ArticleEBioMedicine2025
Robust, fully-automated assessment of cerebral perivascular spaces and white matter lesions: a multicentre MRI longitudinal study of their evolution and association with risk of dementia and accelerated brain atrophy.
Article in EBioMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
- Glymphatic function in humans: indicators, modulators, and measurement strategies.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Review
- Exploring the role of glymphatic system in Alzheimer's disease with insights from MRI-based studies: a systematic review.Neuroradiology · 2026Review
- Associations of physical fitness with brain structure, pathology and cognition in cognitively normal older adults.npj aging · 2026Article
- A Quantitative Assessment of MRI-Visible Perivascular-Space Burden Across the Cognitive Spectrum: Associations with APOE ε4 Status and Venous Sinus Volume.Diagnostics (Basel, Switzerland) · 2026Article
- The Clearance-Centered Bottleneck in Alzheimer's Disease: From Coupled Glymphatic-Lymphatic Circuits to Therapeutic Opportunities.Molecular neurobiology · 2026Review
- A composite measure of cerebral small vessel disease predicts cognitive change after stroke.medRxiv : the preprint server for health sciences · 2026Article
- Altered cerebrospinal fluid-based clearance mechanisms in aging autistic adults.Research square · 2026Article
- Multi-Contrast MRI Inputs Enable Self-Consistent Tissue Segmentation & Robust Perivascular Space Identification.bioRxiv : the preprint server for biology · 2026Article
- Diffusion tensor image analysis along the perivascular space index alterations in Alzheimer's disease: associated with cerebrospinal fluid Aβ40 and cognition.Brain imaging and behavior · 2026Article
- Head circumference assessment in pediatric MRI: a pilot study of manual measurement methods and automated segmentation-based alternatives.Frontiers in neuroscience · 2026Article
- MRI evaluation of cerebral perivascular spaces predicts amyloid-related imaging abnormalities risk in preclinical Alzheimer's disease.Frontiers in dementia · 2026Article
- Spatial coupling of enlarged perivascular spaces and white matter lesions across the Alzheimer's disease continuum.Frontiers in neuroscience · 2026Article
- The brain washing system in sepsis-associated encephalopathy.Journal of neuroinflammation · 2025Review
- Synergistic effect between cortical cerebral microinfarcts and brain atrophy on cognitive decline.Brain : a journal of neurology · 2025Article
- DRIPS: Domain Randomisation for Image-based Perivascular spaces Segmentation.medRxiv : the preprint server for health sciences · 2025Article
- Alterations in MRI-visible perivascular spaces precede dementia diagnosis by 18 years in autosomal dominant Alzheimer's disease.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Article
- Association between white matter hyperintensities and gray matter volume in cerebral small vessel disease: insights from periventricular and deep white matter lesions.Frontiers in neurology · 2025Article
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5 authors.
Funding
Abstract
backgroundPerivascular spaces (PVS) on brain MRI are surrogates for small parenchymal blood vessels and their perivascular compartment, and may relate to brain health. However, it is unknown whether PVS can predict dementia risk and brain atrophy trajectories in participants without dementia, as longitudinal studies on PVS are scarce and current methods for PVS assessment lack robustness and inter-scanner reproducibility.
methodsWe developed a robust algorithm to automatically assess PVS count and size on clinical MRI, and investigated 1) their relationship with dementia risk and brain atrophy in participants without dementia, 2) their longitudinal evolution, and 3) their potential use as a screening tool in simulated clinical trials. We analysed 46,478 clinical measurements of cognitive functioning and 20,845 brain MRI scans from 10,004 participants (71.1 ± 9.7 years-old, 56.6% women) from three publicly available observational studies on ageing and dementia (the Alzheimer's Disease Neuroimaging Initiative, the National Alzheimer's Coordinating Centre database, and the Open Access Series of Imaging Studies). Clinical and MRI data collected between 2004 and 2022 were analysed with consistent methods, controlling for confounding factors, and combined using mixed-effects models.
findingsOur fully-automated method for PVS assessment showed excellent inter-scanner reproducibility (intraclass correlation coefficients >0.8). Fewer PVS and larger PVS diameter at baseline predicted higher dementia risk and accelerated brain atrophy. Longitudinal trajectories of PVS markers differed significantly in participants without dementia who converted to dementia compared with non-converters. In simulated placebo-controlled trials for treatments targeting cognitive decline, screening out participants at low risk of dementia based on our PVS markers enhanced the power of the trial independently of Alzheimer's disease biomarkers.
interpretationThese robust cerebrovascular markers predict dementia risk and brain atrophy and may improve risk-stratification of patients, potentially reducing cost and increasing throughput of clinical trials to combat dementia.
fundingUS National Institutes of Health.
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