ArticleNeuroradiology2026
Vascular permeability mediates contralateral glymphatic dysfunction across glioma grades and IDH status.
Article in Neuroradiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeBilateral hemisphere-specific glymphatic dysfunction (GS) is a prevalent feature in glioma patients and may be affected by vascular permeability. However, the mechanisms by which tumor-related vascular permeability influences tumor-ipsilateral or contralateral glymphatic function remain unclear. This study aimed to elucidate how tumor-related vascular permeability modulates ipsilateral or contralateral glymphatic function in glioma patients, stratified by WHO grades and IDH mutation statuses, employing a novel integration of noninvasive diffusion tensor imaging along the perivascular space (DTI-ALPS) and dynamic contrast-enhanced MRI (DCE-MRI).
methodsA total of 104 patients with histologically confirmed gliomas and 42 age- and sex-matched healthy controls were included. Glymphatic function was assessed bilaterally using DTI-ALPS, while vascular permeability was evaluated via DCE-MRI parameters (Ktrans, Ve, iAUC). Multiple statistical approaches were used to examine the relationships among glioma clinical characteristics (WHO grade and IDH status), DCE-MRI parameters, and bilateral ALPS indices. Mediation models examined the mediating role of vascular permeability in both hemispheres.
resultsGlioma patients showed bilaterally reduced ALPS indices versus controls (p < 0.001), with contralateral higher than ipsilateral (p < 0.05). Lower ALPS indices associated with high-grade and IDH-wild-type tumors (p < 0.01). Ktrans correlated negatively with contralateral ALPS (β = -0.329, p = 0.002) and statistically mediated the relationship between tumor grade (23.4%) / IDH status (21.7%) and contralateral impairment (p < 0.01).
conclusionsGlioma patients exhibit bilateral glymphatic dysfunction, most severe in high-grade or IDH-wild-type tumors. Ktrans, reflecting blood brain barrier permeability, statistically mediated the association between tumor grade / IDH status and contralateral glymphatic impairment, with no such mediation observed ipsilaterally.
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