Perivascular Spaces Are Associated With CSF Aβ in Cerebral Amyloid Angiopathy But Not in Deep Perforator Arteriopathy

Arndt P, Pfister M, Müller SJ, Perosa V, Mattern H, Dörner M, Müller P, Meuth SG, Garz C, Neumann K, Bernal J, Schreiber S (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Stroke American Heart Association

Book Volume: Publish Ahead of Print

DOI: 10.1161/STROKEAHA.125.053794

Abstract

BACKGROUND: – Centrum semiovale perivascular spaces (CSO PVS) are common to different cerebral small vessel disease (CSVD) subtypes, yet their enlargement to the point of visibility on magnetic resonance imaging is thought to occur through distinct mechanisms. In cerebral amyloid angiopathy (CAA), CSO PVS are thought to reflect impaired perivascular Aβ (amyloid-β) drainage, whereas in deep perforator arteriopathy (DPA) they may result from microangiopathy-related arterial stiffening and altered fluid dynamics. The extent to which this can be confirmed in vivo remains unclear. METHODS: – We retrospectively analyzed 186 patients with CSVD and cerebrospinal fluid (CSF) Aβ biomarkers (n=111 probable CAA, n=75 DPA). CSO PVS were counted on axial T2-weighted images. Associations between CSO PVS and CSF biomarkers were assessed via Pearson correlation and multivariable linear regression, including an interaction term between CSF Aβ and CSVD subtype, adjusted for demographics and neuroimaging markers of CSVD. RESULTS: – Patients with higher CSO PVS counts were generally younger, had lower white matter hyperintensity burden, higher basal ganglia PVS counts, and were more frequently affected by cortical superficial siderosis. CSO PVS counts were similar in patients with CAA and DPA. The association between CSF Aβ42/40 ratio and CSO PVS burden was observed in patients with CAA, but not in those with DPA (interaction term between CSF Aβ42/40 ratio and CAA: β=–0.27; P=0.016), independent of demographics and other neuroimaging markers of CSVD. CSF Aβ40 showed no association with CSO PVS counts in any model. CONCLUSIONS: – Our findings strengthen the pathophysiological link between CSO PVS and Aβ pathology in CAA but not in DPA. These results extend previous histopathologic and neuroimaging work and underscore the need to interpret CSO PVS in the context of underlying CSVD subtype.

Involved external institutions

Otto-von-Guericke-Universität Magdeburg DE Germany (DE) Massachusetts General Hospital US United States (USA) (US) Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) DE Germany (DE) Heinrich-Heine-Universität Düsseldorf DE Germany (DE)

How to cite

APA:

Arndt, P., Pfister, M., Müller, S.J., Perosa, V., Mattern, H., Dörner, M.,... Schreiber, S. (2026). Perivascular Spaces Are Associated With CSF Aβ in Cerebral Amyloid Angiopathy But Not in Deep Perforator Arteriopathy. Stroke, Publish Ahead of Print. https://doi.org/10.1161/STROKEAHA.125.053794

MLA:

Arndt, Philipp, et al. "Perivascular Spaces Are Associated With CSF Aβ in Cerebral Amyloid Angiopathy But Not in Deep Perforator Arteriopathy." Stroke Publish Ahead of Print (2026).

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