Spectral Diffusion Analysis of Intravoxel Incoherent Motion MRI in Cerebral Small Vessel Disease

BACKGROUND: Cerebral intravoxel incoherent motion (IVIM) imaging assumes two components. However, more compartments are likely present in pathologic tissue. We hypothesized that spectral analysis using a nonnegative least‐squares (NNLS) approach can detect an additional, intermediate diffusion component, distinct from the parenchymal and microvascular components, in lesion‐prone regions. PURPOSE: To investigate the presence of this intermediate diffusion component and its relation with cerebral small vessel disease (cSVD)‐related lesions. STUDY TYPE: Prospective cross‐sectional study. POPULATION: Patients with cSVD (n = 69, median age 69.8) and controls (n = 39, median age 68.9). FIELD STRENGTH/SEQUENCE: Whole‐brain inversion recovery IVIM acquisition at 3.0T. ASSESSMENT: Enlarged perivascular spaces (PVS) were rated by three raters. White matter hyperintensities (WMH) were identified on a fluid attenuated inversion recovery (FLAIR) image using a semiautomated algorithm. STATISTICAL TESTS: Relations between IVIM measures and cSVD‐related lesions were studied using the Spearman's rank order correlation. RESULTS: NNLS yielded diffusion spectra from which the intermediate volume fraction f (int) was apparent between parenchymal diffusion and microvasular pseudodiffusion. WMH volume and the extent of MRI‐visible enlarged PVS in the basal ganglia (BG) and centrum semiovale (CSO) were correlated with f (int) in the WMHs, BG, and CSO, respectively. f (int) was 4.2 ± 1.7%, 7.0 ± 4.1% and 13.6 ± 7.7% in BG and 3.9 ± 1.3%, 4.4 ± 1.4% and 4.5 ± 1.2% in CSO for the groups with low, moderate, and high number of enlarged PVS, respectively, and increased with the extent of enlarged PVS (BG: r = 0.49, P < 0.01; CSO: r = 0.23, P = 0.02). f (int) in the WMHs was 27.1 ± 13.1%, and increased with the WMH volume (r = 0.57, P < 0.01). DATA CONCLUSION: We revealed the presence of an intermediate diffusion component in lesion‐prone regions of cSVD and demonstrated its relation with enlarged PVS and WMHs. In tissue with these lesions, tissue degeneration or perivascular edema can lead to more freely diffusing interstitial fluid contributing to f (int). Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1170–1180.