Radiologic examination of perivascular spaces in adult Alzheimer patients

The study aimed to evaluate the relationship between perivascular spaces (PVS) and medial temporal lobe atrophy (MTA) in Alzheimer's disease, as well as revealing the diagnostic potential of these structures. It included 125 patients with Alzheimer's disease who were referred to Düzce University Hospital between 2019 and 2024, and underwent magnetic resonance imaging (MRI), as well as 115 healthy individuals without systemic disorders or neurological diagnoses, who served as the control group. Participants were aged between 50 and 65 years. All imaging data were accessed via the Picture Archiving and Communication System (PACS) used at Düzce University Hospital. PVS scoring was performed according to the Potter criteria, and MTA assessment was conducted using the Scheltens visual scoring system. Additionally, the Heier classification was considered for dilated PVS diameter measurements. The anatomical distribution of PVSs was analysed based on three brain regions: the centrum semiovale, the basal ganglia and the mesencephalon. The findings showed that PVS accumulation in the centrum semiovale (CSO) region was significantly higher in patients with Alzheimer's disease. A positive correlation was found between MTA and CSO-PVS scores. Statistical analyses included a chi-squared test, a Spearman correlation test, logistic regression, a ROC curve and subgroup stratification analyses. According to the ROC analysis, the MTA score was found to be the variable with the greatest discriminatory power, although dilated PVS diameter and the CSO-PVS score also made a significant contribution. This study takes a comprehensive approach, considering not only cortical atrophy in Alzheimer's disease, but also neurovascular impairment and glymphatic system deficiencies. These imaging-based findings suggest that PVSs may serve as complementary structural markers that could be incorporated into early diagnostic processes. However, the cross-sectional design and lack of control for lifestyle and genetic variables limit the generalisability of the findings. Future studies should prioritise longitudinal studies that integrate advanced imaging techniques, such as PET, and utilise artificial intelligence-supported analysis programmes. Keywords: Alzheimer's Disease, Glymphatic System, Medial Temporal Atrophy, Neurovascular Dysfunction, Perivascular Space