Small and Large Magnetic Resonance Imaging–Visible Perivascular Spaces in the Basal Ganglia of Parkinson's Disease Patients

Abstract

Background Although previously thought to be asymptomatic, recent studies have suggested that magnetic resonance imaging–visible perivascular spaces (PVS) in the basal ganglia (BG‐PVS) of patients with Parkinson's disease (PD) may be markers of motor disability and cognitive decline. In addition, a pathogenic and risk profile difference between small (≤3‐mm diameter) and large (>3‐mm diameter) PVS has been suggested. Objective The aim of this study was to examine associations between quantitative measures of large and small BG‐PVS, global cognition, and motor/nonmotor features in a multicenter cohort of patients with PD. Methods We performed a cross‐sectional study examining the association between large and small BG‐PVS with Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) Parts I–IV and cognition (Montreal Cognitive Assessment) in 133 patients with PD enrolled in the Ontario Neurodegenerative Disease Research Initiative study. Results Patients with PD with small BG‐PVS demonstrated an association with MDS‐UPDRS Parts I (P = 0.008) and II (both P = 0.02), whereas patients with large BG‐PVS demonstrated an association with MDS‐UPDRS Parts III (P < 0.0001) and IV (P < 0.001). BG‐PVS were not correlated with cognition. Conclusions Small BG‐PVS are associated with motor and nonmotor aspects of experiences in daily living, while large BG‐PVS are associated with the motor symptoms and motor complications. © 2022 International Parkinson and Movement Disorder Society

Diffusion along perivascular spaces as marker for impairment of glymphatic system in Parkinson’s disease

“…Since the PVS system is an important part of the glymphatic system, previous studies evaluated the glymphatic system indirectly by assessing PVS burden 24,25 . PVS burden in basal ganglia (BG) has been shown to correlate with the severity of PD motor symptoms [25][26][27] . PVS is a microscopic tubular structure that contains freely moving water molecules 28 .…”

“…These findings suggest the potential of the DTI-ALPS index as a non-invasive imaging biomarker in evaluating the integrity of the glymphatic system. Ultra-high field 7 T MRI, with increased spatial resolution, contrast and signal-to-noise ratio, improved the visualization and detection rate of PVS, especially small-sized PVS that might be neglected using conventional MRI technology 25,26,35 . Moreover, for DTI studies, 7 T MRI enables visualization of the white matter orientations and making sharp turns into the cortex, which are more difficult to see with the 3 T scanner 36 .…”

A critical guide to the automated quantification of perivascular spaces in magnetic resonance imaging

“…In disease, abnormal PVS measures have been observed in patients with depression, COVID-19, traumatic brain injury, Multiple Sclerosis (MS), Parkinson's disease (PD), mild cognitive impairment (MCI), and Alzheimer's disease (AD) (Table 2; Cai et al, 2015;Ramirez et al, 2015Ramirez et al, , 2016Ramirez et al, , 2022Niazi et al, 2018;Donahue et al, 2021Donahue et al, , 2022George et al, 2021;Piantino et al, 2021;Sepehrband et al, 2021;Shen et al, 2021;Kamagata et al, 2022;Langan et al, 2022;Ranti et al, 2022). Significant higher PVS counts, but not volumes, have been found in COVID-19 patients, compared to controls (Langan et al, 2022).…”

“…Whereas, PVS-VF in the anterior middle cingulate cortex was negatively correlated with levels of N-acetyl containing compounds ( Donahue et al, 2022 ). Additionally, PVS enlargement in both the midbrain and BG has been associated with motor symptom severity ( Shen et al, 2021 ; Ramirez et al, 2022 ).…”

“…Ramirez et al, 2015Berezuk et al, 2015Cai et al, 2015Zong et al, 2016Wang et al, 2016Niazi et al, 2018Piantino et al, 2020Ballerini et al, 2020aBallerini et al, 2020bValdés Hernández et al, 2020Zong et al, 2020Barisano et al, 2021bSepehrband et al, 2021 Ramirez et al, 2021Shen et al, 2021George et al, 2021Piantino et al, 2021Donahue et al, 2021 Langan et al, 2022Ranti et al, 2022Lynch et al, 2022, Preprint Barisano et al, 2022bHupfeld et al, 2022Barnes et al, 2022Kamagata et al, 2022Donahue et al, 2022Ramirez et al, 2022Jokinen et al, 2020Zong et al, 2020Wang et al, 2021Huang et al, 2021 Spijkerman et al, 2022 PVS measures can be broadly categorized as quantitative metrics (volume, count, and volume fractions), and morphological metrics (length, width, solidity, and tortuosity). Listed first are the methods that utlize classical image filtering technique.…”