Choroid Plexus Enlargement Exacerbates White Matter Hyperintensity Growth through Glymphatic Impairment

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY

Annals of Neurology Pub Date : 2023-03-27 DOI:10.1002/ana.26648

Yifei Li MD, Ying Zhou PhD, Wansi Zhong MD, Xiao Zhu MD, Yuping Chen MD, Kemeng Zhang MD, Yaode He MD, Zhongyu Luo PhD, Wang Ran MD, Jianzhong Sun MD, Min Lou MD, PhD

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引用次数: 4

Abstract

Objective

Choroid plexus (CP) is a key regulator in cerebrospinal fluid production, but its contribution to glymphatic clearance function and association with white matter hyperintensity (WMH) remains unclear.

Methods

This retrospective study included 2 prospective 3.0-T magnetic resonance imaging (MRI) cohorts. In cohort 1, patients with indications for lumbar puncture underwent 3-dimensional T1-weighted sequence (3D-T1) before and at 39 hours after intrathecal administration of contrast agent (glymphatic MRI). In cohort 2, patients with WMH were enrolled from the CIRCLE study and had a median follow-up time of 1.4 years. WMH and CP of the lateral ventricles were automatically segmented on T2 fluid-attenuated inversion recovery (FLAIR) and 3D-T1, respectively. CP volume was expressed as a ratio to intracranial volume. Glymphatic clearance was measured as signal percentage change from baseline to 39 hours at 8 brain locations based on glymphatic MRI in the first cohort, or as noninvasive diffusion tensor image analysis along the perivascular space (DTI-ALPS) index based on DTI in the second cohort.

Results

In cohort 1, a total of 52 patients were included. Higher CP volume was correlated with slower glymphatic clearance rate in all brain locations. In cohort 2, a total of 197 patients were included. Baseline CP volume was positively associated with WMH volume and its growth. Furthermore, DTI-ALPS index partially mediated the association of CP with both WMH load and growth.

Interpretations

Enlarged CP volume could be an indicator for larger growth of WMH, potentially involving impaired glymphatic clearance function. The exploration of CP may provide a novel perspective to clarify the mechanism of WMH pathogenesis, as well as other glymphatic-related disorders. ANN NEUROL 2023;94:182–195

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脉络膜丛增大通过淋巴损伤加剧白质高强度生长

目的脉络膜丛(Choroid plexus, CP)是脑脊液生成的关键调节因子，但其在淋巴清除功能中的作用及其与白质高强度(white matter hyperintensity, WMH)的关系尚不清楚。方法回顾性研究纳入2个前瞻性3.0 t磁共振成像(MRI)队列。在队列1中，有腰椎穿刺指征的患者在鞘内注射造影剂(淋巴MRI)之前和之后39小时接受了三维t1加权序列(3D-T1)。在队列2中，WMH患者从CIRCLE研究中入组，中位随访时间为1.4年。侧脑室WMH和CP分别在T2液体衰减反转恢复(FLAIR)和3D-T1自动分割。CP体积表示为与颅内体积的比值。在第一队列中，基于类淋巴MRI测量从基线到39小时8个脑位置的信号百分比变化，或在第二队列中基于DTI测量沿血管周围间隙的无创弥散张量图像分析(DTI- alps)指数。结果队列1共纳入52例患者。较高的CP体积与较慢的脑内淋巴清除率相关。在队列2中，共纳入197例患者。基线CP体积与WMH体积及其生长呈正相关。此外，DTI-ALPS指数部分介导了CP与WMH负荷和生长的关联。CP体积增大可能是WMH增大的一个指标，可能涉及淋巴清除功能受损。对CP的探索可能为阐明WMH的发病机制以及其他淋巴相关疾病提供新的视角。神经科学学报(英文版);2009;39 (4):391 - 391

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.