Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
Ann Neurol. 2023 Jul;94(1):182-195. doi: 10.1002/ana.26648. Epub 2023 Apr 11.
Choroid plexus (CP) is a key regulator in cerebrospinal fluid production, but its contribution to glymphatic clearance function and association with white matter hyperintensity (WMH) remains unclear.
This retrospective study included 2 prospective 3.0-T magnetic resonance imaging (MRI) cohorts. In cohort 1, patients with indications for lumbar puncture underwent 3-dimensional T1-weighted sequence (3D-T1) before and at 39 hours after intrathecal administration of contrast agent (glymphatic MRI). In cohort 2, patients with WMH were enrolled from the CIRCLE study and had a median follow-up time of 1.4 years. WMH and CP of the lateral ventricles were automatically segmented on T2 fluid-attenuated inversion recovery (FLAIR) and 3D-T1, respectively. CP volume was expressed as a ratio to intracranial volume. Glymphatic clearance was measured as signal percentage change from baseline to 39 hours at 8 brain locations based on glymphatic MRI in the first cohort, or as noninvasive diffusion tensor image analysis along the perivascular space (DTI-ALPS) index based on DTI in the second cohort.
In cohort 1, a total of 52 patients were included. Higher CP volume was correlated with slower glymphatic clearance rate in all brain locations. In cohort 2, a total of 197 patients were included. Baseline CP volume was positively associated with WMH volume and its growth. Furthermore, DTI-ALPS index partially mediated the association of CP with both WMH load and growth.
Enlarged CP volume could be an indicator for larger growth of WMH, potentially involving impaired glymphatic clearance function. The exploration of CP may provide a novel perspective to clarify the mechanism of WMH pathogenesis, as well as other glymphatic-related disorders. ANN NEUROL 2023;94:182-195.
脉络丛（CP）是脑脊液产生的关键调节因子，但它在神经胶质淋巴系统清除功能中的作用及其与脑白质高信号（WMH）的关系尚不清楚。
本回顾性研究纳入了两个前瞻性 3.0-T 磁共振成像（MRI）队列。在队列 1 中，有腰椎穿刺指征的患者在鞘内注射造影剂前后（神经胶质淋巴系统 MRI）进行了 3 维 T1 加权序列（3D-T1）。在队列 2 中，从 CIRCLE 研究中招募了有 WMH 的患者，中位随访时间为 1.4 年。分别在 T2 液体衰减反转恢复（FLAIR）和 3D-T1 上自动分割侧脑室的 CP 和 WMH。CP 体积表示为与颅内体积的比值。在第一队列的神经胶质淋巴系统 MRI 上，根据 8 个脑区从基线到 39 小时的信号百分比变化来测量神经胶质淋巴系统清除率，或在第二队列的 DTI 上根据血管周围空间（DTI-ALPS）指数进行无创扩散张量图像分析。
在队列 1 中，共纳入 52 例患者。所有脑区 CP 体积越大，神经胶质淋巴系统清除率越慢。在队列 2 中，共纳入 197 例患者。CP 体积与 WMH 体积及其增长呈正相关。此外，DTI-ALPS 指数部分介导了 CP 与 WMH 负荷及其增长的关系。
CP 体积增大可能是 WMH 更大增长的指标，可能涉及神经胶质淋巴系统清除功能受损。CP 的探索可能为阐明 WMH 发病机制以及其他神经胶质淋巴系统相关疾病的机制提供一个新的视角。
