Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK; Dementia Research Institute, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging, University of Edinburgh, Edinburgh, UK.
Department of Radiology & Nuclear Medicine, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.
Alzheimers Dement. 2019 Jun;15(6):840-858. doi: 10.1016/j.jalz.2019.01.013. Epub 2019 Apr 25.
Cerebral small vessel disease (cSVD) comprises pathological processes of the small vessels in the brain that may manifest clinically as stroke, cognitive impairment, dementia, or gait disturbance. It is generally accepted that endothelial dysfunction, including blood-brain barrier (BBB) failure, is pivotal in the pathophysiology. Recent years have seen increasing use of imaging, primarily dynamic contrast-enhanced magnetic resonance imaging, to assess BBB leakage, but there is considerable variability in the approaches and findings reported in the literature. Although dynamic contrast-enhanced magnetic resonance imaging is well established, challenges emerge in cSVD because of the subtle nature of BBB impairment. The purpose of this work, authored by members of the HARNESS Initiative, is to provide an in-depth review and position statement on magnetic resonance imaging measurement of subtle BBB leakage in clinical research studies, with aspects requiring further research identified. We further aim to provide information and consensus recommendations for new investigators wishing to study BBB failure in cSVD and dementia.
脑小血管病（cSVD）包括脑内小血管的病理过程，这些过程可能在临床上表现为中风、认知障碍、痴呆或步态障碍。人们普遍认为，内皮功能障碍，包括血脑屏障（BBB）的破坏，在病理生理学中起着关键作用。近年来，越来越多地使用成像技术，主要是动态对比增强磁共振成像，来评估 BBB 的渗漏，但文献中报道的方法和结果存在很大的差异。尽管动态对比增强磁共振成像已经得到很好的确立，但由于 BBB 损伤的细微性质，在 cSVD 中出现了挑战。这项由 HARNESS 倡议成员撰写的工作旨在对临床研究中 BBB 渗漏的磁共振成像测量进行深入的回顾和立场声明，并确定需要进一步研究的方面。我们还旨在为希望研究 cSVD 和痴呆症中 BBB 衰竭的新研究人员提供信息和共识建议。
