Annals of neurology · 2025
Disruption of the Blood-Brain Barrier Predicts Progression of Cerebral Small Vessel Disease White Matter Hyperintensities.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Leigh Richard, Kern Kyle C, Wang Nae-Yuh, Gottesman Rebecca F, Wright Clinton B
Аннотация
OBJECTIVE: The objective of this study was to test if blood-brain barrier (BBB) disruption, detected using dynamic susceptibility contrast (DSC) imaging, would predict progression of white matter hyperintensities (WMHs) over the subsequent year in patients with chronic cerebrovascular disease.
METHODS: The study included patients with a history of stroke and at least early confluence of WMH. Magnetic resonance imaging (MRI) scans performed at baseline (> 3 months from stroke) and again 1 year later were segmented to calculate the WMH volume expressed as a fraction of the total brain volume. Change in WMH volume between the 2 timepoints and progression of WMH were the outcome measures. BBB disruption was measured using DSC imaging on the baseline MRI. WMH masks were dilated by 3 mm to create a mask of the adjacent normal appearing white matter (penumbra). BBB disruption was averaged within the WMH and the penumbra.
RESULTS: Fifty patients were included; median age was 69 years, and 46% were women. The mean WMH fraction was 1.25% at baseline and 1.36% at 1 year. The mean baseline BBB disruption was 0.20% in the WMH and 0.22% in the penumbra. More severe BBB disruption was associated with greater WMH progression when measured in the WMH (ß = 0.95, confidence interval [CI] = 0.39-1.51, r2 = 0.19, p = 0.001) and in the penumbra (ß = 0.81, CI = 0.10-1.53, r2 = 0.10, p = 0.027). The best predictor of progression was BBB disruption in the penumbra with an odds ratio (OR) of 2 (OR = 2, CI = 1.01-3.96, p = 0.046) for each 0.1% increase in BBB disruption.
INTERPRETATION: More severe BBB disruption was predictive of greater WMH progression in patients with chronic cerebrovascular disease. ANN NEUROL 2026;99:437-448.
METHODS: The study included patients with a history of stroke and at least early confluence of WMH. Magnetic resonance imaging (MRI) scans performed at baseline (> 3 months from stroke) and again 1 year later were segmented to calculate the WMH volume expressed as a fraction of the total brain volume. Change in WMH volume between the 2 timepoints and progression of WMH were the outcome measures. BBB disruption was measured using DSC imaging on the baseline MRI. WMH masks were dilated by 3 mm to create a mask of the adjacent normal appearing white matter (penumbra). BBB disruption was averaged within the WMH and the penumbra.
RESULTS: Fifty patients were included; median age was 69 years, and 46% were women. The mean WMH fraction was 1.25% at baseline and 1.36% at 1 year. The mean baseline BBB disruption was 0.20% in the WMH and 0.22% in the penumbra. More severe BBB disruption was associated with greater WMH progression when measured in the WMH (ß = 0.95, confidence interval [CI] = 0.39-1.51, r2 = 0.19, p = 0.001) and in the penumbra (ß = 0.81, CI = 0.10-1.53, r2 = 0.10, p = 0.027). The best predictor of progression was BBB disruption in the penumbra with an odds ratio (OR) of 2 (OR = 2, CI = 1.01-3.96, p = 0.046) for each 0.1% increase in BBB disruption.
INTERPRETATION: More severe BBB disruption was predictive of greater WMH progression in patients with chronic cerebrovascular disease. ANN NEUROL 2026;99:437-448.