Application of Texture Analysis to Study Small Vessel Disease and Blood-Brain Barrier Integrity

Maria del C. Valdes Hernandez* (Corresponding Author), Victor Gonzalez-Castro, Francesca M. Chappell, Eleni Sakka, Stephen Makin, Paul A. Armitage, William H. Nailon, Joanna M. Wardlaw

*Corresponding author for this work

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OBJECTIVES: We evaluate the alternative use of texture analysis for evaluating the role of blood-brain barrier (BBB) in small vessel disease (SVD). METHODS: We used brain magnetic resonance imaging from 204 stroke patients, acquired before and 20 min after intravenous gadolinium administration. We segmented tissues, white matter hyperintensities (WMH) and applied validated visual scores. We measured textural features in all tissues pre- and post-contrast and used ANCOVA to evaluate the effect of SVD indicators on the pre-/post-contrast change, Kruskal-Wallis for significance between patient groups and linear mixed models for pre-/post-contrast variations in cerebrospinal fluid (CSF) with Fazekas scores. RESULTS: Textural "homogeneity" increase in normal tissues with higher presence of SVD indicators was consistently more overt than in abnormal tissues. Textural "homogeneity" increased with age, basal ganglia perivascular spaces scores (p <0.01) and SVD scores (p <0.05) and was significantly higher in hypertensive patients (p <0.002) and lacunar stroke (p = 0.04). Hypertension (74% patients), WMH load (median = 1.5 +/- 1.6% of intracranial volume), and age (mean = 65.6 years, SD = 11.3) predicted the pre/post-contrast change in normal white matter, WMH, and index stroke lesion. CSF signal increased with increasing SVD post-contrast. CONCLUSION: A consistent general pattern of increasing textural "homogeneity" with increasing SVD and post-contrast change in CSF with increasing WMH suggest that texture analysis may be useful for the study of BBB integrity.
Original languageEnglish
Article number327
Number of pages16
JournalFrontiers in Neurology
Publication statusPublished - 19 Jul 2017

Bibliographical note

This work was funded by the Row Fogo Charitable Trust (MH, VG-C) grant no. BRO-D.FID3668413 and the Wellcome Trust (patient recruitment, scanning, primary study Ref No. WT088134/Z/09/A). The study was conducted independently of the funders who do not hold the data and did not participate in the study design or analyses the EU H2020 and Fondation Leducq Network grants as specified. Funds from European Union Horizon 2020, PHC-03-15, project No 666881, ‘SVDs@Target’ and Fondation Leducq Network for the Study of Perivascular Spaces in Small Vessel Disease, ref no. 16 CVD 05 are gratefully acknowledged.


  • texture analysis
  • cerebral small vessel disease
  • blood–brain barrier
  • hypertension
  • age
  • stroke
  • leukoaraiosis
  • perivascular spaces


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