ArticleStroke (Hoboken, N.J.)2026
MRI-Based ALPS Index as a Biomarker of Glymphatic Dysfunction and Prognosis After Aneurysmal Subarachnoid Hemorrhage.
Article in Stroke (Hoboken, N.J.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Post-stroke glymphatic and meningeal lymphatic dysfunction: mechanisms, imaging evidence, and translational challenges.Frontiers in stroke · 2026Review
- Network mechanisms of glymphatic system dysfunction in the disruption of the "brain-lung axis".Frontiers in neurology · 2026Review
- The role of glymphatic system in brain injury after subarachnoid hemorrhage.Frontiers in immunology · 2026Review
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Authors and funding
8 authors.
Funding
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Abstract
backgroundThe clinical relevance of glymphatic dysfunction in patients with subarachnoid hemorrhage (SAH) remains unclear. This study aimed to evaluate glymphatic system function in patients with aneurysmal SAH using the diffusion tensor imaging-based analysis along the perivascular space (ALPS) index and to investigate its association with the development of hydrocephalus and clinical outcomes. In particular, we explored whether hydrocephalus could act as a potential mediator of the relationship between glymphatic dysfunction and poor functional outcome.
methodsWe retrospectively analyzed 60 patients with aneurysmal SAH who underwent magnetic resonance imaging, including diffusion tensor imaging, at a median of 18 days after onset. The ALPS index was calculated from directional diffusivity values in the deep white matter, and its relationship with 3-month functional outcomes (modified Rankin Scale) and shunt-dependent hydrocephalus was examined. A logistic regression-based causal mediation analysis was performed to assess whether hydrocephalus statistically mediated the association between a low ALPS index (<1) and poor outcome (modified Rankin Scale score ≥3).
resultsThe ALPS index was significantly lower in patients with poor outcomes (median [interquartile range], 1.09 [0.91-1.17]) than in those with favorable outcomes (1.29 [1.16-1.44];
conclusionsReduced ALPS index, which may reflect impaired glymphatic transport, was associated with poor functional outcomes in patients with aneurysmal SAH. This relationship appeared to be largely mediated by the presence of shunt-dependent hydrocephalus. Although causality cannot be established in this observational study, these findings suggest that glymphatic dysfunction may play a clinically relevant role in the pathophysiology of SAH-related hydrocephalus and outcome.
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