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Updated: May 23, 2026
Evaluation of Blood-Brain Barrier Breakdown in a Mouse Model of Mild Traumatic Brain Injury
Published on: October 18, 2024
Predicting breakdown of the blood-brain barrier in multiple sclerosis without contrast agents
R T Shinohara1, J Goldsmith, F J Mateen
1Department of Biostatistics, Johns Hopkins University, Baltimore, MD 21205, USA. taki.shinohara@gmail.com
Background And Purpose:
Disruption of the BBB in MS is associated with the development of new lesions and clinical relapses and signifies the presence of active inflammation. It is most commonly detected as enhancement on MR imaging performed with contrast agents that are costly and occasionally toxic. We investigated whether the BBB status in white matter lesions may be indirectly ascertained via examination of features on T1- and T2-weighted images obtained before the injection of a contrast agent.
Materials And Methods:
We considered 93 brain MR imaging studies on 16 patients that included T1-, T2-, and T2-weighted FLAIR images and predicted voxel wise enhancement after intravenous injection of a gadolinium chelate. We then used these voxel-level predictions to determine the presence or absence of abnormal enhancement anywhere in the brain.
Results:
On a voxel-by-voxel basis, enhancement can be predicted by using contrast-free measures with an AUC of 0.83 (95% CI, 0.80-0.87). At the whole-brain level, enhancement can be predicted with an AUC of 0.72 (95% CI, 0.62-0.82).
Conclusions:
In many cases, breakdown of the BBB in acute MS lesions may be inferred without the need to inject an MR imaging contrast agent. The inference relies on intrinsic properties of tissue damage in acute lesions. Although contrast studies are more accurate, they may sometimes be unnecessary.
Insights
Researchers can now predict blood-brain barrier (BBB) disruption in multiple sclerosis (MS) lesions using contrast-free MRI scans. This approach may reduce the need for costly and potentially toxic contrast agents in MS imaging.
Area of Science:
- Neuroimaging
- Radiology
- Medical Diagnostics
Background:
- Blood-brain barrier (BBB) disruption in multiple sclerosis (MS) is linked to new lesions and active inflammation.
- Contrast-enhanced MRI is the standard for detecting BBB breakdown but involves costly and potentially toxic agents.
Purpose of the Study:
- To investigate if BBB status in MS white matter lesions can be indirectly assessed using pre-contrast T1- and T2-weighted MRI sequences.
- To determine the feasibility of predicting contrast enhancement without administering contrast agents.
Main Methods:
- Analysis of 93 brain MRI studies from 16 MS patients, including T1-, T2-, and FLAIR sequences.
- Development of voxel-wise prediction models for contrast enhancement based on intrinsic image features.
- Validation of predictions at both voxel and whole-brain levels.
Main Results:
- Contrast enhancement was predictable on a voxel-by-voxel basis with an AUC of 0.83 (95% CI, 0.80-0.87).
- Whole-brain enhancement prediction achieved an AUC of 0.72 (95% CI, 0.62-0.82).
Conclusions:
- Blood-brain barrier (BBB) breakdown in acute MS lesions can often be inferred without contrast agents.
- This inference relies on intrinsic tissue damage characteristics within acute lesions.
- Contrast-enhanced MRI may not always be necessary, offering a potential alternative for MS assessment.
