Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jun 19, 2025; 15(6): 103661
Published online Jun 19, 2025. doi: 10.5498/wjp.v15.i6.103661
Diagnostic dynamic contrast-enhanced magnetic resonance imaging blood-brain barrier assessment combined with plasma biomarkers for mild cognitive impairment
Ling Sun, Meng-Rong Xu, Cheng-Yu Zhou, Shao-Dong Cao, Xiao-Liang Zhang, Si-Qi Guan, Wen-Xu Sang, Xu-Ling Li
Ling Sun, Meng-Rong Xu, Cheng-Yu Zhou, Xiao-Liang Zhang, Si-Qi Guan, Wen-Xu Sang, Xu-Ling Li, Department of Neurology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
Shao-Dong Cao, Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
Author contributions: Sun L designed the research and wrote the draft of the manuscript; Sun L, Xu MR, Zhou CY, Cao SD, Zhang XL, Guan SQ, Sang WX and Li XL conceived the research and analyzed data; Sun L and Li XL performed analysis and provided guidance for the research; All authors reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the Fourth Affiliated Hospital of Harbin Medical University (No. YXLLSC-2018-19).
Informed consent statement: All study participants or their legal guardian provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xu-Ling Li, MD, Doctor, Department of Neurology, The Fourth Affiliated Hospital of Harbin Medical University, No. 37 Yiyuan Street, Nangang District, Harbin 150000, Heilongjiang Province, China. hydlixuling@126.com
Received: March 5, 2025
Revised: March 31, 2025
Accepted: May 7, 2025
Published online: June 19, 2025
Processing time: 85 Days and 2.4 Hours
Abstract
BACKGROUND

The role of cerebral microvascular dysfunction in early cognitive impairment and dementia has become increasingly recognized. Furthermore, pathological changes in both Alzheimer’s disease and vascular dementia are almost always associated with cerebral hemodynamic deficits.

AIM

To investigate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) assessment of the blood-brain barrier (BBB) in combination with relevant plasma biomarkers for mild cognitive impairment (MCI).

METHODS

This study selected 50 patients with non-amnestic MCI (na-MCI group), 52 patients with amnestic MCI (a-MCI group), and 55 healthy elderly controls (control group). The Chinese version of the Montreal cognitive assessment (MoCA), auditory verbal learning test (AVLT), Hamilton anxiety/depression scale (HAMA/HAMD), and activity of daily living (ADL) scales were used to analyze the characteristics of mental and behavioral symptoms of patients with MCI. The DCE-MRI technique was used to assess the contrast enhancement kinetics. The Patlak model was utilized to analyze the BBB permeability (volume transfer constants). Further, fasting blood was was used to quantify plasma homocysteine (Hcy), β-amyloid protein (Aβ) 40, Aβ42, human phosphorylated tau-181 protein (p-tau181), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and plasminogen activator inhibitor-1 (PAI-1) levels, as well as serum neurofilament light chain (NFL) and glial fibrillary acidic protein (GFAP) concentrations.

RESULTS

The na-MCI and a-MCI groups demonstrated significantly lower MoCA and AVLT-Huashan version scores, and statistically higher HAMA, HAMD, and ADL scores compared to the control group. Moreover, the a-MCI group showed notably higher HAMA, HAMD, and ADL scores compared to the na-MCI group. Cranial MRI results revealed significant disparities in cerebral blood flow in the left and right frontal lobes, temporal lobes, hippocampi, cuneus, precuneus, parietal lobes, basal ganglia, and occipital lobes between the a-MCI and na-MCI groups. Compared to healthy controls, patients with MCI demonstrated a smaller amplitude of hippocampal contrast enhancement kinetics and a slower decay rate, indicating smaller vascular volume and increased BBB permeability. Further, Hcy, p-tau181, ICAM-1, VCAM-1, PAI-1, and NFL levels were substantially higher in the a-MCI group than in the na-MCI group, whereas the Aβ42 level was significantly lower. We did not observe any significant differences in Aβ40 and GFAP levels.

CONCLUSION

Patients with MCI may have experienced cerebrovascular system changes in the hippocampal region. Disorders associated with changes in cerebral blood supply may begin before pathophysiological changes are visible by imaging, which provides references for the assessment and treatment of patients with cognitive disorders. Further, DCE-MRI provides a noninvasive approach to diagnose subtle BBB leakage associated with cerebrovascular pathology.

Keywords: Dynamic contrast-enhanced magnetic resonance imaging; Blood-brain barrier; Mild cognitive impairment; Auditory verbal learning test; Montreal cognitive assessment

Core Tip: Mild cognitive impairment (MCI) is considered a transitional state between normal aging and dementia and has several contributing factors. Recent literature indicates that blood-brain barrier (BBB) damage may play a key role in MCI, providing new targets for therapeutic intervention. Currently, magnetic resonance imaging (MRI) techniques are predominantly used for BBB integrity assessment. This study uses dynamic contrast-enhanced MRI to calculate BBB permeability and combines biochemical indicators to understand BBB damage in patients with MCI.