Assessment of blood–brain barrier disruption using dynamic contrast-enhanced MRI. A systematic review

Abstract

There is increasing recognition of the importance of blood–brain barrier (BBB) disruption in aging, dementia, stroke and multiple sclerosis in addition to more commonly-studied pathologies such as tumors. Dynamic contrast-enhanced MRI (DCE-MRI) is a method for studying BBB disruption in vivo. We review pathologies studied, scanning protocols and data analysis procedures to determine the range of available methods and their suitability to different pathologies. We systematically review the existing literature up to February 2014, seeking studies that assessed BBB integrity using T1-weighted DCE-MRI techniques in animals and humans in normal or abnormal brain tissues. The literature search provided 70 studies that were eligible for inclusion, involving 417 animals and 1564 human subjects in total. The pathologies most studied are intracranial neoplasms and acute ischemic strokes. There are large variations in the type of DCE-MRI sequence, the imaging protocols and the contrast agents used. Moreover, studies use a variety of different methods for data analysis, mainly based on model-free measurements and on the Patlak and Tofts models. Consequently, estimated KTrans values varied widely. In conclusion, DCE-MRI is shown to provide valuable information in a large variety of applications, ranging from common applications, such as grading of primary brain tumors, to more recent applications, such as assessment of subtle BBB dysfunction in Alzheimer's disease. Further research is required in order to establish consensus-based recommendations for data acquisition and analysis and, hence, improve inter-study comparability and promote wider use of DCE-MRI.

Permeability imaging in cerebrovascular diseases: applications and progress in research

“…Further improvements for enhancing the reliability and stability of the DCE-MR are needed for its application in the assessment of subtle changes in the permeability of the BBB. Future research should attempt to establish a unified data collection and analysis method, which should help improve the comparability between studies and promote the wide application of DCE-MR in clinical practice and research [46]. …”

“…There is less research focused on the evaluation of mild BBB defects in normal or abnormal aging brains, dementia, or cerebral small vessel disease. More work needs to be done to select the appropriate contrast agents and decide their doses, as well as to identify methods for parameter collection and data analysis [46].…”

Blood-brain barrier permeability of normal-appearing white matter in patients with vestibular schwannoma: A new hybrid approach for analysis of T 1 -W DCE-MRI

“…4,[17][18][19][20][21][22][23][24] Recent work has also identified changes in permeability in NAWM following whole brain radiotherapy in patients with cerebral tumors. 25 The increase in BBB permeability induced by whole-brain radiotherapy has been used to improve penetration of therapeutic agents for the treatment of primary central nervous system (CNS) lymphoma and metastatic disease typically depending on simultaneous measurement of cerebrospinal fluid (CSF) and plasma concentrations of the therapeutic agent.…”

Brain Microstructural White and Gray Matter Alterations after Cardiopulmonary Bypass: Anatomical Distribution and Corresponding Neurocognitive Deficit

“…The MRI studies were analysed for microstructural brain tissue injury, BBB-disruption and for signs for microemboli using DTI-MRI, DCE-MRI and diffusion-weighted imaging (DWI)-MRI, respectively. The yield of these modalities has been previously detailed [7][8][9][10]. Neuropsychological tests were undertaken one day preoperatively (baseline) and on POD 5.…”