Quantifying blood-brain barrier leakage in small vessel disease: Review and consensus recommendations

Michael J. Thrippleton*, Walter H. Backes, Steven Sourbron, Michael Ingrisch, Matthias J. P. van Osch, Martin Dichgans, Franz Fazekas, Stefan Ropele, Richard Frayne, Robert J. van Oostenbrugge, Eric E. Smith, Joanna M. Wardlaw

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

75 Citations (Web of Science)

Abstract

Cerebral small vessel disease (cSVD) comprises pathological processes of the small vessels in the brain that may manifest clinically as stroke, cognitive impairment, dementia, or gait disturbance. It is generally accepted that endothelial dysfunction, including blood-brain barrier (BBB) failure, is pivotal in the pathophysiology. Recent years have seen increasing use of imaging, primarily dynamic contrast-enhanced magnetic resonance imaging, to assess BBB leakage, but there is considerable variability in the approaches and findings reported in the literature. Although dynamic contrast-enhanced magnetic resonance imaging is well established, challenges emerge in cSVD because of the subtle nature of BBB impairment. The purpose of this work, authored by members of the HARNESS Initiative, is to provide an in-depth review and position statement on magnetic resonance imaging measurement of subtle BBB leakage in clinical research studies, with aspects requiring further research identified. We further aim to provide information and consensus recommendations for new investigators wishing to study BBB failure in cSVD and dementia. (C) 2019 The Authors. Published by Elsevier Inc. on behalf of the Alzheimer's Association. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Original languageEnglish
Pages (from-to)840-858
Number of pages19
JournalAlzheimer's & Dementia
Volume15
Issue number6
DOIs
Publication statusPublished - Jun 2019

Keywords

  • Cerebral small vessel disease
  • Dementia
  • Blood-brain barrier
  • Endothelial dysfunction
  • DCE-MRI
  • Permeability
  • MRI
  • ENHANCED T-1-WEIGHTED MRI
  • ARTERIAL INPUT FUNCTION
  • WHITE-MATTER LESIONS
  • IN-VIVO
  • MULTIPLE-SCLEROSIS
  • ALZHEIMERS-DISEASE
  • WATER EXCHANGE
  • PERMEABILITY CHANGES
  • GA-68 EDTA

Cite this