Blood–Brain Barrier Disruption in Ischemic Stroke is associated with Perivenous-Enhanced Cortical Veins Detected by Contrast-Enhanced Black-Blood Magnetic Resonance Imaging.

Abstract

Abstract Background A quantitative and visual assessment of the degree of alteration in the blood-brain barrier (BBB) with magnetic resonance imaging (MRI) following stroke remains challenging. We aimed to explore the feasibility of using a perivenous-enhanced cortical vein (PECV) on contrast-enhanced black-blood MRI (CEBBI) to depict and classify BBB alterations in patients with ischemic stroke. Methods This retrospective study consecutively recruited 168 hospitalized patients with acute, subacute, and chronic ischemic stroke who underwent pre- and post-CEBBI. BBB alterations were classified into three groups as follows: no (NoBBBD), subtle (SuBBBD), and significant BBB disruption (SiBBBD) based on the enhancement ratio (ER) of the normal-appearing white matter before and after contrast administration, besides leptomeningeal and parenchymal enhancement displayed on CEBBI. We recorded the number of PECVs on the source of the CEBBI images in the bilateral cerebrum. Univariate and multivariate linear regression analyses were performed to identify and examine the variables that accounted for BBB alterations. Results Increased BBBD was associated with greater PECVs in the ipsilateral and contralateral hemispheres of cerebral infarction (all p < 0.01). Fewer PECVs were delineated on the contralateral side than those on the ipsilateral side of the infarct (median: 5 vs. 3, p < 0.01). Compared with the NoBBBD group, greater PECVs were visualized on the CEBBI in participants with SuBBBD (median: 3 vs. 14, p < 0.01); we observed a significant difference between the SuBBBD and SiBBBD groups (median: 14 vs. 18, p < 0.01). The median number of PECVs of 4.5 and 8.5 in the ipsilateral hemisphere displayed 83.3% sensitivity and 83.1% specificity for discriminating NoBBBD from SuBBBD, compared with 78.5% sensitivity and 85.0% specificity for determining SuBBBD from SiBBBD, respectively. Conclusions The number of whole-brain PECVs obtained from isotropic high-resolution post-CEBBI provides a direct and semi-quantitative method for detecting and classifying BBBD in patients with cerebral infarct.