TY - JOUR
T1 - Blood-brain barrier leakage is more widespread in patients with cerebral small vessel disease
AU - Zhang, C. Eleana
AU - Wong, Sau May
AU - van de Haar, Harm J.
AU - Staals, Julie
AU - Jansen, Jacobus F. A.
AU - Jeukens, Cecile R. L. P. N.
AU - Hofman, Paul A. M.
AU - van Oostenbrugge, Robert J.
AU - Backes, Walter H.
PY - 2017/1/31
Y1 - 2017/1/31
N2 - Objective: As blood-brain barrier (BBB) dysfunction may occur in normal aging but may also play a pivotal role in the pathophysiology of cerebral small vessel disease (cSVD), we used dynamic contrast-enhanced (DCE)-MRI to quantify the rate and the spatial extent of BBB leakage in patients with cSVD and age-and sex-matched controls to discern cSVD-related BBB leakage from aging-related leakage.Methods: We performed structural brain MRI and DCE-MRI in 80 patients with clinically overt cSVD and 40 age-and sex-matched controls. Using the Patlak pharmacokinetic model, we calculated the leakage rate. The mean leakage rate and relative leakage volume were calculated using noise-corrected histogram analysis. Leakage rate and leakage volume were compared between patients with cSVD and controls for the normal-appearing white matter (NAWM), white matter hyperintensities (WMH), cortical gray matter (CGM), and deep gray matter.Results: Multivariable linear regression analyses adjusting for age, sex, and cardiovascular risk factors showed that the leakage volume of the NAWM, WMH, and CGM was significantly larger in patients with cSVD compared with controls. No significant difference was found for leakage rate in any of the tissue regions.Conclusion: We demonstrated a larger tissue volume with subtle BBB leakage in patients with cSVD than in controls. This was shown in the NAWM, WMH, and CGM, supporting the generalized nature of cSVD.
AB - Objective: As blood-brain barrier (BBB) dysfunction may occur in normal aging but may also play a pivotal role in the pathophysiology of cerebral small vessel disease (cSVD), we used dynamic contrast-enhanced (DCE)-MRI to quantify the rate and the spatial extent of BBB leakage in patients with cSVD and age-and sex-matched controls to discern cSVD-related BBB leakage from aging-related leakage.Methods: We performed structural brain MRI and DCE-MRI in 80 patients with clinically overt cSVD and 40 age-and sex-matched controls. Using the Patlak pharmacokinetic model, we calculated the leakage rate. The mean leakage rate and relative leakage volume were calculated using noise-corrected histogram analysis. Leakage rate and leakage volume were compared between patients with cSVD and controls for the normal-appearing white matter (NAWM), white matter hyperintensities (WMH), cortical gray matter (CGM), and deep gray matter.Results: Multivariable linear regression analyses adjusting for age, sex, and cardiovascular risk factors showed that the leakage volume of the NAWM, WMH, and CGM was significantly larger in patients with cSVD compared with controls. No significant difference was found for leakage rate in any of the tissue regions.Conclusion: We demonstrated a larger tissue volume with subtle BBB leakage in patients with cSVD than in controls. This was shown in the NAWM, WMH, and CGM, supporting the generalized nature of cSVD.
KW - VASCULAR COGNITIVE IMPAIRMENT
KW - WHITE-MATTER HYPERINTENSITIES
KW - LACUNAR STROKE
KW - PERMEABILITY
KW - DEMENTIA
KW - ABNORMALITIES
KW - BREAKDOWN
KW - MRI
KW - PATHOPHYSIOLOGY
KW - DYSFUNCTION
U2 - 10.1212/WNL.0000000000003556
DO - 10.1212/WNL.0000000000003556
M3 - Article
C2 - 28031395
VL - 88
SP - 426
EP - 432
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 5
ER -