Purpose: To assess the feasibility of using perivenous-enhanced cortical veins (PECVs) visualized on contrast-enhanced black-blood MRI (CEBBI) for detecting and classifying blood-brain barrier disruption (BBBD) in patients with ischemic stroke.

Materials & methods: This retrospective study included 168 hospitalized patients with acute, subacute, and chronic ischemic stroke who underwent pre- and post-CEBBI imaging. BBBD was classified into three groups based on the enhancement ratio (ER) of normal-appearing white matter (NAWM) before and after contrast administration, as well as leptomeningeal and parenchymal enhancement patterns on CEBBI: no BBBD (NoBBBD), subtle BBBD (SuBBBD), and significant BBBD (SiBBBD). The number of PECVs was recorded bilaterally from the CEBBI source images. Univariate and multivariate linear regression analyses were performed to identify factors associated with BBBD.

Results: Increased BBBD was significantly associated with a higher number of PECVs in both the ipsilateral and contralateral hemispheres of the infarct (all p < 0.01). Patients with SuBBBD had significantly more PECVs than those with NoBBBD (median: 14 vs. 3, p < 0.01), and the SiBBBD group had significantly more PECVs than the SuBBBD group (median: 18 vs. 14, p < 0.01). In the ipsilateral hemisphere, a median PECV count of 4.5 distinguished NoBBBD from SuBBBD with 83.3% sensitivity and 83.1% specificity. Similarly, a median count of 8.5 PECVs discriminated SuBBBD from SiBBBD with 78.5% sensitivity and 85.0% specificity.

Conclusions: Our findings demonstrated that PECVs are more numerous in the SiBBBD group compared to SuBBBD and NoBBBD groups. The number of PECVs detected on high-resolution post-CEBBI provides a reliable, semi-quantitative method for identifying and classifying BBBD in patients with ischemic stroke. This method offers a direct assessment of BBB integrity and could improve clinical evaluation of stroke-related BBB disruption.

Keywords: Black-blood magnetic resonance imaging; Blood-brain barrier disruption; Contrast-enhanced; Cortical vein; Ischemic stroke.

© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

目的： 评估在对比增强黑血MRI（CEBBI）上可视化周围静脉强化皮层静脉（PECVs）是否可用于检测和分类缺血性卒中患者脑-血屏障破坏（BBBD）的可行性。

材料与方法： 这项回顾性研究包括168名接受急性、亚急性和慢性缺血性卒中前后CEBBI成像的住院患者。根据正常外观白质（NAWM）在对比剂给药前后的增强比（ER），以及CEBBI上的软脑膜和实质强化模式，将BBBD分为三组：无BBBD（NoBBBD）、轻微BBBD（SuBBBD）和显著BBBD（SiBBBD）。从CEBBI原始图像中记录双侧PECVs的数量。进行单变量和多变量线性回归分析以确定与BBBD相关的因素。

结果： 在梗死的同侧和对侧半球中，BBBD增加显著地与更多数量的PECVs相关（所有p

结论： 我们的研究发现表明，与轻微BBBD和无BBBD组相比，显著BBBD组中的PECVs数量更多。在高分辨率的CEBBI后检测到的PECVs的数量提供了一种可靠的半定量方法来识别和分类缺血性卒中患者的脑-血屏障破坏。该方法可以直接评估脑-血屏障的完整性，并有助于改善对与卒中相关的脑-血屏障破坏的临床评价。

关键词： 黑血磁共振成像；脑-血屏障破坏；对比增强；皮层静脉；缺血性卒中。

© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.