Sources of systematic error in DCE-MRI estimation of low-level blood-brain barrier leakage. Link to paper on Magnetic Resonance in Medicine Authors Cameron Manning, Michael Stringer, Ben Dickie, Una Clancy, Maria C. Valdés Hernandez, Stewart J. Wiseman, Daniela Jaime Garcia, Eleni Sakka, Walter H. Backes, Michael Ingrisch, Francesca Chappell, Fergus Doubal, Craig Buckley, Laura M. Parkes, Geoff J. M. Parker, Ian Marshall, Joanna M. Wardlaw, Michael J. Thrippleton Abstract Purpose: Dynamic contrast-enhanced (DCE) -MRI with Patlak model analysis is increasingly used to quantify low-level blood-brain barrier (BBB) leakage in studies of pathophysiology. We aimed to investigate systematic errors due to physiological, experimental, & modeling factors influencing quantification of the permeability-surface area product PS & blood plasma volume vp, & to propose modifications to reduce the errors so that subtle differences in BBB permeability can be accurately measured. Methods: Simulations were performed to predict the effects of potential sources of systematic error on conventional PS & vp quantification: restricted BBB water exchange, reduced cerebral blood flow, arterial input function (AIF) delay & B1+ error. The impact of targeted modifications to the acquisition & processing were evaluated, including: assumption of fast versus no BBB water exchange, bolus versus slow injection of contrast agent, exclusion of early data from model fitting & B1+ correction. The optimal protocol was applied in a cohort of recent mild ischaemic stroke patients. Results: Simulation results demonstrated substantial systematic errors due to the factors investigated (absolute PS error ≤ 4.48 × 10−4 min−1). However, these were reduced (≤0.56 × 10−4 min−1) by applying modifications to the acquisition & processing pipeline. Processing modifications also had substantial effects on in-vivo normal-appearing white matter PS estimation (absolute change ≤ 0.45 × 10−4 min−1). Conclusion: Measuring subtle BBB leakage with DCE-MRI presents unique challenges & is affected by several confounds that should be considered when acquiring or interpreting such data. The evaluated modifications should improve accuracy in studies of neurodegenerative diseases involving subtle BBB breakdown. Keywords Blood-brain barrier DCE-MRI Dementia Gadolinium Small vessel disease Related links Link to paper on Magnetic Resonance in Medicine Professor Joanna Wardlaw Dr Fergus Doubal Dr Michael Thrippleton Professor Ian Marshall Dr Una Clancy Dr Michael Stringer Dr Maria Valdés Hernandez Cameron Manning Brain & nervous system Small vessel disease (SVD) Stroke Dementia What is a MR scan? Social media tags & titles Featured paper: Sources of systematic error in DCE-MRI estimation of low-level blood-brain barrier leakage. @fergusdoubal @CameronJManning @SymptomsOfSVD Publication date 26 May, 2021
