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Background <p>To investigate the differential associations of basal ganglia perivascular spaces (BGPVS) and centrum semiovale perivascular spaces (CSOPVS) with deep medullary vein (DMV) disruption in cerebral small vessel disease (CSVD), and to explore the potential mediating role of white matter free water (FW) accumulation.</p> Methods <p>A total of 125 CSVD patients underwent multimodal MRI, including susceptibility-weighted imaging (SWI) for DMV scoring, T2-weighted imaging for PVS grading, and diffusion tensor imaging for FW quantification. DMV visibility was scored (0–18), and PVS were graded (0–4) in BGPVS and CSOPVS regions.</p> Results <p>BGPVS score was independently associated with DMV scores (<i>β</i> = 1.566, 95% CI 0.474–2.658, <i>P</i> &lt; 0.05) controlling with age and vascular risk factors, while CSOPVS showed no significant association (<i>P</i> &gt; 0.05). Mediation analysis revealed that FW accumulation partially mediated the BGPVS–DMV relationship (indirect effect = 0.088, 95% bootstrapped CI [0.002, 0.216]), accounting for 34.6% of the total effect.</p> Conclusions <p>Enlarged BGPVS, but not CSOPVS, is associated with DMV disruption in CSVD, potentially through disrupted perivascular fluid transport and interstitial fluid accumulation.</p>

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Higher basal ganglia perivascular space burden is associated with reduced deep medullary vein visibility via free water accumulation in sporadic cerebral small vessel disease

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  • 发表日期：

    2025年12月22日

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  • Jie Yu,
  • Xinjun Lei,
  • Zhihua Xu,
  • Haiyuan Lan,
  • Zehui Wu

摘要

Background

To investigate the differential associations of basal ganglia perivascular spaces (BGPVS) and centrum semiovale perivascular spaces (CSOPVS) with deep medullary vein (DMV) disruption in cerebral small vessel disease (CSVD), and to explore the potential mediating role of white matter free water (FW) accumulation.

Methods

A total of 125 CSVD patients underwent multimodal MRI, including susceptibility-weighted imaging (SWI) for DMV scoring, T2-weighted imaging for PVS grading, and diffusion tensor imaging for FW quantification. DMV visibility was scored (0–18), and PVS were graded (0–4) in BGPVS and CSOPVS regions.

Results

BGPVS score was independently associated with DMV scores (β = 1.566, 95% CI 0.474–2.658, P < 0.05) controlling with age and vascular risk factors, while CSOPVS showed no significant association (P > 0.05). Mediation analysis revealed that FW accumulation partially mediated the BGPVS–DMV relationship (indirect effect = 0.088, 95% bootstrapped CI [0.002, 0.216]), accounting for 34.6% of the total effect.

Conclusions

Enlarged BGPVS, but not CSOPVS, is associated with DMV disruption in CSVD, potentially through disrupted perivascular fluid transport and interstitial fluid accumulation.