Arterial Spin-Labeling MRI Identifies Abnormal Perfusion Metric at the Gray Matter/CSF Interface in Cerebral Small Vessel Disease.

Abdelkader Mahammedi, Ates Fettahoglu, Jeremy J Heit, Joanna M Wardlaw, Greg Zaharchuk
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Abstract

Background and purpose: Cerebral small vessel disease (SVD) is a common cause of stroke and cognitive decline. SVD is characterized by white matter hyperintensities (WMH) and dilated perivascular spaces (PVS). While WMH can be associated with reduced CBF and glymphatic clearance, current clinical and radiologic assessments of these associations remain controversial and mostly qualitative. We aim to identify if arterial spin-labeling (ASL)-based CBF differences, particularly in the cortical surface at the GM/CSF interface, correlate with SVD severity.

Materials and methods: We performed a retrospective cohort study of healthy controls with normal cognition who underwent a brain MRI as part of our university's Alzheimer Disease Research Center (ADRC) and an 15O-water PET study database. Our inclusion criteria included patients aged >50 years with no structural brain abnormalities besides SVD with ASL perfusion images. WMH grading was performed by using the Fazekas scale, WMH score, PVS grade, and manually segmented WMH volume. We identified patients with moderate-to-severe SVD and then selected age-matched samples of patients with minimal or no SVD. CBF of the whole brain (WB), GM, WM, and along the GM/CSF interface were calculated. Several perfusion metrics (WB, GM, and WM) as well as a novel perfusion metric, normalized GM/CSF interface (nGCI) perfusion metric, which indirectly reflects the relative ASL signal near the GM-CSF boundary, were evaluated by using receiver operating characteristic and correlation analyses.

Results: Thirty-two patients met the inclusion criteria (n=11 moderate-to-severe SVD, mean age 72 ± 10 years, 6 women; n = 21 none-to-minimal SVD, mean age 70 ± 10 years, 12 women). Of the measured perfusion markers, nGCI had the strongest negative correlation with Fazekas score, total WMH volume, PVS grade, and average total SVD score (r = -0.68, -0.67, -0.54, -0.54, respectively; P < .001) as well as the highest area under the receiver operating characteristics curve (0.95, 95% CI: 0.87-1.0) as a predictor of WMH severity.

Conclusions: nGCI, a novel perfusion metric that may capture features of perfusion at the GM-CSF boundary, was strongly correlated with WMH and PVS severity. Further, longitudinal studies are required to determine the potential role of nGCI as a predictive marker of SVD progression.

动脉自旋标记MRI识别脑小血管疾病灰质/脑脊液界面异常灌注测量
背景与目的:脑血管病(SVD)是脑卒中和认知能力下降的常见原因。SVD的特征是白质高信号(WMH)和血管周围空间(PVS)扩张。虽然WMH可能与CBF减少和淋巴清除率有关,但目前对这些关联的临床和放射学评估仍存在争议,而且主要是定性的。我们的目的是确定基于动脉自旋标记(ASL)的CBF差异,特别是在GM/CSF界面的皮质表面,是否与SVD严重程度相关。材料和方法:我们对认知正常的健康对照进行了回顾性队列研究,作为我校阿尔茨海默病研究中心(ADRC)和15O-water PET研究数据库的一部分,他们接受了脑MRI检查。我们的入选标准为年龄在bb0 ~ 50岁之间,除SVD外无脑结构性异常且伴有ASL灌注图像的患者。采用Fazekas量表、WMH评分、PVS评分和人工分割的WMH体积进行WMH分级。我们确定了中度至重度SVD患者,然后选择了年龄匹配的轻度或无SVD患者样本。计算全脑CBF (WB)、GM、WM及GM/CSF交界面CBF。几种灌注指标(WB、GM和WM)以及一种新的灌注指标,即规范化GM/CSF界面(nGCI)灌注指标,该指标间接反映GM-CSF边界附近的相对ASL信号,通过受体工作特征和相关性分析进行评估。结果:32例患者符合纳入标准(n=11例中重度SVD,平均年龄72±10岁,女性6例;n = 21例无至最小SVD,平均年龄70±10岁,女性12例)。在测量的灌注指标中,nGCI与Fazekas评分、总WMH体积、PVS分级和平均总SVD评分负相关最强(r分别为-0.68、-0.67、-0.54、-0.54;P < .001),以及受试者工作特征曲线下的最高面积(0.95,95% CI: 0.87-1.0)作为WMH严重程度的预测因子。结论:nGCI是一种新的灌注指标,可以捕捉GM-CSF边界的灌注特征,与WMH和PVS严重程度密切相关。此外,还需要进行纵向研究来确定nGCI作为SVD进展的预测标志物的潜在作用。
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