Edinburgh Imaging

20 Jul 17. Featured Paper

Application of texture analysis to study small vessel disease & blood–brain barrier integrity.

Link to paper on Frontiers in Neurology



Maria del C. Valdés Hernández, Victor González-Castro, Francesca M. Chappell, Eleni Sakka, Stephen Makin, Paul A. Armitage, William H. Nailon, and Joanna M. Wardlaw



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 & 20 min after intravenous gadolinium administration.

We segmented tissues, white matter hyperintensities (WMH) & applied validated visual scores.

We measured textural features in all tissues pre- & post-contrast & used ANCOVA to evaluate the effect of SVD indicators on the pre-/post-contrast change, Kruskal–Wallis for significance between patient groups & 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) & SVD scores (p < 0.05) & was significantly higher in hypertensive patients (p < 0.002) & lacunar stroke (p = 0.04).

Hypertension (74% patients), WMH load (median = 1.5 ± 1.6% of intracranial volume), & age (mean = 65.6 years, SD = 11.3) predicted the pre/post-contrast change in normal white matter, WMH, & index stroke lesion.

CSF signal increased with increasing SVD post-contrast.

Conclusion: A consistent general pattern of increasing textural “homogeneity” with increasing SVD & post-contrast change in CSF with increasing WMH suggest that texture analysis may be useful for the study of BBB integrity.


  • Age

  • Blood–brain barrier

  • Cerebral small vessel disease

  • Hypertension 

  • Leukoaraiosis

  • Perivascular spaces

  • Stroke

  • Texture analysis