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- Title
Blood–Brain Barrier Disruption and Perivascular Spaces in Small Vessel Disease and Neurodegenerative Diseases: A Review on MRI Methods and Insights.
- Authors
Voorter, Paulien H. M.; van Dinther, Maud; Jansen, Willemijn J.; Postma, Alida A.; Staals, Julie; Jansen, Jacobus F. A.; van Oostenbrugge, Robert J.; van der Thiel, Merel M.; Backes, Walter H.
- Abstract
Perivascular spaces (PVS) and blood–brain barrier (BBB) disruption are two key features of cerebral small vessel disease (cSVD) and neurodegenerative diseases that have been linked to cognitive impairment and are involved in the cerebral waste clearance system. Magnetic resonance imaging (MRI) offers the possibility to study these pathophysiological processes noninvasively in vivo. This educational review provides an overview of the MRI techniques used to assess PVS functionality and BBB disruption. MRI‐visible PVS can be scored on structural images by either (subjectively) counting or (automatically) delineating the PVS. We highlight emerging (diffusion) techniques to measure proxies of perivascular fluid and its movement, which may provide a more comprehensive understanding of the role of PVS in diseases. For the measurement of BBB disruption, we explain the most commonly used MRI technique, dynamic contrast‐enhanced (DCE) MRI, as well as a more recently developed technique based on arterial spin labeling (ASL). DCE MRI and ASL are thought to measure complementary characteristics of the BBB. Furthermore, we describe clinical studies that have utilized these MRI techniques in cSVD and neurodegenerative diseases, particularly Alzheimer's disease (AD). These studies demonstrate the role of PVS and BBB dysfunction in these diseases and provide insight into the large overlap, but also into the differences between cSVD and AD. Overall, MRI techniques may provide valuable insights into the pathophysiological mechanisms underlying these diseases and have the potential to be used as markers for disease progression and treatment response. Level of Evidence: 3 Technical Efficacy: Stage 2
- Subjects
BLOOD-brain barrier; CEREBRAL small vessel diseases; NEURODEGENERATION; MAGNETIC resonance imaging; ALZHEIMER'S disease; CEREBRAL amyloid angiopathy
- Publication
Journal of Magnetic Resonance Imaging, 2024, Vol 59, Issue 2, p397
- ISSN
1053-1807
- Publication type
Article
- DOI
10.1002/jmri.28989