Wenli Lu, Li Yang, Ran Chen, Xinyi Chen, Shengnan Zhu, Liya Ji, Han Liao, Jing Qiang, Wenyi Li, Cheng Li, Dan Zhou
{"title":"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","authors":"Wenli Lu, Li Yang, Ran Chen, Xinyi Chen, Shengnan Zhu, Liya Ji, Han Liao, Jing Qiang, Wenyi Li, Cheng Li, Dan Zhou","doi":"10.21037/qims-2025-733","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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] cm<sup>3</sup>, CSVD-CN: 1.39 [1.11, 1.72] cm<sup>3</sup>, CSVD-MCI: 1.88 [1.41, 2.94] cm<sup>3</sup>, VaD: 2.89 [2.09, 3.39] cm<sup>3</sup>; 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 <i>vs.</i> CSVD: AUC =0.978, 95% CI: 0.958-0.998; VaD <i>vs.</i> NCs/CSVD-CN/CSVD-MCI: AUC =0.825, 95% CI: 0.747-0.903; CSVD-MCI/VaD <i>vs.</i> NCs/CSVD-CN: AUC =0.900, 95% CI: 0.847-0.952.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":"15 9","pages":"8173-8188"},"PeriodicalIF":2.3000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397676/pdf/","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"Wenli Lu, Li Yang, Ran Chen, Xinyi Chen, Shengnan Zhu, Liya Ji, Han Liao, Jing Qiang, Wenyi Li, Cheng Li, Dan Zhou\",\"doi\":\"10.21037/qims-2025-733\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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] cm<sup>3</sup>, CSVD-CN: 1.39 [1.11, 1.72] cm<sup>3</sup>, CSVD-MCI: 1.88 [1.41, 2.94] cm<sup>3</sup>, VaD: 2.89 [2.09, 3.39] cm<sup>3</sup>; 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 <i>vs.</i> CSVD: AUC =0.978, 95% CI: 0.958-0.998; VaD <i>vs.</i> NCs/CSVD-CN/CSVD-MCI: AUC =0.825, 95% CI: 0.747-0.903; CSVD-MCI/VaD <i>vs.</i> NCs/CSVD-CN: AUC =0.900, 95% CI: 0.847-0.952.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":54267,\"journal\":{\"name\":\"Quantitative Imaging in Medicine and Surgery\",\"volume\":\"15 9\",\"pages\":\"8173-8188\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397676/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Quantitative Imaging in Medicine and Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/qims-2025-733\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/15 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Quantitative Imaging in Medicine and Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/qims-2025-733","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/15 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
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.
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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