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Abstract
Objective To investigate the link between blood-brain-barrier (BBB) permeability and cerebral blood flow (CBF) and the relation with white matter hyperintensities (WMH) in cerebral small vessel disease (cSVD).
Methods Twenty-seven patients with cSVD received dynamic susceptibility contrast and dynamic contrast-enhanced MRI to determine CBF and BBB permeability (expressed as leakage rate and volume), respectively. Structural MRI were segmented into normal-appearing white matter (NAWM) and WMH, for which a perilesional zone was defined. In these regions, we investigated the BBB permeability, CBF, and their relation using Pearson correlation r.
Results We found a decrease in CBF of 2.2 mL/min/100 g (p < 0.01) and an increase in leakage volume of 0.7% (p < 0.01) per mm closer to the WMH in the perilesional zones. Lower CBF values correlated with higher leakage measures in the NAWM and WMH (−0.53 < r < −0.40, p < 0.05). This relation was also observed in the perilesional zones, which became stronger in the proximity of WMH (p = 0.03).
Conclusion BBB impairment and hypoperfusion appear in the WMH and NAWM, which increase in the proximity of the WMH, and are linked. Both BBB and CBF are regulated in the neurovascular unit (NVU) and the observed link might be due to the physiologic regulation mechanism of the NVU. This link may suggest an early overall deterioration of this unit.
Glossary
- BBB=
- blood-brain barrier;
- CBF=
- cerebral blood flow;
- CI=
- confidence interval;
- cSVD=
- cerebral small vessel disease;
- DCE=
- dynamic contrast-enhanced;
- DSC=
- dynamic susceptibility contrast;
- DSI=
- dynamic scan interval;
- FLAIR=
- fluid-attenuated inversion recovery;
- FOV=
- field of view;
- GM=
- gray matter;
- NAWM=
- normal-appearing white matter;
- NVU=
- neurovascular unit;
- ROI=
- region of interest;
- TE=
- echo time;
- TI=
- inversion time;
- TR=
- repetition time;
- VCI=
- vascular cognitive impairment;
- WM=
- white matter;
- WMH=
- white matter hyperintensities
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 687
- Received March 21, 2018.
- Accepted in final form November 28, 2018.
- © 2019 American Academy of Neurology
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