An exploratory study of the diffusion tensor imaging analysis along perivascular spaces (DTI-ALPS) index combined with quantitative analysis of choroid plexus volume and perivascular spaces in different cognitive stages of cerebral small vessel disease.

IF 2.3 2区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Quantitative Imaging in Medicine and Surgery Pub Date : 2025-09-01 Epub Date: 2025-08-15 DOI:10.21037/qims-2025-733

Wenli Lu, Li Yang, Ran Chen, Xinyi Chen, Shengnan Zhu, Liya Ji, Han Liao, Jing Qiang, Wenyi Li, Cheng Li, Dan Zhou

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Abstract

Background: Cerebral small vessel disease (CSVD) is a major contributor to cognitive impairment and dementia. Growing evidence suggests that impaired perivascular clearance plays a pivotal role in CSVD pathogenesis, yet non-invasive biomarkers for early cognitive decline remain limited. This study aimed to explore the diagnostic value of the diffusion tensor imaging analysis along perivascular spaces (DTI-ALPS) index, enlarged perivascular spaces (EPVS) numbers/volume, and choroid plexus volume (CPV) across different cognitive stages of CSVD.

Methods: We retrospectively analyzed data from 102 CSVD patients [33 CSVD-cognitive normal (CSVD-CN); 39 CSVD-mild cognitive impairment (CSVD-MCI); 30 vascular dementia (VaD)] and 29 normal controls (NCs). Quantitative measurements of the DTI-ALPS index, EPVS numbers/volume, and CPV were obtained. Correlations with Montreal Cognitive Assessment (MoCA) scores and diagnostic performance were also evaluated.

Results: Progressive DTI-ALPS index reduction (NCs: 1.50±0.19, CSVD-CN: 1.41±0.17, CSVD-MCI: 1.34±0.16, VaD: 1.33±0.17; P<0.001, r=0.36) and increases in basal ganglia (BG)-EPVS numbers {NCs: 4 [3, 6], CSVD-CN: 14 [10, 17], CSVD-MCI: 16 [12, 25], VaD: 22 [13, 31]; P<0.001, r=-0.45} and CPV {NCs: 1.35 [1.02, 1.65] cm³, CSVD-CN: 1.39 [1.11, 1.72] cm³, CSVD-MCI: 1.88 [1.41, 2.94] cm³, VaD: 2.89 [2.09, 3.39] cm³; P<0.001, r=-0.43} correlated with cognitive decline. BG-EPVS numbers excellently distinguished CSVD from NCs [area under the receiver operating characteristic (ROC) curve (AUC) =0.926; 95% confidence interval (CI): 0.882-0.971; sensitivity =84.2%; specificity =89.7%]. CPV emerged as the optimal standalone biomarker for VaD (AUC =0.758; 95% CI: 0.647-0.869; sensitivity =82.8%; specificity =69.5%). The multiparametric model (DTI-ALPS + BG-EPVS numbers + CPV) achieved high diagnostic accuracy: NCs vs. CSVD: AUC =0.978, 95% CI: 0.958-0.998; VaD vs. NCs/CSVD-CN/CSVD-MCI: AUC =0.825, 95% CI: 0.747-0.903; CSVD-MCI/VaD vs. NCs/CSVD-CN: AUC =0.900, 95% CI: 0.847-0.952.

Conclusions: Combining the DTI-ALPS index, BG-EPVS numbers, and CPV may enhance early diagnosis and subtype differentiation in CSVD-related cognitive impairment, supporting targeted interventions.

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沿血管周围间隙弥散张量成像分析（DTI-ALPS）指数结合脉络膜丛体积和血管周围间隙定量分析在脑血管病不同认知阶段的探索性研究

背景：脑血管病（CSVD）是认知障碍和痴呆的主要诱因。越来越多的证据表明，受损的血管周围清除在CSVD发病机制中起着关键作用，但早期认知能力下降的非侵入性生物标志物仍然有限。本研究旨在探讨沿血管周围间隙（DTI-ALPS）指数、血管周围间隙增大（EPVS）数/容积、脉络膜丛容积（CPV）在CSVD不同认知阶段的诊断价值。方法：回顾性分析102例CSVD患者的资料[33例CSVD-认知正常（CSVD- cn）；39例csvd -轻度认知障碍（CSVD-MCI）；血管性痴呆（VaD） 30例，正常对照（nc） 29例。定量测量DTI-ALPS指数、EPVS数/容积和CPV。还评估了与蒙特利尔认知评估（MoCA）评分和诊断表现的相关性。结果：渐进式DTI-ALPS指数降低(nc: 1.50±0.19,CSVD-CN: 1.41±0.17,CSVD-MCI: 1.34±0.16,VaD: 1.33±0.17;P3, CSVD-CN: 1.39 [1.11, 1.72] cm3, CSVD-MCI: 1.88 [1.41, 2.94] cm3, VaD: 2.89 [2.09, 3.39] cm3；Csvd: auc =0.978, 95% ci: 0.958-0.998；VaD与nc /CSVD-CN/CSVD-MCI: AUC =0.825, 95% CI: 0.747-0.903；CSVD-MCI/VaD vs. NCs/CSVD-CN: AUC =0.900, 95% CI: 0.847-0.952。结论：结合DTI-ALPS指数、BG-EPVS数和CPV可增强csvd相关认知障碍的早期诊断和亚型分化，支持有针对性的干预。

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