Blood-brain barrier impairment and hypoperfusion are linked in cerebral small vessel disease

Objective: To investigate the link between BBB permeability and CBF and the relation with white matter hyperintensities (WMHs) in cerebral small vessel disease (cSVD). Methods: Twenty-seven patients with cSVD received dynamic susceptibility contrast and dynamic contrast-enhanced MRI to determine CBF and BBB permeability (expressed as leakage rate and volume), respectively. Structural MR images were segmented into normal appearing white matter (NAWM) and WMHs, for which a perilesional zone was defined. In these regions, we investigated the BBB permeability, CBF, and their relation using Pearson correlation r. Results: We found a decrease in CBF of 2.2 mL/min/100g(p<0.01) and an increase in leakage volume of 0.7%(p<0.01) per mm closer to the WMHs in the perilesional zones. Lower CBF values correlated with higher leakage measures in the NAWM and WMHs (-0.53