Baseline Blood-Brain Barrier Leakage and Longitudinal Microstructural Tissue Damage in the Periphery of White Matter Hyperintensities

D. Kerkhofs*, S.M. Wong, E.L.A.N. Zhang, J. Staals, J.F.A. Jansen, R.J. van Oostenbrugge, W.H. Backes

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Web of Science)

Abstract

Objective

To investigate the 2-year change in parenchymal diffusivity, a quantitative marker of microstructural tissue condition, and the relationship with baseline blood-brain barrier (BBB) permeability, in tissue at risk, i.e., the perilesional zone surrounding white matter hyperintensities (WMH) in patients with cerebral small vessel disease (cSVD).

Methods

Patients with sporadic cSVD (lacunar stroke or mild vascular cognitive impairment) underwent 3T MRI at baseline, including dynamic contrast-enhanced MRI to quantify BBB permeability (i.e., leakage volume and rate) and intravoxel incoherent motion imaging (IVIM), a diffusion technique that provides parenchymal diffusivity D. After 2 years, IVIM was repeated. We assessed the relation between BBB leakage measures at baseline and change in parenchymal diffusivity (Delta D) over 2 years in the perilesional zones (divided in 2-mm contours) surrounding WMH.

Results

We analyzed 43 patients (age 68 +/- 12 years, 58% male). In the perilesional zones, Delta D increased 0.10% (confidence interval [CI] 0.07-0.013%) (p < 0.01) per 2 mm closer to the WMH. Furthermore, Delta D over 2 years showed a positive correlation with both baseline BBB leakage volume (r = 0.29 [CI 0.06-0.52], p = 0.013) and leakage rate (r = 0.24 [CI 0.02-0.47], p = 0.034).

Conclusion

BBB leakage at baseline is related to the 2-year change in parenchymal diffusivity in the perilesional zone of WMH. These results support the hypothesis that BBB impairment might play an early role in subsequent microstructural white matter degeneration as part of the pathophysiology of cSVD.

Original languageEnglish
Pages (from-to)E2192-E2200
Number of pages9
JournalNeurology
Volume96
Issue number17
DOIs
Publication statusPublished - 27 Apr 2021

Keywords

  • SMALL VESSEL DISEASE
  • NEUROVASCULAR UNIT
  • PERMEABILITY
  • DIFFUSION
  • PERFUSION
  • DEMENTIA
  • STROKE
  • MICROVASCULATURE
  • PARENCHYMA
  • INTEGRITY

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