From the J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.C.Z.Z., P.Y., L.S., D.S., S.J.v.V., M.R.E., A.C., S.M.G., A.V.); Center for Imaging Sciences and Medical Physics, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, 3900 Ten. Catão Roxo Street, Monte Alegre, Campus Universitário, Ribeirão Preto, SP 14015-010, Brazil (M.C.Z.Z.); Departments of Epidemiology and Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (P.Y.); Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospital, Faculty of Medicine, University of Geneva, Geneva, Switzerland (L.S.); Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania (L.S.); and Medical Image Analysis Center (MIAC AG) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering, University of Basel, Basel, Switzerland (M.D.).
Radiology. 2023 Mar;306(3):e212780. doi: 10.1148/radiol.212780. Epub 2023 Jan 24.
A leading cause of white matter (WM) injury in older individuals is cerebral small vessel disease (SVD). Cerebral SVD is the most prevalent vascular contributor to cognitive impairment and dementia. Therapeutic progress for cerebral SVD and other WM disorders depends on the development and validation of neuroimaging markers suitable as outcome measures in future interventional trials. Diffusion-tensor imaging (DTI) is one of the best-suited MRI techniques for assessing the extent of WM damage in the brain. But the optimal method to analyze individual DTI data remains hindered by labor-intensive and time-consuming processes. Peak width of skeletonized mean diffusivity (PSMD), a recently developed fast, fully automated DTI marker, was designed to quantify the WM damage secondary to cerebral SVD and reflect related cognitive impairment. Despite its promising results, knowledge about PSMD is still limited in the radiologic community. This focused review provides an overview of the technical details of PSMD while synthesizing the available data on its clinical and neuroimaging associations. From a critical expert viewpoint, the authors discuss the limitations of PSMD and its current validation status as a neuroimaging marker for vascular cognitive impairment. Finally, they point out the gaps to be addressed to further advance the field.
老年人脑白质（WM）损伤的一个主要原因是脑小血管病（SVD）。脑 SVD 是认知障碍和痴呆最常见的血管致病因素。脑 SVD 和其他 WM 疾病的治疗进展取决于合适的神经影像学标志物的开发和验证，这些标志物可作为未来干预性试验的结局指标。弥散张量成像（DTI）是评估大脑 WM 损伤程度的最适合的 MRI 技术之一。但分析个体 DTI 数据的最佳方法仍然受到劳动密集型和耗时过程的阻碍。最近开发的快速、全自动 DTI 标志物——骨架化平均弥散度峰值宽度（PSMD），旨在量化继发于脑 SVD 的 WM 损伤，并反映相关认知障碍。尽管它具有广阔的前景，但放射学界对 PSMD 的了解仍然有限。这篇重点综述概述了 PSMD 的技术细节，并综合了其在临床和神经影像学方面的现有数据。作者从批判性专家的角度讨论了 PSMD 的局限性及其作为血管性认知障碍神经影像学标志物的当前验证状态。最后，他们指出了进一步推进该领域需要解决的差距。
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