DCE-MRI Assessment of Blood-Brain Barrier Permeability in Early Alzheimer's Disease

Background and Purpose: Recently, it could be demonstrated that the disruption of the blood-brain barrier (BBB) in the hippocampus correlates with functional cognitive impairment (1) independent of Alzheimer's disease (AD) pathology. Aim of this study was to assess the BBB in the AD continuum. Method: Examination on a 3 T MR scanner (Prisma_fit, Siemens AG). The dynamic contrast enhanced (DCE) protocol comprised pre-contrast T1 measurements with 4 different flip angles (2[degrees], 10[degrees], 20[degrees], 35[degrees]) for T1 mapping, as well as continuous serial acquisitions of 60 volumes after administration of 10 ml contrast agent at a flow rate of 1 ml/s. Patlak analysis was employed to assess BBB permeability using the open source software package ROCKETSHIP ( Results: We examined 81 participants (MCI+ n = 29, NC = 52). Mean age was 74.4 [+ or -] 6.5 years, 33 (40.7%) were females. The median MMSE for MCI+ was 25, for NC 29. Median Wahlund score (2) for MCI was 6, for NC 4. After controlling for age, Wahlund score, vascular risk factors and log transformation of mean [K.sup.trans] values, participants with cognitive impairment as defined by the CDR in combination with neuropsychological deficits showed a disruption of the hippocampal BBB (left p = 0.04, right p = 0.035). An example of a bilateral BBB permeability disruption is given in Fig. 1. Conclusion: Using DCE-MRI early BBB disruption can be detected in the AD continuum independently of vascular risk factors and white matter lesions.