Glymphatic system dysfunction and cerebrospinal fluid retention in gliomas: evidence from perivascular space diffusion and volumetric analysis

作者：Weiqiang Liang, Wenbo Sun, Chunyan Li, Jie Zhou, Changyou Long, Huan Li, Dan Xu, Haibo Xu · 发表于：Cancer Imaging · 年份：2025 · DOI：10.1186/s40644-025-00868-y · 被引用次数：12 · 研究领域：Cerebrospinal fluid and hydrocephalus、Glioma Diagnosis and Treatment、Spinal Dysraphism and Malformations

BACKGROUND: Gliomas may impair glymphatic function and alter cerebrospinal fluid (CSF) dynamics through structural brain changes, potentially affecting peritumoral brain edema (PTBE) and fluid clearance. This study investigated the impact of gliomas on glymphatic system function and CSF volume via diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) and volumetric magnetic resonance imaging (MRI), which clarified the relationships between tumor characteristics and glymphatic system disruption. METHODS: In this prospective study, 112 glioma patients and 56 healthy controls underwent MRI to calculate DTI-ALPS indices and perform volumetric analyses of CSF, tumor, and PTBE. Statistical analyses were used to assess the relationships between the DTI-ALPS index, tumor volume, PTBE volume, and clinical characteristics. RESULTS: Glioma patients had significantly lower DTI-ALPS indices (1.266 ± 0.258 vs. 1.395 ± 0.174, p < 0.001) and greater CSF volumes (174.53 ± 34.89 cm³ vs. 154.25 ± 20.89 cm³, p < 0.001) than controls did. The DTI-ALPS index was inversely correlated with tumor volume (r = -0.353, p < 0.001) and PTBE volume (r = -0.266, p = 0.015). High-grade gliomas were associated with lower DTI-ALPS indices and larger PTBE volumes (all p < 0.001). Tumor grade emerged as an independent predictor of the DTI-ALPS index in multivariate analysis (β = -0.244, p = 0.011). CONCLUSION: Gliomas are associated with significant glymphatic dysfunction, as evidenced by red...