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Increased blood–brain barrier permeability in type II diabetes demonstrated by gadolinium magnetic resonance imaging
  1. J M Starr1,
  2. J Wardlaw2,
  3. K Ferguson1,
  4. A MacLullich1,
  5. I J Deary1,
  6. I Marshall3
  1. 1SHEFC Centre for the Study of the Ageing Brain, University of Edinburgh, Western General Hospital, Edinburgh, UK
  2. 2Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital
  3. 3Department of Medical Physics, University of Edinburgh, Western General Hospital
  1. Correspondence to:
 Professor J M Wardlaw, Department of Clinical Neurosciences, Western General Hospital NHS Trust, Bramwell Dott Building, Crewe Road, Edinburgh EH4 2XU, UK;


Objectives: Patients with type II diabetes are at increased risk of cognitive impairment. The retinal and renal complications of diabetes follow microvascular damage permitting small arterioles to leak, hence the cerebral damage might also follow loss of blood–brain barrier (BBB) integrity. Magnetic resonance (MR) brain imaging with intravenous gadolinium (Gd) diethylenetriamine pentaacetic acid (Gd-DTPA) was used to identify increased BBB permeability.

Methods: Ten well controlled type II diabetic patients aged 65–70 years and 10 controls underwent MR brain imaging with fluid attenuated inversion recovery (FLAIR); T1 weighted (T1W) volumetric imaging before; and T1W volumetric imaging at 5, 15, 30, 45, 60, and 90 minutes after intravenous Gd-DTPA. The T1W image before Gd-DTPA was subtracted from the images at each time point after Gd-DTPA. Net signal intensity was plotted against time for different brain regions. White matter hyperintensities were scored from the FLAIR image.

Results: The signal intensity/time curves showed that brain signal intensity increased more in the diabetic group than controls during the first 15 minutes after Gd-DTPA, particularly in the basal ganglia (p=0.018). Signal intensity in controls peaked at five minutes and diabetics at 15 minutes. Subjects with more white matter hyperintensities had greater signal increase after Gd-DTPA, whether diabetic or not (p=0.001).

Conclusions: Increased BBB permeability with MR imaging was detected in patients with type II diabetes or white matter hyperintensities. Increased permeability of the BBB might account for some of the cerebral effects of type II diabetes, and so possibly also for the effect of other conditions that affect the microvasculature (like hypertension), on the brain.

  • blood-brain barrier
  • magnetic resonance imaging
  • gadolinium-DTPA
  • leukoaraiosis
  • diabetes
  • BBB, blood-brain barrier
  • Gd
  • gadolinium
  • FLAIR, fluid attenuated invasion recovery
  • T1W, T1 weighted
  • MRI, magnetic resonance imaging
  • CSF, cerebrospinal fluid
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  • Competing interests: none declared.

  • See editorial commentary p 6

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