White Matter Hyperintensities in Cerebral Small Vessel Disease Linked to a Leaky Blood-Brain Barrier

A study published in Neurology showed that people with cerebral small vessel disease (cSVD) who had more blood-brain barrier leakage also had more white matter hyperintensities (WMH) than those with less leakage.

Participants with cerebral small vessel disease mean age 68 (n=43) had MRI at the start of the study to measure the leakiness of the blood-brain barrier. Intravoxel incoherent motion imaging (IVIM), a diffusion technique that provides parenchymal diffusivity, was used to measure tissue integrity around WMH at baseline and 2 years later.

Higher levels of blood-brain barrier leakage at baseline correlated with larger losses of integrity around WMH 2 years later. For every 10% increase in leakage volume at baseline, diffusivity of the brain tissue increased by 1.4% 2 years later. A higher leakage rate at the baseline also correlated with more tissue loss around WMH 2 years later. 

“Previous research has shown that disruption of the blood-brain barrier is increased in people with cSVD,” said Danielle Kerkhofs, MD, of Maastricht University Medical Center, Maastricht, Netherlands. For our study, we wanted to see if a leaky blood-brain barrier was linked to degeneration of brain tissue even before WMH appear. We looked at normal brain tissue, surrounding and close to WMH, because we consider this ‘tissue at risk.' Our results support the theory that a compromised blood-brain barrier may play an early role in loss of brain tissue integrity as part of the cSVD process, even before brain lesions are visible on MRI. The change in integrity of brain tissue at risk, close to the WMH, could be a promising biomarker in future cerebral cSVD studies examining possible prevention strategies and treatment options.”