DCE-MRI reveals elevated blood-brain barrier leakage of heterogeneous white matter in cerebral small vessel disease

Key Points

Significant BBB leakage was found surrounding white matter hyperintensities in patients with cSVD, indicating compromised barrier function.
Analysis revealed that the normal appearing white matter leaks more strongly in cSVD patients compared to controls, highlighting the need for targeted investigations.
Dynamic contrast-enhanced MRI was utilized to assess regional BBB leakage, tracking variations in both patients and age-matched controls.
The findings suggest that subtle BBB leakage assessment in normal appearing white matter is crucial for understanding cSVD pathology.

Abstract

Motivation: Blood-brain barrier (BBB) function is impaired in cerebral small vessel disease (cSVD), but challenging to detect with MRI. Goal(s): To improve our understanding of regional BBB leakage variations in patients with cSVD. Approach: BBB leakage was assessed in cSVD patients and age-matched controls using dynamic contrast-enhanced MRI. Inside the normal appearing white matter (NAWM) 2 mm thick shells were dilated from manually delineated white matter hyperintensities (WMH). Results: WMH exhibited more widespread leakage in cSVD; the shells surrounding WMH showed that NAWM leaks more strongly in patients than controls, while no differences were found for the whole NAWM. Impact: A more regionally targeted analysis is required to determine the subtle BBB leakage in the NAWM of patients with cSVD and to assess differences with controls.

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