{"doi":"10.1002/jmri.28989","title":"Blood–Brain Barrier Disruption and Perivascular Spaces in Small Vessel Disease and Neurodegenerative Diseases: A Review on <scp>MRI</scp> Methods and Insights","abstract":"<jats:sec><jats:label/><jats:p>Perivascular spaces (PVS) and blood–brain barrier (BBB) disruption are two key features of cerebral small vessel disease (cSVD) and neurodegenerative diseases that have been linked to cognitive impairment and are involved in the cerebral waste clearance system. Magnetic resonance imaging (MRI) offers the possibility to study these pathophysiological processes noninvasively in vivo. This educational review provides an overview of the MRI techniques used to assess PVS functionality and BBB disruption. MRI‐visible PVS can be scored on structural images by either (subjectively) counting or (automatically) delineating the PVS. We highlight emerging (diffusion) techniques to measure proxies of perivascular fluid and its movement, which may provide a more comprehensive understanding of the role of PVS in diseases. For the measurement of BBB disruption, we explain the most commonly used MRI technique, dynamic contrast‐enhanced (DCE) MRI, as well as a more recently developed technique based on arterial spin labeling (ASL). DCE MRI and ASL are thought to measure complementary characteristics of the BBB. Furthermore, we describe clinical studies that have utilized these MRI techniques in cSVD and neurodegenerative diseases, particularly Alzheimer's disease (AD). These studies demonstrate the role of PVS and BBB dysfunction in these diseases and provide insight into the large overlap, but also into the differences between cSVD and AD. Overall, MRI techniques may provide valuable insights into the pathophysiological mechanisms underlying these diseases and have the potential to be used as markers for disease progression and treatment response.</jats:p></jats:sec><jats:sec><jats:title>Level of Evidence</jats:title><jats:p>3</jats:p></jats:sec><jats:sec><jats:title>Technical Efficacy</jats:title><jats:p>Stage 2</jats:p></jats:sec>","journal":"Journal of Magnetic Resonance Imaging","year":2024,"id":608219,"datarank":0.5926865577872142,"base_score":3.9512437185814275,"endowment":3.9512437185814275,"self_citation_contribution":0.5926865577872142,"citation_network_contribution":0.0,"self_endowment_contribution":0.5926865577872142,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":51,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1562010,"name":"Maud van Dinther","orcid":null,"position":1,"is_corresponding":false},{"id":661778,"name":"Willemijn J. Jansen","orcid":"0000-0001-9081-1496","position":2,"is_corresponding":false},{"id":716759,"name":"Alida A. Postma","orcid":"0000-0002-1116-054X","position":3,"is_corresponding":false},{"id":85623,"name":"Julie Staals","orcid":"0000-0002-9502-6937","position":4,"is_corresponding":false},{"id":210404,"name":"J.F.A. Jansen","orcid":"0000-0002-5271-8060","position":5,"is_corresponding":false},{"id":85663,"name":"Robert J. van Oostenbrugge","orcid":"0000-0003-1032-9099","position":6,"is_corresponding":false},{"id":716755,"name":"Merel M. van der Thiel","orcid":"0000-0001-7190-2157","position":7,"is_corresponding":false},{"id":716762,"name":"Walter H. Backes","orcid":"0000-0001-7905-0681","position":8,"is_corresponding":false},{"id":1562009,"name":"Paulien H. M. 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We highlight emerging (diffusion) techniques to measure proxies of perivascular fluid and its movement, which may provide a more comprehensive understanding of the role of PVS in diseases. For the measurement of BBB disruption, we explain the most commonly used MRI technique, dynamic contrast‐enhanced (DCE) MRI, as well as a more recently developed technique based on arterial spin labeling (ASL). DCE MRI and ASL are thought to measure complementary characteristics of the BBB. Furthermore, we describe clinical studies that have utilized these MRI techniques in cSVD and neurodegenerative diseases, particularly Alzheimer's disease (AD). These studies demonstrate the role of PVS and BBB dysfunction in these diseases and provide insight into the large overlap, but also into the differences between cSVD and AD. Overall, MRI techniques may provide valuable insights into the pathophysiological mechanisms underlying these diseases and have the potential to be used as markers for disease progression and treatment response.</jats:p></jats:sec><jats:sec><jats:title>Level of Evidence</jats:title><jats:p>3</jats:p></jats:sec><jats:sec><jats:title>Technical Efficacy</jats:title><jats:p>Stage 2</jats:p></jats:sec>","is_dataset_classified":null,"base_score":3.9318256327243257,"endowment":3.9318256327243257,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"37658640","pmcid":null,"openalex_id":"https://openalex.org/W4386386640","authors":[],"funders":[{"funder_name":"European Union's Horizon 2020 project \"CRUCIAL\"","grant_id":"848109","title":"MiCrovasculaR rarefaction in vascUlar Cognitive Impairement and heArt faiLure"}],"total_grants":1,"fwci":5.599,"citation_percentile":0.97309978,"influential_citations":0,"citation_trend":[{"year":2023,"count":1},{"year":2024,"count":14},{"year":2025,"count":23},{"year":2026,"count":12}],"oa_status":"hybrid","license":"cc-by-nc","oa_locations":[{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jmri.28989","host_type":"journal"},{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jmri.28989","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmri.28989","host_type":"publisher"},{"url":"https://doi.org/10.1002/jmri.28989","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/37658640","host_type":"repository"},{"url":"https://cris.maastrichtuniversity.nl/en/publications/f73b7194-98ad-4eaf-976a-b8c37b97292f","host_type":"repository"},{"url":"http://dx.doi.org/10.1002/jmri.28989","host_type":""}],"fields_of_study":["Cerebrospinal fluid and hydrocephalus","Advanced Neuroimaging Techniques and Applications","Fetal and Pediatric Neurological Disorders","03 medical and health sciences","0302 clinical medicine","Humans","Blood-Brain Barrier","Neurodegenerative Diseases","Magnetic Resonance Imaging","Alzheimer Disease","Cognitive Dysfunction","Vascular Diseases"],"mesh_terms":["Alzheimer Disease","Blood-Brain Barrier","Humans","Magnetic Resonance Imaging","Vascular Diseases","Neurodegenerative Diseases","Cognitive Dysfunction"],"keywords":["Perivascular space","Magnetic resonance imaging","Blood–brain barrier","Disease","Neuroscience","Diffusion MRI","Medicine","Cognitive impairment","Pathology","Psychology","Radiology","Central nervous system","Alzheimer's disease","Cerebral Small Vessel Disease","Blood-brain Barrier Breakdown","Perivascular Spaces","Brain Clearance","Blood-Brain Barrier","Alzheimer Disease","Humans","Neurodegenerative Diseases","Cognitive Dysfunction","Vascular Diseases"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-07-30T07:43:39.850443Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}