Glymphatic clearance function in patients with cerebral small vessel disease

Zhang, Wenhua; Zhou, Ying; Wang, Jianan; Gong, Xiaoxian; Chen, Zhicai; Zhang, Xuting; Cai, Jinsong; Chen, Siyan; Fang, Lei; Sun, Jianyong; Lou, Min

doi:10.1016/j.neuroimage.2021.118257

Cited by 171 publications

(227 citation statements)

References 40 publications

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“…The DTI-ALPS method is used for evaluating the glymphatic system’s function or the interstitial fluid dynamics, and this method has been adopted in several studies evaluating the alteration of the glymphatic system or interstitial fluid dynamics in various pathologies [ 21 – 28 ]. One of the report showed that results of ALPS method were significantly related to glymphatic clearance function calculated on MRI by intrathecal administration of GBCA [ 28 ]. The current study evaluated the reproducibility or robustness of the DTI-ALPS method for the fixed imaging sequence and the effect of modifying the method of image acquisition and data evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…The DTI-ALPS method provides ALPS index, which is a ratio of the diffusivity in the direction of the perivascular space and the diffusivity in the direction perpendicular to both major fiber tract and perivascular space, based on a special spatial relationship in the fiber tracts and the perivascular space in the axial imaging plane at the corona radiata [ 19 , 20 ]. Recently, the DTI-ALPS method has been adopted in several studies evaluating the alteration of the glymphatic system or interstitial fluid dynamics in various pathologies [ 21 – 28 ]. These reports indicated that the ALPS-index is a useful biomarker to evaluate the interstitial fluid dynamics or glymphatic function.…”

Section: Introductionmentioning

confidence: 99%

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Reproducibility of diffusion tensor image analysis along the perivascular space (DTI-ALPS) for evaluating interstitial fluid diffusivity and glymphatic function: CHanges in Alps index on Multiple conditiON acquIsition eXperiment (CHAMONIX) study

et al. 2021

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Purpose The diffusion tensor image analysis along the perivascular space (DTI-ALPS) method was developed to evaluate the brain’s glymphatic function or interstitial fluid dynamics. This study aimed to evaluate the reproducibility of the DTI-ALPS method and the effect of modifications in the imaging method and data evaluation. Materials and methods Seven healthy volunteers were enrolled in this study. Image acquisition was performed for this test–retest study using a fixed imaging sequence and modified imaging methods which included the placement of region of interest (ROI), imaging plane, head position, averaging, number of motion-proving gradients, echo time (TE), and a different scanner. The ALPS-index values were evaluated for the change of conditions listed above. Results This test–retest study by a fixed imaging sequence showed very high reproducibility (intraclass coefficient = 0.828) for the ALPS-index value. The bilateral ROI placement showed higher reproducibility. The number of averaging and the difference of the scanner did not influence the ALPS-index values. However, modification of the imaging plane and head position impaired reproducibility, and the number of motion-proving gradients affected the ALPS-index value. The ALPS-index values from 12-axis DTI and 3-axis diffusion-weighted image (DWI) showed good correlation (r = 0.86). Also, a shorter TE resulted in a larger value of the ALPS-index. Conclusion ALPS index was robust under the fixed imaging method even when different scanners were used. ALPS index was influenced by the imaging plane, the number of motion-proving gradient axes, and TE in the imaging sequence. These factors should be uniformed in the planning ALPS method studies. The possibility to develop a 3-axis DWI-ALPS method using three axes of the motion-proving gradient was also suggested.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reproducibility of diffusion tensor image analysis along the perivascular space (DTI-ALPS) for evaluating interstitial fluid diffusivity and glymphatic function: CHanges in Alps index on Multiple conditiON acquIsition eXperiment (CHAMONIX) study

et al. 2021

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“…Second, the ALPS index can be affected by several factors, including imaging plane, head position, and motion-proving gradients. [20] However, a previous report showed that the results of the ALPS method were signi cantly related to glymphatic system function calculated by intrathecal administration of gadolinium-based contrast agent on MRI, [23] and another study successfully demonstrated good test-retest reproducibility and robustness of the ALPS method.…”

Section: Discussionmentioning

confidence: 98%

“…Recently, several studies have utilized the ALPS method to evaluate glymphatic system function in various neurological diseases, such as Alzheimer's disease, [13] normal pressure hydrocephalus, [21] Parkinson's disease, [22] cerebral small vessel disease, [23] and juvenile myoclonic epilepsy. [19] They successfully demonstrated glymphatic system dysfunction in neurological diseases.…”

Section: Discussionmentioning

confidence: 99%

How About Glymphatic System Function in Patients With Migraine?

Lee

Park

et al. 2021

Preprint

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Background: There have been no studies evaluating the glymphatic system function in patients with migraine. In this study, we evaluated the alterations in glymphatic system function in patients with migraine compared to healthy controls using a diffusion tensor imaging (DTI) analysis along the perivascular space (DTI-ALPS) method. We also investigated the differences in glymphatic system function between migraine patients with and without aura using the ALPS method.Methods: We prospectively enrolled patients with migraine and healthy controls. All brain magnetic resonance imaging (MRI), including DTI, in participants, patients with migraine, and healthy controls were obtained using the same MRI scanner. We calculated the ALPS index and compared the differences in the ALPS index between patients with migraine and healthy controls, and between migraine patients with and without aura. In addition, we conducted a correlation analysis between glymphatic system function and the clinical characteristics of migraine.Results: We enrolled 92 patients with migraine and 80 healthy controls. There were no significant differences in the ALPS index between patients with migraine and healthy controls (1.655 vs. 1.713, p = 0.233), and between migraine patients with and without aura (1.690 vs. 1.645, p = 0.601). There were no significant correlations between the ALPS index and clinical characteristics of migraine, including age (r = -0.070, p = 0.507), age of onset (r = 0.066, p = 0.552), disease duration (r = -0.115, p = 0.306), attack frequency (r = -0.049, p = 0.668), and headache intensity (r = -0.003, p = 0.976).Conclusions: There was no glymphatic system dysfunction in patients with migraine. In addition, there were no differences in glymphatic system function between migraine patients with and without aura. We also demonstrated the feasibility of the ALPS method, which can be used for further research on various neurological diseases.

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“…Alterations of the glymphatic system in Alzheimer disease, 15,48 idiopathic normal pressure hydrocephalus, 18 diabetes, 49 and Parkinson disease 50 have been shown in living humans using the ALPS method, which is in line with the findings of studies using gadolinium-based contrast agents as tracers. 3,39,51 Additionally, Zhang et al 52 recently reported that the ALPS index is significantly associated with the glymphatic clearance function calculated by glymphatic MR imaging, following intrathecal administration of gadolinium in patients with small-vessel disease (r ¼ À0.772 to À0.844, P , .001). The report strongly supported the clinical use of the ALPS index as a glymphatic biomarker.…”

Section: Discussionmentioning

confidence: 98%