Abstract
The blood–brain barrier (BBB) is a functional and structural barrier separating the intravascular and neuropil compartments of the brain. It characterizes the vascular bed and is essential for normal brain functions. Dysfunction in the BBB properties have been described in most common neurological disorders, such as stroke, traumatic injuries, intracerebral hemorrhage, tumors, epilepsy and neurodegenerative disorders. It is now obvious that the BBB plays an important role in normal brain activity, stressing the need for applicable imaging and assessment methods. Recent advancements in imaging techniques now make it possible to establish sensitive and quantitative methods for the assessment of BBB permeability. However, most of the existing techniques require complicated and demanding dynamic scanning protocols that are impractical and cannot be fulfilled in some cases. We review existing methods for the evaluation of BBB permeability, focusing on quantitative magnetic resonance-based approaches and discuss their drawbacks and limitations. In light of those limitations we propose two new approaches for BBB assessment with less demanding imaging sequences: the “post-pre” and the “linear dynamic” methods, both allow semi-quantitative permeability assessment and localization of dysfunctional BBB with simple/partial dynamic imaging protocols and easy-to-apply analysis algorithms. We present preliminary results and show an example which compares these new methods with the existing standard assessment method. We strongly believe that the establishment of such “easy to use” and reliable imaging methods is essential before BBB assessment can become a routine clinical tool. Large clinical trials are awaited to fully understand the significance of BBB permeability as a biomarker and target for treatment in neurological disorders.
Highlights
The blood–brain barrier (BBB) is a functional and structural barrier separating the intravascular and neuropil compartments of the brain
While the DCE-magnetic resonance imaging (MRI) has been described for more than a decade and shown to yield dysfunctional BBB under different clinical conditions, it has not been implemented in the routine clinical setup, nor tested for its power in predicting patients’ outcome, or having any contribution to clinical decision
The high temporal resolution is mainly needed for sampling the rapid passage of tracer in the arterial phase, which occurs within seconds following the injection
Summary
The blood–brain barrier (BBB) is a functional and structural barrier separating the intravascular and neuropil compartments of the brain. BBB assessment and permeability quantification are carried out by either using semi-quantitative methods, where statistical differences between scans before and after tracer injection are calculated [8], or by using more quantitative approaches based on a dynamic contrast enhanced MRI (DCE-MRI) [9,10]. Most of the existing techniques require complicated and demanding dynamic scanning protocols, including tracer injection during the scan and long scanning sessions These imaging protocols in addition to the complex and computationally-demanding assessment algorithms, make these dynamic methods impractical and in some cases even unfeasible, stressing the need for developing “lighter” and less demanding semi-quantitative methods. Both proposed methods overcome some of the limitations described while supplying semi-quantitative assessment comparable to the existing more complex method
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