Distinct spatial patterns of perivascular spaces enlargement for multiple and Co-existing pathologies of cognitive impairment - 02/07/26
, Wha Jin Lee b, ⁎
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Highlights |
• | Quantified regional PVS from thick-slice 2D T2 MRI using automated segmentation. |
• | Basal Ganglia PVS linked predominantly to vascular pathology. |
• | Lobar WM PVS associated with amyloid-β and vascular pathology. |
• | Amyloid-vascular effects on PVS burden were less-than-additive. |
• | Spatial PVS patterns disentangle mixed pathways of cognitive impairment. |
Abstract |
Background |
This study examines how amyloid-β and vascular pathology independently and jointly relate to regional perivascular space (PVS) burden on T2-weighted MRI.
Methods |
In 307 cognitively impaired participants retrospectively identified from the Seoul National University dementia cohort, PVS were automatically quantified in the basal ganglia (BG) and lobar white matter regions from 2D T2-weighted MRI. Amyloid-β and vascular pathology positivity were defined by [18F]Florbetaben PET and small vessel disease markers. Group differences among pathology-negative ( n =36), vascular-only ( n =106), amyloid-only ( n =48), and mixed ( n =117) subgroups, as well as amyloid–vascular interactions, were assessed using analysis of covariance and multivariable linear regression.
Results |
BG PVS were greater in participants with vascular burden than in pathology-negative participants ( F =26.97, p < 0.001; Cohen's d =1.28), independent of amyloid-β. Lobar PVS were higher in single-pathology than pathology-negative participants across the parietal, temporal, and occipital regions ( F =8.25–18.04, Cohen's d =0.66–0.98, all p ≤0.014), with no additional increase in the mixed group. Greater amyloid-β retention was associated with parietal, temporal, and occipital PVS in VB− participants ( β [95% CI]=0.55 [0.19, 0.92], 0.69 [0.35, 1.02], 0.40 [0.16, 0.64], respectively). Among AB− participants, vascular burden was associated with BG PVS ( β [95% CI]=0.65 [0.40, 0.89]). Multivariable regression demonstrated less-than-additive AB×VB interactions in parietal, temporal, and occipital PVS ( β [95% CI]=−0.65 [−1.08, −0.23], −0.74 [−1.13, −0.35], −0.42 [−0.70, −0.14], respectively).
Conclusions |
Distinct regional PVS patterns reflect spatially selective and severity-dependent glymphatic-related structural alterations associated with amyloid-β and vascular pathologies, supporting PVS as a quantitative imaging biomarker for disentangling mixed pathways of cognitive impairment.
El texto completo de este artículo está disponible en PDF.Keywords : Alzheimer’s disease, Cerebral small vessel disease, Glymphatic dysfunction, MRI segmentation, Perivascular spaces
Esquema
Vol 13 - N° 8
Artículo 100631- octobre 2026 Regresar al número
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Bienvenido a EM-consulte, la referencia de los profesionales de la salud.