Linking juxtacortical perivascular spaces to cerebral amyloid angiopathy: A study based on 5.0 T MRI

BackgroundJuxtacortical perivascular spaces (jPVS) were observed in cerebral amyloid angiopathy (CAA), yet the diagnostic relevance between jPVS and CAA remains unclear.ObjectiveTo explore the association between in-vivo jPVS burden and clinical diagnosis of CAA, as well as established CAA imaging markers.MethodsWe retrospectively enrolled patients with probable CAA or arteriolosclerosis who underwent ultrahigh-field 5.0 T MRI. A visual rating scale was used to quantify jPVS burden. Established CAA markers were evaluated, including centrum semiovale perivascular spaces (CSO-PVS), lobar intracerebral hemorrhage (ICH), lobar cerebral microbleeds (CMBs), and cortical superficial siderosis (cSS). Multivariable logistic regression, receiver operating characteristic analyses, and generalized linear models were applied.ResultsAmong 117 participants (48 probable CAA and 69 arteriolosclerosis, mean age 65.6 ± 9.8 years, 63.2% males), jPVS burden was significantly higher in CAA (<i>p</i> < 0.001). The jPVS burden was independently associated with clinically diagnosed CAA (odds ratio for the highest tertile of total jPVS: 14.93; 95% confidence interval: 4.59-48.53; <i>p</i> < 0.001, compared with the lowest tertile), after adjusting for age, sex, hypertension, diabetes, and hyperlipidemia. Total jPVS count demonstrated good discrimination for CAA (area under the curve 0.799, 95% confidence interval: 0.717-0.882, <i>p</i> < 0.001) and was independently correlated with CSO-PVS, lobar ICH, lobar CMBs, and cSS (all <i>p</i> < 0.05).ConclusionsThe jPVS burden is independently associated with the clinical diagnosis of CAA and established CAA imaging markers. These findings may contribute to advancing the current understanding of CAA imaging and support jPVS as a complementary marker with potential clinical utility.