From the Departments of Radiology and Nuclear Medicine (S.M.W., J.F.A.J., W.H.B.), Neurology (C.E.Z., J.S., R.J.v.O.), School for Mental Health and Neuroscience (MHeNs) (S.M.W., J.F.A.J., C.E.Z., R.J.v.O., W.H.B.), and Cardiovascular Research Institute Maastricht (CARIM) (C.E.Z., J.S., R.J.v.O.), Maastricht University Medical Centre; and the Department of Neurology (E.I.H.), Zuyderland Medical Centre, Heerlen, the Netherlands.
Neurology. 2019 Apr 9;92(15):e1669-e1677. doi: 10.1212/WNL.0000000000007263. Epub 2019 Mar 13.
To investigate the link between blood-brain-barrier (BBB) permeability and cerebral blood flow (CBF) and the relation with white matter hyperintensities (WMH) in cerebral small vessel disease (cSVD).
Twenty-seven patients with cSVD received dynamic susceptibility contrast and dynamic contrast-enhanced MRI to determine CBF and BBB permeability (expressed as leakage rate and volume), respectively. Structural MRI were segmented into normal-appearing white matter (NAWM) and WMH, for which a perilesional zone was defined. In these regions, we investigated the BBB permeability, CBF, and their relation using Pearson correlation .
We found a decrease in CBF of 2.2 mL/min/100 g ( < 0.01) and an increase in leakage volume of 0.7% ( < 0.01) per mm closer to the WMH in the perilesional zones. Lower CBF values correlated with higher leakage measures in the NAWM and WMH (-0.53 < < -0.40, < 0.05). This relation was also observed in the perilesional zones, which became stronger in the proximity of WMH ( = 0.03).
BBB impairment and hypoperfusion appear in the WMH and NAWM, which increase in the proximity of the WMH, and are linked. Both BBB and CBF are regulated in the neurovascular unit (NVU) and the observed link might be due to the physiologic regulation mechanism of the NVU. This link may suggest an early overall deterioration of this unit.
探讨血脑屏障（BBB）通透性与脑血流（CBF）之间的关系，以及与脑小血管病（cSVD）中脑白质高信号（WMH）的关系。
27 例 cSVD 患者接受动态磁敏感对比和动态对比增强 MRI 检查，分别确定 CBF 和 BBB 通透性（表示为漏出率和容积）。结构 MRI 被分割为正常表现的白质（NAWM）和 WMH，并定义了一个病变周围区。在这些区域，我们使用 Pearson 相关性研究了 BBB 通透性、CBF 及其之间的关系。
我们发现，在病变周围区，距离 WMH 每毫米处 CBF 降低 2.2 mL/min/100 g（ < 0.01），漏出容积增加 0.7%（ < 0.01）。NAWM 和 WMH 中 CBF 值越低，漏出测量值越高（-0.53 < < -0.40， < 0.05）。这种关系也在病变周围区观察到，在靠近 WMH 时更强（ = 0.03）。
BBB 损伤和低灌注出现在 WMH 和 NAWM 中，在靠近 WMH 时增加，并存在关联。BBB 和 CBF 都在神经血管单元（NVU）中受到调节，观察到的关联可能是由于 NVU 的生理调节机制。这种关联可能表明该单元的早期整体恶化。
