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. 2025 Nov;12(9):100323.
doi: 10.1016/j.tjpad.2025.100323. Epub 2025 Aug 14.

A novel early imaging biomarker for glymphatic function: Cerebral cortical arterial pulsatility index from 2-Minute phase-contrast MRI

Sung-Hye You  1 , Byungjun Kim  2 , Moonjung Hwang  1 , Kyung-Sook Yang  3 , Hye-Won Park  1 , InSeong Kim  4 , SuGil Kim  4 , Kyung Min Kim  1 , Bo Kyu Kim  1 , Jae Ho Shin  1
Affiliations

A novel early imaging biomarker for glymphatic function: Cerebral cortical arterial pulsatility index from 2-Minute phase-contrast MRI

Sung-Hye You et al. J Prev Alzheimers Dis. 2025 Nov.

Abstract

Background: Arterial pulsatility is one of the driving forces of glymphatic flow.

Objectives: To evaluate the feasibility of the pulsatility index (PI) of cortical arteries in the centrum semiovale (PICSO) as a novel non-invasive imaging biomarker for Alzheimer's disease (AD) in the context of glymphatic function.

Design: Retrospective cross-sectional study.

Setting: Single tertiary academic center equipped with both 3.0 T MRI systems.

Participants: A total of 160 individuals were enrolled: 50 healthy volunteers, 46 cognitively normal controls, and 64 AD patients who underwent diffusion tensor imaging (DTI) and 2D phase-contrast MRI.

Measurements: Diffusion Tensor Imaging Analysis along the Perivascular Space (DTI-ALPS) index and PICSO were assessed using 2D phase-contrast MRI. Correlations with age, DTI-ALPS index, and Mini-Mental State Examination (MMSE) scores were analyzed.

Results: PICSO was significantly higher in the AD group than those in healthy volunteers (P<0.001) and cognitively normal aging (P=0.001) groups. PICSO correlated positively with age (rho=0.613, P<0.001) and negatively with both the DTI-ALPS index (rho=-0.439, P<0.001) and MMSE scores (rho=-0.486, P<0.001) in total group.

Conclusion: PICSO derived from 2D phase-contrast 3.0T MRI may serve as a novel imaging biomarker for Alzheimer's disease in relation to glymphatic function.

Keywords: 2D Phase-contrast MRI; Alzheimer’s disease; Glymphatics; Pulsatility index.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image, graphical abstract
Graphical abstract
Fig 1
Fig. 1
Study design. Note: SNSB-II = Seoul Neuropsychological Screening Battery-II.
Fig 2
Fig. 2
Measurement of Diffusion Tensor Image Analysis along the Perivascular Space (DTI-ALPS) index and pulsatility index (PI).
Fig 3
Fig. 3
Comparison of Diffusion Tensor Image Analysis along the Perivascular Space (DTI-ALPS) index and pulsatility index (PI) among the healthy volunteers, cognitively normal, and Alzheimer’s disease groups. Note: In this box-and-Whisker plot, the green box represents the interquartile range (IQR), the horizontal line inside the box indicates the median, the red square shows the mean, and the blue bars denote the 95% confidence interval of the mean. Whiskers extend to the minimum and maximum values within 1.5×IQR, and orange circles indicate outliers. *indicates P < 0.05.
Fig 4
Fig. 4
Correlation of pulsatility index (PI) with age, Mini-Mental State Examination (MMSE) score, and Diffusion Tensor Image Analysis along the Perivascular Space (DTI-ALPS) index. Note: Each dot represents an individual participant. The solid blue line indicates the linear regression fit, with shaded areas representing the 95% confidence interval. The dashed orange lines indicate the 95% prediction interval. Linear regression equations, Spearman’s correlation coefficients (rho), and P-values are provided in each panel.
See this image and copyright information in PMC

References

    1. De la Torre J. Impaired brain microcirculation may trigger Alzheimer's disease. Neurosci Biobehav Rev. 1994;18:397–401. - PubMed
    1. Knopman D. Cerebrovascular disease and dementia. Br J Radiol. 2007;80:S121–S127. - PubMed
    1. Roher A.E., Esh C., Rahman A., Kokjohn T.A., Beach T.G. Atherosclerosis of cerebral arteries in Alzheimer disease. Stroke. 2004;35:2623–2627. - PubMed
    1. Tormos A, Taléns Visconti R, Pérez Garrido S, Rius Pérez S. Vascular pathology: cause or effect in Alzheimer disease? 2018. - PubMed
    1. Pahlavian S.H., Wang X., Ma S., et al. Cerebroarterial pulsatility and resistivity indices are associated with cognitive impairment and white matter hyperintensity in elderly subjects: A phase-contrast MRI study. J Cereb Blood Flow Metab. 2021;41:670–683. - PMC - PubMed