyzed data from 102 CSVD patients 33 CSVD-cognitive normal (CSVD-CN) ; 39 CSVD-mild cognitive impairment (CSVD-MCI) ; 30 vascular dementia (VaD) and 29 normal controls (NCs). Quantitative measurements of the DTI-ALPS index, EPVS numbers/volume, and CPV were obtained. Correlations with Montreal Cognitive Assessment (MoCA) scores and diagnostic performance were also evaluated. Progressive DTI-ALPS index reduction (NCs: 1. 50±0. 19, CSVD-CN: 1. 41±0. 17, CSVD-MCI: 1. 34±0. 16, VaD: 1. 33±0. 17; P<0. 001, r=0. 36) and increases in basal ganglia (BG) -EPVS numbers NCs: 4 3, 6, CSVD-CN: 14 10, 17, CSVD-MCI: 16 12, 25, VaD: 22 13, 31; P<0. 001, r=-0. 45 and CPV NCs: 1. 35 1. 02, 1. 65 cm3, CSVD-CN: 1. 39 1. 11, 1. 72 cm3, CSVD-MCI: 1. 88 1. 41, 2. 94 cm3, VaD: 2. 89 2. 09, 3. 39 cm3; P<0. 001, r=-0. 43 correlated with cognitive decline. BG-EPVS numbers excellently distinguished CSVD from NCs area under the receiver operating characteristic (ROC) curve (AUC) =0. 926; 95% confidence interval (CI): 0. 882-0. 971; sensitivity =84. 2%; specificity =89. 7%. CPV emerged as the optimal standalone biomarker for VaD (AUC =0. 758; 95% CI: 0. 647-0. 869; sensitivity =82. 8%; specificity =69. 5%). The multiparametric model (DTI-ALPS + BG-EPVS numbers + CPV) achieved high diagnostic accuracy: NCs vs. CSVD: AUC =0. 978, 95% CI: 0. 958-0. 998; VaD vs. NCs/CSVD-CN/CSVD-MCI: AUC =0. 825, 95% CI: 0. 747-0. 903; CSVD-MCI/VaD vs. NCs/CSVD-CN: AUC =0. 900, 95% CI: 0. 847-0. 952. Combining the DTI-ALPS index, BG-EPVS numbers, and CPV may enhance early diagnosis and subtype differentiation in CSVD-related cognitive impairment, supporting targeted interventions.

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