Diffusion prepared pseudo-continuous arterial spin labeling reveals blood–brain barrier dysfunction in patients with CADASIL
Diffusion prepared pseudo-continuous arterial spin labeling reveals blood–brain barrier dysfunction in patients with CADASIL
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DOI：
10.1007/s00330-023-09652-7
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发表时间：
2023-04
影响因子：
5.9
通讯作者：
Chen Ling;Jinyuan Zhang;Xingfeng Shao;Li Bai;Zhixin Li;Yunchuang Sun;Fan Li;Zhaoxia Wang
中科院分区：
文献类型：
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作者：
Chen Ling;Jinyuan Zhang;Xingfeng Shao;Li Bai;Zhixin Li;Yunchuang Sun;Fan Li;Zhaoxia Wang
目的：弥散预处理伪连续动脉自旋标记（DP-pCASL）是一种新提出的无创检测血脑屏障（BBB）功能的MRI方法。我们的目的是研究是否通过血脑屏障的水交换率，估计与DP-pCASL，是改变患者的常染色体显性遗传性脑动脉病与皮质下梗死和白质脑病（CADASIL），方法对41例CADASIL患者和36例年龄、性别匹配的对照者进行了动态脑血流灌注成像（DP-1），并分析其BBB水交换率与MRI/临床特征的相关性。pCASL MRI以估计BBB水交换速率（kw）。还检查了MRI病变负荷、改良兰金量表（mRS）和神经心理量表。结果与对照组相比，CADASIL患者在正常外观白色物质（NAWM）（t= − 4.742，p < 0.001）、皮质灰质（t= − 5.137，p <0.001）和深部灰质（t = − 3.552，p = 0.001）的kwin值均降低。校正年龄、性别和动脉通过时间后，kwat NAWM与白色高信号体积呈负相关（β=-0.754，p = 0.001），而kwat NAWM降低与mRS量表异常风险增加独立相关。（OR = 1.058，95%CI：1.013- 1.106，p = 0.011）。BBB水交换率降低与患者MRI病变负荷增加和功能依赖性增加相关，提示BBB功能障碍参与CADASIL的发病机制。BBB水交换率降低与MRI病变负荷和功能依赖性相关，表明DP-pCASL作为疾病严重程度评估方法的潜力。关键点·DP-pCASL揭示CADASIL患者的血脑屏障功能障碍。·BBB水交换率降低是通过DP-pCASL检测到的BBB功能障碍的指标，与CADASIL患者的MRI/临床特征相关。DP-pCASL可用作评估CADASIL患者疾病严重程度的评价方法。
ObjectivesDiffusion prepared pseudo-continuous arterial spin labeling (DP-pCASL) is a newly proposed MRI method to noninvasively measure the function of the blood–brain barrier (BBB). We aim to investigate whether the water exchange rate across the BBB, estimated with DP-pCASL, is changed in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), and to analyze the association between the BBB water exchange rate and MRI/clinical features of these patients.MethodsForty-one patients with CADASIL and thirty-six age- and sex-matched controls were scanned with DP-pCASL MRI to estimate the BBB water exchange rate (kw). The MRI lesion burden, the modified Rankin scale (mRS), and the neuropsychological scales were also examined. The association betweenkwand MRI/clinical features was analyzed.ResultsCompared with that in the controls,kwin patients with CADASIL was decreased at normal-appearing white matter (NAWM) (t= − 4.742,p< 0.001), cortical gray matter (t= − 5.137,p< 0.001), and deep gray matter (t= − 3.552,p= 0.001). After adjustment for age, gender, and arterial transit time,kwat NAWM was negatively associated with the volume of white matter hyperintensities (β= − 0.754,p= 0.001), whereas decreasedkwat NAWM was independently associated with an increased risk of abnormal mRS scale (OR = 1.058, 95% CI: 1.013–1.106,p= 0.011) in these patients.ConclusionsThis study found that the BBB water exchange rate was decreased in patients with CADASIL. The decreased BBB water exchange rate was associated with an increased MRI lesion burden and functional dependence of the patients, suggesting the involvement of BBB dysfunction in the pathogenesis of CADASIL.Clinical relevance statementDP-pCASL reveals BBB dysfunction in patients with CADASIL. The decreased BBB water exchange rate is associated with MRI lesion burden and functional dependence, indicating the potential of DP-pCASL as an evaluation method for disease severity.Key Points•DP-pCASL reveals blood–brain barrier dysfunction in patients with CADASIL.•Decreased BBB water exchange rate, an indicator of BBB dysfunction detected by DP-pCASL, was associated with MRI/clinical features of patients with CADASIL.•DP-pCASL can be used as an evaluation method to assess the severity of disease in patients with CADASIL.