脑小血管疾病血脑屏障通透性与MRI总负担的相关性

Correlation between permeability of blood-brain barrier and total MRI burden in patients with cerebral small vessel disease

目的通过动态增强MRI(DCE-MRI)探讨血脑屏障(BBB)通透性与脑小血管疾病(CSVD)MRI总负担之间的关系。方法对104例患者以5分制CSVD影像学总负担评分表进行评价,包括腔隙性梗死(lacunes)、脑白质高信号(WMH)、脑微出血(CMB)、血管周围间隙扩大(EPVS)和脑萎缩(BA),并根据得分0~5分为CSV0组(0分)~CSVD5组(5分)共6组。对各组均行DCE-MRI,并以Patlak双室药代动力学模型测量WMH、常规MRI表现正常的脑白质区(NAWM)、皮层灰质区(CGM)以及深部灰质区(DGM)BBB通透性。结果最终纳入99名,校正年龄、性别和血管危险因素后,NAWM、WMH、CGM及DGM 4个区域的CSVD影像学总负担与渗漏速率(K trans)和曲线下面积(AUC)均呈显著正相关(P均<0.05);NAWM、CGM及DGM区域CSVD影像学总负担与局部脑血浆容量(V p)呈显著负相关(P<0.05)。结论CSVD患者BBB通透性增高与其MRI所示总CSVD负担相关;BBB受损可能是CSVD病理生理过程的关键因素之一。

Objective To investigate the relationship between permeability of blood-brain barrier(BBB)and total MRI cerebral small vessel disease(CSVD)burden with dynamic contrast-enhanced MRI(DCE-MRI).Methods A total of 104 patients were evaluated using 5 points CSVD imaging burden scale,including lacunes,white matter hyperintensities(WMH),cerebral microbleeds(CMB),enlarged perivascular spaces(EPVS)and brain atrophy(BA).The patients were then were divided into 6 groups according to the result of total CSVD burden score(0-5),i.e.CSVD0 group,1 group,2 group,3 group,4 group and CSVD5 group.DCE-MRI were performed,and Patlak pharmacokinetic model was used to quantify BBB permeability in WMH,normal-appearing white matter(NAWM),cortical gray matter(CGM)and deep gray matter(DGM).Results Finally 99 patients were included.After adjusting for age,gender and vascular risk factors,the total imaging burden of CSVD was positively correlated with leakage rate(K trans)and area under the curve(AUC)in 4 regions of NAWM,WMH,CGM and DGM(all P<0.05).In NAWM,CGM and DGM regions,the total imaging burden of CSVD was negatively correlated with fractional blood plasma volume(V p)(all P<0.05).Conclusion Increased BBB permeability associated with total MRI CSVD burden,suggesting that damaged BBB may be a crucial contributor to the pathogenesis of CSVD.