DCE-MRI reveals elevated blood-brain barrier leakage of heterogeneous white matter in cerebral small vessel disease

Motivation: Blood-brain barrier (BBB) function is impaired in cerebral small vessel disease (cSVD), but challenging to detect with MRI. Goal(s): To improve our understanding of regional BBB leakage variations in patients with cSVD. Approach: BBB leakage was assessed in cSVD patients and age-matched controls using dynamic contrast-enhanced MRI. Inside the normal appearing white matter (NAWM) 2 mm thick shells were dilated from manually delineated white matter hyperintensities (WMH). Results: WMH exhibited more widespread leakage in cSVD; the shells surrounding WMH showed that NAWM leaks more strongly in patients than controls, while no differences were found for the whole NAWM. Impact: A more regionally targeted analysis is required to determine the subtle BBB leakage in the NAWM of patients with cSVD and to assess differences with controls.