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White matter lesions in dementia: an MRI study on blood-brain barrier dysfunction
1Department of Radiology, Huddinge University Hospital, Huddinge, Sweden. lena.bronge@radiol.hs.sll.se
Abstract:
White matter lesions (WMLs) and blood-brain barrier (BBB) dysfunction are common in dementia. Both conditions may be a consequence of small-vessel disease, in which case the BBB damage would be suspected to be located to the WMLs. To further evaluate the nature of WMLs in dementia we examined 10 demented patients with WMLs, including 5 cases with elevated CSF/serum albumin ratios as an indication of BBB damage. An optimised gadolinium (Gd)-enhanced MRI technique was used including a double dose of Gd, a 30-min scan time after injection and analysis of the MR signal in the WMLs as a function over time. Results showed no significant changes in MR signal in the WMLs after contrast administration. We conclude that WMLs are not connected to BBB damage to such a degree that is detectable with this method and that the elevated CSF albumin might have another origin.
Insights
White matter lesions (WMLs) in dementia are not linked to blood-brain barrier (BBB) damage detectable by MRI. Elevated cerebrospinal fluid (CSF) albumin in some patients may stem from other causes.
Area of Science:
- Neurology
- Neuroimaging
- Vascular Dementia
Background:
- White matter lesions (WMLs) and blood-brain barrier (BBB) dysfunction are prevalent in dementia.
- These conditions are often associated with small-vessel disease, suggesting BBB damage may occur within WMLs.
Purpose of the Study:
- To investigate the relationship between WMLs and BBB integrity in patients with dementia.
- To determine if BBB damage is localized to WMLs in demented individuals.
Main Methods:
- Examined 10 dementia patients with WMLs, 5 with elevated CSF/serum albumin ratios indicating BBB damage.
- Utilized an optimized gadolinium (Gd)-enhanced MRI technique with double Gd dose and 30-minute post-injection scan time.
- Analyzed MR signal changes in WMLs over time post-contrast administration.
Main Results:
- No significant changes in MR signal were observed within the WMLs after contrast administration.
- The optimized MRI technique did not detect BBB damage associated with WMLs.
Conclusions:
- WMLs in dementia are not connected to BBB damage to a detectable degree using this MRI method.
- Elevated CSF albumin in some dementia patients with WMLs may originate from sources other than BBB breakdown within the lesions.