Measuring subtle leakage of the blood-brain barrier in cerebrovascular disease with DCE-MRI: Test-retest reproducibility and its influencing factors.
Increased blood-brain barrier (BBB) permeability has been shown to play a significant role in the pathophysiology of cerebrovascular disease and it may provide an early functional marker of progression or treatment effects. The aim of the study was to investigate the test-retest reproducibility and influencing factors of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in measuring subtle leakage in patients with cerebrovascular disease.



DCE-MRI (3T) was performed on two separate days in 16 patients (age 66 ± 9 years) with cerebrovascular disease, prospectively. The leakage rate was quantified for white matter (WM) and gray matter (GM) using the Patlak graphical approach with individual vascular input functions (VIFs). Furthermore, the influence of session-averaged VIFs, the average of the VIFs obtained on two days, and shorter scan times (range 5-25 minutes) on the reproducibility were evaluated in WM and GM.



Coefficients of variation (CV) ≤14.4% (WM and GM), intraclass correlation coefficients (ICCs) of 0.77 (WM) and 0.49 (GM), were observed for the leakage rate. Session-averaged VIFs hardly affected these results (CV ≤13.4%). The repeatability coefficients (RCs) of the leakage rate decreased from 2.7·10-3to 0.4·10-3min-1in WM (P < 0.01) and 4.4·10-3to 0.9·10-3min-1in GM (P < 0.01) with increasing scan time (range 5-25 minutes).



Based on the moderate CVs and moderate-to-excellent ICCs, we demonstrate that measuring subtle BBB leakage using DCE-MRI is moderate-to-excellent reproducible. Longer scan times improve the reproducibility. The provided RCs at various scan times may assist future clinical studies investigating BBB leakage using DCE-MRI.



2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:159-166.
Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.|School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands.
Sau May
SM
Wong
Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.|School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands.
Jacobus F A
0000-0002-5271-8060
JFA
Jansen
School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands.|Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands.
C Eleana
CE
Zhang
Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands.
Julie
J
Staals
Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.|School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands.
Paul A M
PAM
Hofman
School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands.|Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands.
Robert J
RJ
van Oostenbrugge
Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
Cécile R L P N
CRLPN
Jeukens
Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.|School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, the Netherlands.
Walter H
WH
Backes
D000368:Aged; D001812:Blood-Brain Barrier / Q000000981:diagnostic imaging*; D002199:Capillary Permeability; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D003287:Contrast Media
blood-brain barrier; cerebrovascular disease; dynamic contrast-enhanced magnetic resonance imaging; permeability; reproducibility