Quantifying blood-brain barrier leakage in small vessel disease: Review and consensus recommendations

Area of Science:

• Neurology
• Radiology
• Neuroimaging

Background:

• Cerebral small vessel disease (cSVD) is a major cause of stroke, cognitive decline, and dementia.
• Endothelial dysfunction and blood-brain barrier (BBB) failure are key in cSVD pathophysiology.
• Magnetic resonance imaging (MRI) is increasingly used to assess BBB leakage in cSVD.

Purpose of the Study:

• To provide a comprehensive review and position statement on MRI measurement of subtle BBB leakage in cSVD clinical research.
• To identify areas requiring further research in BBB assessment within cSVD.
• To offer guidance and consensus recommendations for researchers studying BBB failure in cSVD and dementia.

Main Methods:

• Review of current literature on dynamic contrast-enhanced MRI (DCE-MRI) for BBB assessment in cSVD.
• Analysis of variability in DCE-MRI approaches and findings.
• Consensus development by the HARNESS Initiative members.

Main Results:

• Significant variability exists in current DCE-MRI methodologies and reported findings for BBB leakage in cSVD.
• Subtle BBB impairment in cSVD presents challenges for accurate MRI measurement.
• Specific research gaps and areas for methodological standardization were identified.

Conclusions:

• Standardized MRI approaches are needed for reliable assessment of BBB leakage in cSVD research.
• Further research is crucial to refine BBB assessment techniques in cSVD and dementia.
• This work provides a foundation for consistent investigation of BBB failure in neurological disorders.